Cancer experts seeking to minimize overdiagnosis of cancer, unnecessary patient anxiety, and wasted spending on overtreatment have published recommendations for screening that include removing the word “cancer” from many diagnoses.

Members of the National Cancer Institute working group behind the guidance would remove the word “cancer” from the diagnosis of some premalignant conditions. The recommendations would refocus cancer screening efforts away from early detection and treatment for all cancers, in favor of emphasizing harmful cancers more likely to be cured if detected early, cancers for which curative treatments are more effective in early-stage disease.

Increased public awareness and clinical screening in recent years created an emphasis on early diagnosis of cancer, but has also led to problems, the group says.

“Although the goals of these efforts were to reduce the rate of late-stage disease and decrease cancer mortality,” write the working group’s co-chairs in The Journal of the American Medical Association, data suggest the goals have not been met. The authors say that the focus on early detection has resulted in “significant increases in early-stage disease, without a proportional decline in later-stage disease.”

Current screening for breast and prostate cancers, for example, often detect many cases where cancers are clinically insignificant. In contrast, current colon and cervical cancer screening programs that detect and remove precancerous lesions have reduced both the incidence of these two cancers as well as cases of late-stage disease.

Members of the group hope to raise public awareness of overdiagnosis as as result of cancer screening and minimize the problem by curbing the frequency of screening examinations, encouraging efforts to focus screening on high-risk populations, and raising the thresholds for criteria triggering biopsies.

The group also recommends leveraging molecular diagnostic tools and data from companion diagnostics to identify slow-growing or low-risk lesions, the creation of large observational tumor registries for lesions with low potential for malignancy, and expansion of research underpinning doctors’ conceptual understandings of each cancer's progression.

The recommendations of the task force are intended as initial approaches, and the chairs encourage physicians and patients to engage in open discussion about the issues.