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http://umanitoba.ca/outreach/evidencenetwork/archives/16439
A biopsy report using the c word inevitably causes fear and distress for the patient and, frequently, an aggressive treatment plan from the doctors. This problem overdiagnosing cancer is now widely recognized, even by the USA National Cancer Institute that recently issued a seminal report by an expert panel recommending that these uncertain cancers should instead be labeled IDLE (indolent lesions) until research can help us differentiate those that need treatment from those that do not. Those working in the cancer field, including clinicians and pathologists will have to consider a new vocabulary, nomenclature and reporting language. At the very least, physicians need to share honestly with patients the serious uncertainty about the prognosis for these so-called cancers rather than pretending that current treatments are always based on good evidence of benefit. It is widely believed by health care analysts that a significant proportion of currently provided health services is inappropriate whether due to overdiagnosis, overtreatment or unnecessary and repetitive testing and imaging. This represents a huge wasted resource health care dollars that could be spent productively elsewhere in the system but even worse is the obvious fact that such services may not offer any benefit while subjecting patients to a wide range of all too familiar adverse side effects, risks and harms. There is an urgent need for patients to be given more accurate and accessible information about the risks and benefits of health interventions, especially in screening programs involving normal healthy people with no signs or symptoms of disease. And remember the old adage, in health care as in many other things: more is not always better. Charles Wright is an expert advisor with EvidenceNetwork.ca and Chair of the Ontario Health Technology Advisory Committee.