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Personalized Strategies to Reduce Cancer Overtreatment

To address the growing problem of people being overdiagnosed and overtreated for cancer, a group of scientists convened by the National Cancer Institute and chaired by a UC San Francisco breast cancer expert is proposing a major update of the way the nation approaches diseases now classified as “cancer.”

“By recognizing that cancer is not one disease, but a number of different diseases, we can individualize our treatment based on biology and avoid overtreatment,” said panel chair Laura J. Esserman, MD, MBA, director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center.

The authors recommend creation of a new classification for tumors that are indolent (unlikely to cause patients harm). For example, ductal carcinoma of the breast – currently considered the earliest form of breast cancer – would no longer be called cancer. The authors also call for the formation of registries for lesions with low potential for malignancy, and for a multidisciplinary approach across pathology, imaging, surgery and other medical specialties “to revise the taxonomy of lesions now called cancer.”

The recommendations include:

– Recognize that screening will identify indolent cancers.

– Change terminology and omit the word “cancer” from premalignant/indolent conditions;

– Convene a multidisciplinary body to revise the current taxonomy of cancer and to create reclassification criteria for indolent conditions;

– Create observational registries for lesions with low potential for malignancy – generate the data to provide patients and their doctors “with confidence to select less invasive interventions;”

– Develop, validate and adopt molecular diagnostic tools that identify indolent or low-risk lesions;

– Mitigate overdiagnosis: appropriately reduce frequency of screening exams while focusing on high-risk populations, and raise the threshold for patients being recalled for re-testing and biopsy.

“Although no physician has the intention to overtreat or overdiagnose cancer, screening and patient awareness have increased the chance of identifying a spectrum of cancers, some of which are not life threatening,” the authors wrote. “The ultimate goal is to preferentially detect consequential cancer while avoiding detection of inconsequential disease.”

Source: University of California, San Francisco, USA

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Personalized Strategies to Reduce Cancer Overtreatment
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