Yesterday, I talked about the critical importance of routine cancer screening, even in the era of COVID-19.
So today, I thought we should take a quick look at the other side of the coin. Because while routine screens are obviously essential, sometimes, it actually is possible to have too much of a good thing.
Because overdiagnosis of cancer is a very real problem. In fact, it may be the bigger problem in the long run…
The dark side of routine screens
A recent study out of Australia looked at 30 years’ worth of health data and found that a whopping 20 percent of five common cancer diagnoses were the result of overdiagnosis.
In other words, these patients would have never suffered symptoms or harm if the cancer had just been left undetected.
The researchers looked at five cancers where overdiagnosis is a documented problem: breast cancer, thyroid cancer, renal cancer, prostate cancer, and melanoma. Among these, thyroid cancer emerged as the clear winner in this sad contest.
Among women, overdiagnosis accounted for 22 percent of breast cancers. Among men, it accounted for 42 percent of prostate cancers and 58 percent of melanomas. And in both sexes, overdiagnosis was responsible for up to 73 percent of thyroid cancers.
The reason? Well, in the case of breast cancer, prostate cancer, and melanoma, at least, you can blame routine screenings (such as yearly mammography) in healthy patients.
Meanwhile, according to this study, renal and thyroid cancers are typically found during abdominal imaging for an unrelated problem—putting them in a category we call “incidentalomas.”
The steep drop in routine screenings since this pandemic started is certainly dangerous. But the problem of overdiagnosis far predates it. And unfortunately, it’s not likely to change anytime soon.
Overdiagnosis was rampant even when I was in medical school, when we didn’t image everyone every five minutes. And it’s clear that we have to get the balance right between too little and too much screening and testing.
Needless to say, that’s tricky—especially here in the lawsuit-happy United States.
There has been a push only to screen higher-risk patients. But clearly, we need to be reconsidering the treatment plans for many of these “cancer” diagnoses, too. One example: Ductal carcinoma in situ (DCIS)—which was never treated back when I started practicing medicine—can now potentially qualify you for a double mastectomy and hysterectomy.
Five-year survival rates really tell you all you need to know about the bigger picture here: For stage one breast cancer, prostate cancer, and melanoma, those rates hover between 99 and 100 percent. For stage one kidney and thyroid cancers, the rate is between 88 and 89 percent.
Those numbers have nothing to do with being better at curing cancer. The fact is, we’re just better at finding it. But until we also get better at judging which of these diagnoses are actually clinically significant, all we’re doing is saddling more people with a needless cancer diagnosis… and all of the mental and physical suffering that comes with it.
P.S. I outline the many simple, science-backed strategies to fortify your cellular defenses—and stop cancer in its tracks—in my Essential Cancer Protocol. To learn more about this innovative online learning tool, or to enroll today, click here now!
“’Overdiagnosis’ in About 20% of Common Cancers.” Medscape Medical News, 01/30/2020. (medscape.com/viewarticle/924550)