By contrast, the authors said, colon and cervical cancer serve as examples of “effective screening programs in which early detection and removal of precancerous lesions have reduced incidence as well as late-stage disease.”   

Cancer screening should have three important missions, the authors write: To detect disease that would ultimately harm the patient; to uncover tumors that benefit from intervention; and to detect disease that is more likely to be cured or better treated when spotted early.

Optimal screening frequency depends on a cancer’s growth rate. If a cancer is fast growing, screening is less likely to be effective. “If a cancer is slow growing but progressive, with a long latency and a precancerous lesion, screening is ideal and less frequent screening (eg.10 years for colonoscopy) may be effective,” the authors said.

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.”

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