Doctors make fewer cancer diagnoses

Doctors advocate fewer cancer diagnoses

08/01/2013

Cancer is a horror picture for most people. Friends or relatives who have already died of cancer show how quickly it can be torn out of life. But not every cancer tumor has to end with a quick demise. So many women do not die of breast cancer but with him. Also, many men are diagnosed with malignant prostate cancer. Often, however, this grows extremely slowly, so that life is hardly or not at all shortened.

In conventional medicine, a very interesting debate is currently taking place. A renowned medical team of the US National Cancer Institute calls for „Radical rethinking in cancer therapy“ on. While medical discoveries in breast cancer, colon, skin, cervix, and prostate cancer can help save more and more lives. On the other hand, the highly complex and sensitive devices can also make minimal changes visible that will not degenerate much later or not at all. Patients who can not or hardly distinguish between minimal changes and cancerous tumors are seriously burdened by the supposed diagnoses. In addition, numerous unnecessary diagnostic procedures, surgeries, radiation treatments and chemotherapies are carried out, which put a strain on the body of the affected person.

The critics do not come from the ranks of naturopathy, but from the inside of conventional medical cancer therapy. So the high-profile doctors Laura Esserman, Ian Thompson and Brian Reid demand in the US science magazine „JAMA“ a far-reaching reform on cancer. "The term 'cancer' should only be used for changes that are likely to kill if left untreated," the team of experts said. Cancer precursors or harmless tumors should instead be reclassified and defined.

For the radical restructuring, which could lead to a massive rethinking in the treatment of cancer, the doctors have already made specific proposals. In five points, they put together a package of measures that could benefit patients in the future.

Five-point plan for a few cancer operations
First of all, doctors and patients should learn that over-diagnosis is relatively common. This is also because the screening programs continue to improve and increase in size. In the second step, the term should „Cancer on the part of doctors only be used with caution.“ Pre-stages must be redefined. For this purpose, new diagnostic methods have to be developed to distinguish aggressive from harmless tumor variants at the molecular biological level. A new collection register could be created to distinguish more harmless and less dangerous cancerous tumors. As time progresses, new insights can gradually be gained. In addition, according to the authors, the overdiagnosis must be significantly reduced. For this purpose it would make sense only to carry out targeted screenings of high-risk groups and to increase the intervals between screening tests. Researchers and physicians need to develop a new understanding of tumorigenesis. As a result, preventive measures and alternatives to surgical therapy can be designed.

The authors also demand that communication between the doctor and the patient should be much more sensitive. Only if the „Patients are properly informed, probably unnecessary intervention could be avoided“.

For some years the topic swells in medical circles. Again and again, individual scientists warn against using PSA as a marker for prostate cancer. This would lead to many unnecessary operations. The same thing happens with breast cancer screening. For example, it turned out that only one out of every ten women who had a suspicious finding during mammography actually had breast cancer. "The new CT screenings of the lungs yield noticeable findings by as much as one in four," says Rudolf Kaaks, Head of Epidemiology at the German Cancer Research Center, on Spiegel magazine. "We have not yet found the optimal balance between saving lives through early diagnosis and wrong diagnoses."

Cancer is not the same as cancer
In the case of humans, however, the knowledge does not arrive. Most would overestimate the benefits of screening. For this reason, the fear decides and the vast majority of patients decide to further investigate or remove abnormalities. However, this is associated with many risks. Here, cancers and their precursors are very different. Crucial factors include age, diet, genetics, lifestyle and gender. In addition, cells are still developing in many ways, so that even highly-specialized doctors can not always understand this. So it can not be predicted whether a small tumor in the breast will grow very fast or will never cause any problems.

Criticizing the restructuring
For this reason, other experts are the reform for a wrong idea. "I wish we knew which precursors turn into an aggressive tumor and which do not," said Larry Norton, director of the Evelyn Lauder Breast Center opposite The New York Times. "But you can not rewrite centuries-old literature because you suddenly want to change the terminology." (Sb)

Picture: Rainer Sturm