Abstract
A delay in diagnosing cancer is widely perceived to compromise severely a patient's chance of being cured. The unrealistic expectations of technology and of physicians' capabilities are inconsistent with modern knowledge of the natural history of cancer. Established and recent precepts in clinical oncology and tumor biology emphasize that inherent characteristics of a malignant neoplasm predict its dissemination, rather than a real or perceived delay in diagnosis. The processes of carcinogenesis and dissemination are more nearly simultaneous than sequential. Uncritical belief in the ability of most cancer screening techniques to provide cure through early detection may do more harm than good. Policy and efforts would be better directed to the primary prevention or reversal of preneoplasia and to improved therapy for established cancer.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aznavoorian S., Murphy A. N., Stetler-Stevenson W. G., Liotta L. A. Molecular aspects of tumor cell invasion and metastasis. Cancer. 1993 Feb 15;71(4):1368–1383. doi: 10.1002/1097-0142(19930215)71:4<1368::aid-cncr2820710432>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
- Carter H. B., Pearson J. D., Metter E. J., Brant L. J., Chan D. W., Andres R., Fozard J. L., Walsh P. C. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA. 1992 Apr 22;267(16):2215–2220. [PMC free article] [PubMed] [Google Scholar]
- Fleming C., Wasson J. H., Albertsen P. C., Barry M. J., Wennberg J. E. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team. JAMA. 1993 May 26;269(20):2650–2658. [PubMed] [Google Scholar]
- Jacobson P. D. Medical malpractice and the tort system. JAMA. 1989 Dec 15;262(23):3320–3327. [PubMed] [Google Scholar]
- Johansson J. E., Adami H. O., Andersson S. O., Bergström R., Holmberg L., Krusemo U. B. High 10-year survival rate in patients with early, untreated prostatic cancer. JAMA. 1992 Apr 22;267(16):2191–2196. [PubMed] [Google Scholar]
- Meyers F. J. Tumor biology in explanation of the failure of screening for cancer and in determination of future strategies. Am J Med. 1986 May;80(5):911–916. doi: 10.1016/0002-9343(86)90637-6. [DOI] [PubMed] [Google Scholar]
- Schmid H. P., McNeal J. E., Stamey T. A. Observations on the doubling time of prostate cancer. The use of serial prostate-specific antigen in patients with untreated disease as a measure of increasing cancer volume. Cancer. 1993 Mar 15;71(6):2031–2040. doi: 10.1002/1097-0142(19930315)71:6<2031::aid-cncr2820710618>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]