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In 1985, a post-mortem study of 101 people in Finland
found that 35.6% of the subjects had thyroid cancer.
The researchers went on to argue that if they had examined the tissue more thoroughly,
they expect most, if not all, of their subjects
would have had at least one small tumor in their thyroid,
and for clarity, these were people who were not diagnosed with thyroid cancer prior to their death.
Similarly, in 2005, an American study did full body CT scans of almost 1200 people of all ages,
and found that 86% of them had at least one “abnormal finding.”
And that was just one scan on one day of their lives.
Studies like these suggest that if you made full-body scans part of your regular routine,
odds are you’d find a bunch of cancers over the years.
Which sounds terrifying.
But, it doesn’t change your odds of having a life-threatening cancer.
See, what you’d be finding are harmless cancers that don’t ever make you sick
or even go away without treatment.
So, really, what this is, is an indicator that our definition of cancer is just kind of crummy.
Now for a long time, cancer has been defined as any uncontrollable growth of cells in your body.
And that definition worked super well back when the only way we could detect tumors was
feeling around for weird lumps.
But our ability to detect strange cell growths has improved immensely,
especially over the past 50 years.
In fact, our ability to scan the human body has progressed to the point
where we can identify tiny abnormalities which may or may not be headed for malignancy,
the ability to spread between tissues.
And this is making many doctors reevaluate what cancers should really be considered “cancer.”
The old-school definition can encompass any wonky collection of cells in your body.
But when a cancer isn’t going to be malignant, treating it doesn’t really prevent anything.
And even malignancy isn’t enough to make something worthy of being, like a quote “cancer”,
because there are a lot of cancers which actually aren’t that bad.
Instead, they’re indolent:
even though they’re malignant in the sense that they can spread between tissues,
they spread so slowly that ultimately don’t cause symptoms.
Some even regress or disappear all by themselves.
Like, the teeny thyroid tumors found in that Finnish study, for example.
Those almost always stay small or go away, only on rare occasions do they become problematic.
And researchers report that, depending on the organ,
between 15 and 75% of diagnosed cancers are indolent.
Which doctors have to ask which cancers are actually worth looking for.
For decades, many have thought doctors should err on the side of caution
by basically screening everyone for as many potentially dangerous cancers as they often as they can.
Because, hey!
It catches more cancers!
And it’s true that people who are diagnosed with early stage cancer typically live longer.
But screenings have also led to cancer overdiagnosis.
And while the tumors in overdiagnosis are harmless, the diagnosis itself isn’t,
because people are understandably upset when they hear they have cancer.
They may end up taking medicines or undergoing surgeries they don’t actually need,
which can take a toll on their bodies and their wallets.
Back when these screening tests were first developed, doctors made the logical prediction
that early detection of tumors would decrease the number of people who died from them.
But often, that’s not what happened.
For instance, between 1975 and 2016, the number of people diagnosed with thyroid, kidney,
and skin cancers more than tripled.
But the number of deaths for those cancers stayed pretty much the same.
Because if there are really 3 or more times as many clinically-relevant cancers occurring nowadays,
more people should be dying from them.
Because while our treatments have gotten better, they haven’t gotten that much better.
So no change in the number of deaths suggests that
the screening programs are really good at catching weird cell growths that don’t matter medically
rather than catching dangerous cancers earlier on.
And this is likely thanks to rapid increases in imaging technology.
The bittersweet reality is that a lot of the time,
doctors can’t tell the difference between cancer that needs treatment, and cancer that does not,
especially if the cancer is small.
Though, there’s hope they will be able to do that someday.
The upside to all this is that widespread screening programs have helped scientists discover ways
to distinguish between dangerous malignant cancers and harmless ones.
For example, with breast cancers, doctors can use molecular identifiers to determine
if patients need chemotherapy.
But that kind of fine-grained sorting isn’t yet available for all cancers,
so while scientists continue to search for diagnostic markers,
doctors are trying to narrow down who should be screened, when, and how, to minimize overdiagnosis.
Also they’re trying to change how we talk about cancer.
Some doctors think the term “cancer” should be reserved for tumors
that are at the highest risk of becoming malignant or already are.
Other overgrowths or abnormal cells should be called something else specific to their nature.
And even malignant cancers that grow super slowly, and therefore are unlikely to cause real harm
whether or not they’re treated, could rebranded as I.D.L.E. disorders.
I D L E: indolent lesions of epithelial origin.
But, on the upside, until we redefine cancer in a more meaningful way,
at least you, like, always have an iron-clad reason to get out of work.
Just tell your boss that if you looked hard enough,
you’d probably find some weird cells growing somewhere in your body.
Sorry, I got weird cells!
Got to go home.
Thanks for watching this episode!
If you liked learning about cancer overdiagnosis,
we also have an episode on why we haven’t cured all the cancers yet which you might like.
Why don’t you watch that one next?
And if you like it, too, you should probably just subscribe to the channel
because we have so many videos that are good.
I promise.
They’re good!
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