Sorting out the low-risk cancers

There is so much attention on the aggressiveness and dangers of cancer – and rightly so, as it is a major cause of death in our society. However, there is a flip side to this story – a diverse group of low-risk cancers, or "precancers" that could in some cases even be better left undiagnosed, as the treatment may actually cause more harm than good. These types of malignancies include diagnoses like "in situ" or "non-invasive" cancers that are commonly seen in the breast, prostate and cervix, or "borderline ovarian tumors." In many cases, they do not have the potential to invade other tissue or to spread, so they don't carry the same risks of illness and death. Some have even advocated that we rename these diseases without using the words "carcinoma" or "cancer," which bring out fear and anxiety and also motivate patients, as well as clinicians, to carry out more aggressive treatments. However, these low-risk cancers can sometimes co-exist with more dangerous invasive (or infiltrating) cancers, and as they are typically treated with surgical removal, there can still be recurrences over the course of time, which can be either in situ or invasive. They rarely can result in death. However, these bad outcomes are unusual enough that when one looks at large population statistics for many of the in situ types of cancer, survival rates are indistinguishable from the normal population. So, what are medical experts and even some patient advocates now saying? The messages are mixed as there is controversy that balances the small risks of these cancers against side effects of diagnosis and treatment. For one, there are calls for modifying our cancer screening procedures – this is particularly true for breast and prostate cancer, where "overtreatment" of harmless cancers carry significant short- and long-term side effects. We also need to develop better imaging and tissue-based tests to identify the rare aggressive cancer hiding among a sea of low-risk cases. Finally, we need to make sure that physicians and the public are up to date on the latest recommendations and developments in this area, as it will continue to evolve.