Cancer overdiagnosis: A path forward

As oncologists, radiologists and epidemiologists continue to debate the details of overdiagnosis and overtreatment, a viewpoint published online July 29 in JAMA listed several recommendations for the National Cancer Institute to consider as it attempts to evaluate the overdiagnosis issue.

Laura J. Esserman, MD, MBA, of the University of California, San Francisco, and colleagues recommended the following strategies:

• Stakeholders, including physicians and patients, understand the connection between cancer screening and overdiagnosis, particularly in cancers of the breast, lung, prostate and thyroid;
• Revise terminology so that premalignant and indolent lesions are not labeled "cancer";
• Develop registries to track prognosis and development of lesions with low malignant potential;
• Curb overdiagnosis by reducing low-yield evaluations, reducing the frequency of screening studies, targeting screening to high-risk populations, raising recall and biopsy thresholds and evaluating risk-based screening models; and
• Expanding approaches to management of cancer progression.