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Overdiagnosis: Relocating from Cancerland

Medically reviewed by Susan Kerrigan, MD and Marianne Madsen on February 10, 2023

Along with being the title of an acclaimed memoir, Cancerland is also the name bestowed by concerned healthcare professionals on the anxiety-ridden place inhabited by many of their patients. Cancerland was once home only to those actively battling the disease. Over the past decade, it’s become a land with porous borders and a growing population. Citizens of Cancerland include survivors worried about recurrence, patients dealing with false positives, and those whose genetic profiles or screening results put them at an elevated risk for the disease. From a psychological standpoint, being convinced cancer is just around the corner is only marginally better than being diagnosed with it –– just as knowing sharks rarely attack humans probably won’t allow you to enjoy a lazy breaststroke ten feet from a Great White. So what are the best strategies for healthy people to avoid permanent residency in Cancerland?


New Screening Tools 


Along with Cancerland, another word that some find troubling is “previvor.” The term applies to someone informed they are at a higher genetic risk for cancer yet don’t currently have the disease –– let alone having overcome it and have become a cancer survivor. This collective is growing despite the limited number of known markers. Truth is, there are very few inherited single gene mutations that clearly indicate a heightened risk for cancer. Although having well known ones like BRCA1 and BRCA2 have been shown to increase a person’s risk, it’s increasingly likely that most cancers are connected to mutations in multiple genes just as our height, while inherited, is determined by a similarly varied collection. Enter the algorithm. By scouring scores of genetic code and leveraging a variety of data sets, researchers have accurately predicted an infant’s adult height. The same technique could be applied to calculating cancer risk on a genetic level.


Similarly, the so-called liquid biopsy detects chemical signals shed by cancer cells like proteins or strands of DNA to detect minute amounts of the disease in blood or other liquids—which sounds amazing. Except the problem is that while cancer by definition is the result of genetically damaged cells which multiply and spread rather than die off, it’s actually fairly rare for those cells to become numerous enough to threaten their host. Others are slow to do so, like early stage prostate cancer. This means an older patient could well die of other causes long before the cancer became a genuine cause for concern. For such a patient, painful life-altering treatment isn’t just unpleasant. It’s a waste of money and other scarce resources. Even more anxiety-provoking, liquid biopsies can generally detect the presence of cancer cells but can’t pinpoint their location. So yes, there’s a bomb in your house but we don’t know where and we aren’t sure if it will ever go off. Sleep tight!


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Cancer - Screening

Cancer - Screening

The Growing Risk of Overdiagnosis


While false positives and incorrect diagnoses bother both patients and doctors, it’s overdiagnosis that’s really worrying a growing community of medical professionals. Defined as “the diagnosis of a condition that otherwise would not have caused symptoms or death… it is the detection of a condition without any possible benefit of early treatment to the person with the condition.” Overdiagnosis means worry, expense, and discomfort. While being able to accurately screen for fast-growing and hard-to-detect cancers like ovarian cancer would bring a host of benefits, in general, putting healthy people into a risk pool isn’t ideal.


In the future, patients may have to advocate for fewer screenings. There are some beneficial ones, like Pap smears, colonoscopies, and tests for the HPV virus. Yet enlisting doctors in a quest to access the most advanced screening tools is unlikely to improve your health or peace of mind. Indeed even as pundits and politicians emphasize recent moderate reductions in life expectancy, the truth is the average person born today can expect to live a longer, healthier life than someone born 100 or even 50 years ago. Yet even as our life expectancy has climbed, our risk tolerance has plummeted. Yes, there are circumstances where caution is called for. Still, the pandemic often reflected an impossible trend toward total risk aversion that’s apparent in the escalating numbers of distracting auto safety features, redundant and ridiculous warning labels, and spongy playgrounds. No one wants cancer. But until advanced screenings can demonstrably discover dangerous tumor growth rather than potentially benign microscopic cells, no one should be voluntarily relocating to Cancerland either. 


Written by John Bankston

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