too early and too late cancer detection

In clinical practice, the suspicion of cancer leads to biopsy and biopsy generally requires surgical excision or removal of the lesion. As a matter of fact, sometimes the lesion turns to be benign (a cancer mimic) or premalignant (i.e. lacking the full features of malignancy) or, if malignant, to represent a very early step of the disease (and one cannot be sure that the tumor would have behaved as an aggressive disease if left untreated).  These possible events lead to overdiagnosis of cancer which is responsible for unjustified mutilation, anxiety of the patient, and cost escalation. A paper published in the  Journal of the National Cancer Institute in 2010 has stirred up another round of debate about this topic. To mitigate the ongoing problem of cancer overdiagnosis, the authors of the above paper suggest three possibilities: raising the threshold of labeling a test abnormal, waiting for the growth of a lesion over time before biopsying, and ignoring smaller abnormalities. In summary, we are realizing that it is better not to continue on the path where we are compelled to investigate and treat anything that resembles cancer. 

This is what is happening in the high-income developed countries of the world where screening procedures are highly effective in the detection of early cancer and its mimics. The best examples are cancer of the uterine cervix, the breast, the lung, etc. The opposite is true, instead, in the low-income developing countries where the above malignancies are detected too late due to the lack of resources in screening and secondary prevention, and the chance of successful treatment are low or null.  For example, it is estimated that over 1 million women worldwide currently have cervical cancer, most of whom (living in developing countries) have not been diagnosed, or have no access to treatment that could cure them or prolong their life. According to the World Health Organization, in 2005, almost 260 000 women died of the disease, nearly 95% of them in developing countries, making cervical cancer one of the gravest threats to women’s lives. In these areas, cervical cancer is the most common cancer in women and the leading cause of cancer death among women.