Question ID: Feb 4-1
Submitted by: February 4, 2011 Behavioral, Population, Epidemiology, and Prevention Provocative Questions workshop - Submitted to the website
March 27, 2011
Are there characteristics of cancers, especially early cancers, that can be used to match therapeutic strategies more accurately with clinical risk?
Background: Not all cancers that are detected early are worth treating. However, uncertainties about the clinical behavior of a given lesion often lead to more aggressive treatment than may be warranted, which can result in net harm to the patient. For example, such problems can arise with breast ductal carcinoma in situ (DCIS) and some prostate cancers. In addition, the inherent uncertainty in predicting the outcome of a given cancer can result in poor communication of actual risk to the patient, promoting decisions that may not be appropriate for the given benefit/risk profile.
Feasibility: Major advances in genomic and proteomic technologies, together with a greater awareness of the tumor microenvironment, are resulting in a better understanding of how molecular profiles relate to phenotype, which could allow for better prognostic measurements. Prospective studies could lead to a substantial improvement in the accuracy with which the clinical behavior of a given lesion can be predicted.
Implications of success: Improved prediction of clinical risk could help clinicians in communicating risk/benefit profiles for treatment options, so that patients could make more informed decisions, thus matching the diagnosis with the most appropriate treatment. These developments would also identify more clearly where therapeutic advances are most needed. These changes could improve the overall benefit from early detection by reducing the risk of harm that arises from overtreatment.
Average Score: 5.0
 (1 evaluation)Provocativeness - 5.0
Novelty - 5.0
Public Health Significance - 5.0
Feasibility - 5.0
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