Last Spring, the New York Times magazine featured an article titled “Our Feel Good War on Breast Cancer” The article addressed the problems created by overdiagnosis.
Many of those women [who undergo mammography] are told they have something called ductal carcinoma in situ (D.C.I.S.), or “Stage Zero” cancer, in which abnormal cells are found in the lining of the milk-producing ducts. Before universal screening, D.C.I.S. was rare. Now D.C.I.S. and the less common lobular carcinoma in situ account for about a quarter of new breast-cancer cases — some 60,000 a year. In situ cancers are more prevalent among women in their 40s. By 2020, according to the National Institutes of Health’s estimate, more than one million American women will be living with a D.C.I.S. diagnosis.
D.C.I.S. survivors are celebrated at pink-ribbon events as triumphs of early detection: theirs was an easily treatable disease with a nearly 100 percent 10-year survival rate. The thing is, in most cases (estimates vary widely between 50 and 80 percent) D.C.I.S. will stay right where it is — “in situ” means “in place.” Unless it develops into invasive cancer, D.C.I.S. lacks the capacity to spread beyond the breast, so it will not become lethal. Autopsies have shown that as many as 14 percent of women who died of something other than breast cancer unknowingly had D.C.I.S.
There is as yet no sure way to tell which D.C.I.S. will turn into invasive cancer, so every instance is treated as if it is potentially life-threatening.
I was reminded of this article when I saw articles such as this one from CNN pop up this week reporting that the medical community (and specifically a National Cancer Institute working group) is exploring the idea of redefining certain cancers in order to alleviate this type of problem.
Meanwhile Healthline reports that the U.S. Preventive Services Task Force has decided that asymptomatic tobacco smokers over the age of 55 should undergo an annual low dose CT scan to screen for the early stages of lung lung cancer. The CNN article notes that this is an example of focused not overtesting but it’s certainly cost curve up. This USPTF decision requires FEHB plans to cover such testing with no enrollee cost sharing beginning in 2015. (USPSTF recommendation changes to FEHB plan benefits take effect on the first day of the plan year that begins on or after the date that is one year after the date the recommendation or guideline is issued.)