How to decrease overtreatment in cancer

Abstract

Screen more selectively, do different research, and change our vocabulary.

n the US and in other “overdeveloped” nations, we excel at finding and treating medical problems, at least in some members of our populations. Among the results of these capabilities are overdiagnosis and overtreatment—finding diseases that don’t need to be treated and providing treatments that lead to more harm than good. I first understood this to be a generalized problem after reading Shannon Brownlee’s Overtreated in 2007, but the BMJ had published a theme issue on “Too Much Medicine” in 2002. The BMJ and others are now sponsoring a conference on this topic and have launched a campaign “to highlight the threat to human health posed by overdiagnosis and the waste of resources on unnecessary care.”

As with threats to patient safety, we need to move beyond the simple recognition and documentation of overtreatment to find ways to prevent it. Cancer screening tests may provide a good opportunity. A group of experts convened by the US National Cancer Institute (NCI) recently published a commentary in which they presented a useful perspective on evaluating cancer screening tests for their overdiagnosis potential as well as suggestions for improvement.