Overtreatment in cancer - is it a problem?
The word "cancer" invokes fear even today in those diagnosed with it, largely due to the deep-rooted stigma associated with this emotive word, one associated with an incurable and fatal disease. This was true in years gone by, when cancer patients presented late with symptoms from advanced disease. Today, however, in the era of screening and an awareness of the value of early detection, it is no longer the case. The last half century has heralded an unparalleled rise in every aspect of cancer research, diagnostics and therapeutics, with a better understanding of basic science, pathological classifications, risk factors, prognosis and treatments. Screening programs have been adopted or suggested for many cancers. The pendulum is shifting. A new concept has emerged - that of cancer overdiagnosis, and together with this, cancer overtreatment. Medicine still remains a science of uncertainty and an art of assessing probability. Until personalized medicine evolves to a level that a person's lifetime risk of clinically significant cancer formation and expected outcome can be computed with a great degree of precision and confidence, clinicians and patients have to be cognizant of the problem of cancer overdiagnosis and overtreatment. In this editorial, we explore the current evidence and magnitude of this problem.