The fundamental way to determine the best plan and timing for imaging in combination with a cancer screening test is to conduct prospective randomized clinical trials. Trials should be developed by a team from primary care, radiology, and oncology. A multidisciplinary team is best suited to determine if a new screening method such as a blood test, imaging test, or procedure is clinically acceptable beyond the scope of research. Questions that need to be asked are: does the new screening evaluation lead to earlier diagnosis and save lives? And does it allow for more effective, safer, less invasive, or more cost-effective treatment than existing screening tests do? Or does it add expense and risk to patients? This takes vast numbers of asymptomatic or at-risk patients to determine.

Optimal screening frequency depends on a cancer’s growth rate. If the cancer is fast-growing, screening is probably not going to be effective. To prevent harmful disease, frequent screening would be needed. Progressive harmful cancers that take a long time to develop are much more suitable for screening. Additionally, screening is more beneficial if associated with precancerous lesions. Detecting and eliminating colonic polyps or cervical intraepithelial neoplasia have the added benefit of preventing cancer from occurring. Following a negative colonoscopy in a low-risk individual, follow-up in ten years is recommended, for example. Non-progressive or indolent cancers do not need to be detected to begin with, and screening may be harmful. Illustrating the problem with overdiagnosis and overtreatment.

-How to decrease overdiagnosis and overtreatment of cancer?

-All screening tests should be tested for safety and efficacy before being offered to the public. Evaluation of screening tests with randomized clinical trials is an important first step to launching a screening test. Trial results can help form safer and more effective guidelines. And Selecting high-risk populations to screen increases the likelihood that progressive and harmful cancers will be found. Also, allowing smaller and benign-appearing lesions to be monitored and biopsied less frequently helps decrease indolent cancers from ultimately being treated as harmful cancers.

Reference:

Pinsky P. F. (2015). Principles of Cancer Screening. The Surgical clinics of North America, 95(5), 953–966. https://doi.org/10.1016/j.suc.2015.05.009

Esserman, L. J., Thompson, I. M., Jr, & Reid, B. (2013). Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA, 310(8), 797–798. https://doi.org/10.1001/jama.2013.108415

Cancer Screening – Understanding Overdiagnosis and Overtreatment