Maurie Markman, MD
It would be difficult to name a more vexing oncology problem than overdiagnosis—that is, poorly defined conditions that are initially labeled as “malignant” but ultimately do not become clinically relevant cancers.1
The intense and never-ending debates regarding the potential benefits versus harms associated with screening strategies for breast and prostate malignancies are testimony to this complex issue.
Unfortunately, the debate regarding overdiagnosis of cancer today appears to have become less about pragmatic solutions and more about somewhat arcane discussions about the interpretation of large population-based screening trials often initiated more than a decade ago that used diagnostic approaches and biomarker algorithms not currently employed in routine practice.
Testing for Risk Factors
How might the rapidly evolving and increasingly clinically relevant role of precision medicine favorably influence the development of diagnostic paradigms that may reduce the risk of the overdiagnosis of malignant conditions? Today, the major focus of molecular efforts in oncology has been on optimal treatment strategies following the diagnosis but there is no reason to conclude this basic approach cannot in certain well-defined situations be effectively used earlier in the cancer management continuum.
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