The potential problems associated with over-diagnosis and over-treatment that have been much debated in the world of prostate cancer over the past few years actually go well beyond prostate cancer.
There is an interesting article in this week’s issue of the British Medical Journal that helps to put the situation regarding prostate cancer into a larger context, along with the over-diagnosis and over-treatment of a variety of other disorders.
To give just one example among those described by Moynihan et al.:
Diagnostic scanning of the abdomen, pelvis, chest, head, and neck can reveal “incidental findings” in up to 40% of individuals being tested for other reasons. … Some of these are tumours, and most of these “incidentalomas” are benign. A very small number of people will benefit from early detection of an incidental malignant tumour, while others will suffer the anxiety and adverse effects of further investigation and treatment of an “abnormality” that would never have harmed them.
The “New” Prostate Cancer InfoLink is extremely cognizant of the fact that early detection of aggressive forms of prostate cancer is the only currently available strategy that has a good chance of offering curative therapy for a man so diagnosed. However, we are also extremely cognizant of the related fact that for every one of those men who really needs such early diagnosis and treatment, we may be diagnosing and treating anywhere between a dozen and a couple of hundred men who really did not need such a diagnosis because they will never benefit from treatment and may indeed suffer irreparable harm to their quality of life.
In the case of prostate cancer, we, like others, have no “perfect solution” to the current problem. What we do understand, however, is that our technological ability to identify possible risk for disease now far outdistances our abilities to provide therapeutic care in an appropriate manner to those who actually need such care and to not over-treat those who will never actually benefit from such care.
If the Hippocratic principle of medicine that a physician should “first do no harm” is to be kept alive and well given the technological capabilities of the 21st Century, we all need to appreciate that the current debate about over-diagnosis and over-treatment is timely and highly appropriate — even if we have individual, personal opinions about exactly what the implications are for the diagnosis and management of early stage prostate cancer.