Advanced cancer screenings find early, slow growing cancers more often than fast aggressive ones

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A cluster of breast cancer cells (Credit: Annie Cavanagh. Wellcome Images [email protected] via Flickr)

The medical definition of ‘cancer’ hasn’t changed in more than 150 years when physicians pioneering autopsy procedures first found and categorized tumors. But the science and treatment of cancer has become wildly different.

What began with simple surgeries, progressed to chemotherapy drug development now so specific doctors match drugs to the genetic profile of tumors.

Alongside treatment, screenings have progressed from physician palpitation to x-rays, CT scans and MRIs to regular hormone checks like the controversial PSA test. Soon, doctors will look for cancer’s DNA signatures in blood tests as part of a person’s annual physical.

And while we are finding more and more cancers, which has led to many saved lives, some physicians and public health experts are beginning to worry we’ve gone too far. We may now be over-screening and over-treating thousands of patients each year for small, slow cancers but still not catching and treating super aggressive cancers that pop up and grow dangerously between routine screenings reports Melinda Beck at the Wall Street Journal.

“We’re not finding enough of the really lethal cancers, and we’re finding too many of the slow-moving ones that probably don’t need to be found,” says Laura Esserman, a breast-cancer surgeon at the University of California, San Francisco.

Esserman advocates removing the label ‘cancer’ from pre-cancerous tumors which are diagnosed in tens of thousands of patients each year and creating tracking protocols for small, slow growing cancers rather than recommending treatments as a first course of action.

But this presents another challenge: How to tell a patient they have cancer but you don’t want to treat it. Patients are savvy and reactive. They want to do something. For example, many women continue to undergo preventative mastectomies rather than follow enhanced screening protocols after finding a positive genetic risk factor for breast cancer.

It’s the hope that advancements in genetic profiling of cancers will yield useful tools to identify which tumors are going to stay small and grow slowly, making them surveillance candidates, and which require immediate treatment:

As many as 60 percent of the tumors detected via screening grow so slowly that they pose little threat in a man’s lifetime, experts say, and treating them with surgery or radiation carries a substantial risk of impotence or incontinence. About 15 percent of patients now opt to monitor them instead—and some experts say more could probably do so safely.

Many companies and government labs are working on tests that would be able to pick out the cancers that need to be treated based on their biochemical and genetic signatures. “We need to start testing some of these ideas, rather than just fighting over them. People are afraid to do less. We want to figure out how to do less safely,” Esserman said.

Meredith Knight is a blogger for Genetic Literacy Project and a freelance science and health writer in Austin, Texas. Follow her @meremereknight.
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