When You Have Cancer, But You’re Fine: Cancer Overdiagnosis

[♪ INTRO] 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! [♪ OUTRO]

100 thoughts on “When You Have Cancer, But You’re Fine: Cancer Overdiagnosis

  1. I always thought if they were benign they were just called tumors, and they weren’t called cancer unless they were malignant.

  2. Why didn't you talk about how AI is actually really successful in trials at identifying cancers, and will probably outperform the doctors/scientists in the very near future?

  3. I think it's important to say that yes, there are ways of describing growths precisely. Tumor staging and grading is one example.

  4. My mom's friend was diagnosed with breast cancer today, and I come on YouTube and see this. I'm hoping it's a sign and her breast cancer isn't malignant and she will be fine 🤞

  5. When asking questions like this we need to stop asking if people “live longer” as the result of some intervention or not, and instead ask if they live to a normal life expectancy. IMHO extending someone’s life by a few years may be positive progress in terms of the treatment of cancer in general and yes we should of course collect such stats. But when it comes to whether I want extensive screening done, the only question I care about is if my life will be saved. If I only get a few more years out of the deal on average and have to deal with a lot more false positives, no thank you.

  6. This kind of happened to me. I had a lump on a testicle and it was diagnosed as cancerous by ultrasound and had it removed. Turned out to just be a cyst upon tissue analysis.

  7. Friend of mine got a strange mole on his arm, asymmetrical and really strange looking. Doctor took a long look at it said "I can't tell you for sure that it's cancer. I could biopsy it and send it to the lab, or I could skip all that and just cut it out. It's right here on the surface. Chances are it's harmless, but if it was me, I'd just have it cut out."
    He took out a considerable amount of tissue around the mole, just to be safe. While it probably could have been left alone, it literally just took like 10 minutes to be dead sure. Lab results would take days, and even if they revealed it was a benign tumour, that would be a source of anxiety for quite some time.

  8. I had a lump on my thyroid and was experiencing hypothyroid symptoms. I was diagnosed with papillary carcimoma of the thyroid. It's often called the "easy" cancer, and for me, it was. The tumor was the size of a half dollar, and because I changed my diet after the diagnosis, it started to peel away from the thyroid. But I still had to hear the diagnosis, get my thyroid removed, and now I have a chronic illness due to being dependent on synthetic hormone medication to replace my thyroid hormones. And not all cases of thyroid cancer are as easy as mine was. And life after surviving thyroid cancer is never easy.

    The worst part was getting diagnosed on my 30th birthday.

  9. colon cancer screening is one of the biggest scams going. All the stats show, and Cancer societies admit, that all the millions and millions of colonoscopies have not reduced the rate at which people are diagnosed or die of colon cancer. But each procedure is a cool $1000 for the industry. And they can do a lot of harm, too.

    So honestly, don't have a colonoscopy just because you are 50 years old. Only have one if you have a suspicion you might have cancer.

  10. I watched a catalyst episode about this very subject when it came to prostate cancers, They showed that in most older men they were those super slow growing ones and removing them often did more harm than good as these the men were most likely going to die of old age before it caused issues. As far as I remember only monitoring them was the only way they could tell if it was a dangerous one or harmless slow growing type.

  11. Want to get out of work the easy way? Just call in an hour before your shift starts and say , "So I was in the shower this morning, and discovered I have a pretty severe crack in my buttocks, I think I need to go get it checked out.

  12. Makes me wonder if my Thyroid cancer was one of those. It was super small, and they ended up removing my whole thyroid. But I feel much better now, so either way it was a good thing.

  13. Video: some cancers are harmless, so we need to develop better tests for when we should treat cancers.

    Inevitable popular media stories: Should we not bother treating cancer any more?

  14. I get fine needle aspiration done on my thyroid every 2-3 years because they found 3 nodules. They're.slowly growing but still say its benign. Freaky stuff.

  15. My aunt was diagnosed with “stage 0” cancer. She had a quick precautionary procedure and she was fine. But since then she posts all the time about being a CANCER SURVIVOR and how people don’t understand what it’s like to have cancer. Tbh it’s insensitive to people who actually go through chemo and actually suffer from their disease

  16. Even in the series House md, they said the doc didn't liked full body scans cause you could find at least 3 things wrong that are not the problem when people get sick.

  17. I used to think cancer was easily treatable and rarely deadly.
    Then it killed my Dad when he was 55.
    Now it's ALWAYS a death sentence for me, even though I know that's not true.

  18. I sometimes feel like we don't give our immune systems enough credit.

    Our bodies work really hard to get rid of all kinds of unwanted diseases that would freak us out if we knew about all of them!

  19. Yesterday i thought what if i have cancer and i don't know?
    I should go get tested even if there will be a false positive just to be sure.
    I think the universe wants to tell me something.

  20. I had heard it postulated decades ago that we're probably developing cancer periodically our entire lives and our immune system is killing them off.

  21. Honestly, I think this is what's happened with my cat. When he got old, somewhere between 20 and 23(?) (we can't know for sure because he was already an adult when the shelter found him, and all evidence pointed to him having been born a stray), he was found to have lung cancer. It hadn't spread yet, and it wasn't negatively affecting his quality of life yet, and at his age, him going through treatment wouldn't be worth it. We were told to bring him back for check ups to see how it progresses, and that if anything had to be done, it would just be to keep him comfortable until his time came. It's hard to tell with cats, but we were told we had maybe three months left with him. That was in January of this year. It hasn't spread, it hasn't gotten worse, and it hasn't actually caused any problems for him. He's got some unrelated arthritis that he has some pain killers for, but other than that he's his usual self. If he hadn't come down with a chest infection (which quickly cleared up with medication) that lead to the tests and scans, we'd never even have known he had cancer.

  22. What does a crab have to do with tumors?
    Basically why is a the zodiac cancer sign a crab.
    Crabs are delicious or something to avoid if you are allergic or hate STIs. So why does the clawed decapod related to Breast, Lung, and others tumorous illnesses called cancer.

  23. I hate the idea that overtreatment of cancer means we should reduce cancer screenings. Knowledge is good. I want to know if I have cancerous cells so I can monitor them to see if I need treatment or should just live with it.

  24. I had a strange mole on the back of my neck as well as a swollen lymph node next to it.
    In the days between showing it to the doctor and having the biopsy done it had totally disappeared.
    Doctor said if it was skin cancer I would likely have died from it….

  25. Same goes for disc bulges seen on mri. Nearly everyone has them back pain or not. But we attribute them to people with back pain. Because we only mri people with back pain. Moral of the story, if you go looking for something, you'll find something. But is it relevant?

  26. How does this affect studies that have shown that consuming a certain food or being exposed to a certain chemical has a strong correlation with cancer? Are these foods or chemicals making us more likely to get mutations like cancers that eventually go away, or actual dangerous cancers? Of course this probably depends on each compounds and/or scenario, but how do we know that there aren't a bunch of studies out there that has to be re-evalued all over again with this in mind? Or did they already have this in mind?

  27. I think changing the definition of a word is always ineffective. The word cancer is roughly around 2,500 years old (I’m not sure of the exact timeline), and has made its way into multiple languages.

    A better strategy would be to create a new medical term or set of terms. They would be synonymous with cancer but with different nuances.

  28. Here's the thing…
    Everyone everywhere gets cancer all the time…… It is a fact of life and existence.
    The trick is, our body is usually…… really good at identifying the cancer and killing it LOOOOONG before it becomes life threatening. There are a few notable exceptions here that are rather lethal, but for the most part, as a human you are going to get cancer of the EVERYTHING at least once…

  29. It sounds to me like what you are saying is that the American medical care trash inferno is actually bankrupting way more people than it would if it was just a plain old dumpster fire.

  30. I was told I had a tiny itty bitty tumor somewhere but it isnt growing. Always in the back of my mind (not literally) but I guess it’s part of life.

  31. Thank you so much for this video. I was diagnosed with myxoinflammatory fibroblastic sarcoma on my ear. The recommendation from the specialists was to remove my whole ear. My doctor told everyone to chill out. He said it was a low level cancer with a low malignancy rate sitting on ear cartilage. The specialists are just being over cautious. Instead, he numbed my ear with a local, took about 15 minutes to removed it, then burned the remaining tissue under it. After almost two years, still cancer free. But my wife still says I don't listen to her……..or something like that.

  32. I had thyroid cancer when i was 18… i never felt sick before, only the treatment made me feel sick.. and for the whole time doctors weren't sure if the cancer was malignant or not, but they treated it just in case…. now i have to eat thyroid medicine for the rest of my life because the removed my thyroid Dx

  33. I could swear I have a skin cancer pop up on my ear every now and then. I can't help but pick at it. It bleeds like crazy and takes a long time to heal, almost a year, last time. I promised my doctor that I would get it checked out next time that happens.

    I did have breast cancer and they just cut it out and threw it away!

  34. The US should do like Japan n make everyone get a full blown health screening. If that country w a lot more ppl than the US then the US should b able to do the same.

    I caught my breast cancer myself in early stages.

  35. It would be great if you had a numerical legend attached to your quotes to sources in the description to make it easy for us to double check what you mean. You mentioned that “the number of deaths for those cancers stayed pretty much the same” but I want to easily be able to see which study your referring to so I can see if the study accounted for population growth.

  36. Oncologist should be CONologist. They love cancer so much they will kill you for it. They killed my dad. Long story, but if you are ever diagnosed with cancer get 3 more opinions. 😷🏥💩.

  37. I thought we already have the distinction like that – tumor (used in reference to harmless types, theoretically cancers are tumors but pragmatically nobody will call a cancer a tumor, and effectively that word is used only for the harmless ones) and cancer (harmful type of tumor that can spread)… at least that's how it functions in Polish – nowotrów (literally "newgrowth", tumor), and rak (crayfish/cancer).

  38. Yeah I've had tiny tumors in the joints of my fingers that went away in 3 – 5 days, and that's common for this sort of benign "cancer"

  39. this video is very sense- and useless….unless…ohhh you want to thin out the anti-vaxers and alike. I see what you did there. Naughty but smart move SciShow ;p

  40. Weird cells, indeed, especially in bad people. Cancer should just take those not helping humanity keep after God's creation, out.

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