title: Addressing overdiagnosis and overtreatment in cancer: a prescription for change.
abstract: A vast range of disorders--from indolent to fast-growing lesions--are labelled as cancer. Therefore, we believe that several changes should be made to the approach to cancer screening and care, such as use of new terminology for indolent and precancerous disorders. We propose the term indolent lesion of epithelial origin, or IDLE, for those lesions (currently labelled as cancers) and their precursors that are unlikely to cause harm if they are left untreated. Furthermore, precursors of cancer or high-risk disorders should not have the term cancer in them. The rationale for this change in approach is that indolent lesions with low malignant potential are common, and screening brings indolent lesions and their precursors to clinical attention, which leads to overdiagnosis and, if unrecognised, possible overtreatment. To minimise that potential, new strategies should be adopted to better define and manage IDLEs. Screening guidelines should be revised to lower the chance of detection of minimal-risk IDLEs and inconsequential cancers with the same energy traditionally used to increase the sensitivity of screening tests. Changing the terminology for some of the lesions currently referred to as cancer will allow physicians to shift medicolegal notions and perceived risk to reflect the evolving understanding of biology, be more judicious about when a biopsy should be done, and organise studies and registries that offer observation or less invasive approaches for indolent disease. Emphasis on avoidance of harm while assuring benefit will improve screening and treatment of patients and will be equally effective in the prevention of death from cancer.
authors.affiliation: University of California San Francisco, San Francisco, CA, USA. Electronic address: laura.esserman@ucsfmedctr.org.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Thompson
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Reid
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Nelson
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Ransohoff
authors.affiliation: Dartmouth College, Hanover, NH, USA.
authors.forename: H Gilbert
authors.initials: HG
authors.lastname: Welch
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hwang
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Berry
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Kinzler
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Black
authors.affiliation: Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
authors.forename: Mina
authors.initials: M
authors.lastname: Bissell
authors.affiliation: Division of Prostate and Urologic Cancer Research Group, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Parnes
authors.affiliation: Cancer Biomarkers Research Group, Division of Cancer Prevention, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Srivastava
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000145:classification* / Q000175:diagnosis*; D011230:Precancerous Conditions / Q000145:classification* / Q000175:diagnosis*; D009626:Terminology as Topic