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Updated: Jul 15, 2025
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Detection and Monitoring of Tumor Associated Circulating DNA in Patient Biofluids
Published on: June 8, 2019
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Cancer Screening, Incidental Detection, and Overdiagnosis.
H Gilbert Welch1, Regan Bergmark1
1Center for Surgery & Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States.
Clinical Chemistry
|September 27, 2023
Summary
Early cancer detection through screening can lead to overdiagnosis, where asymptomatic cancers not destined to cause harm are identified. This challenges the assumption that earlier diagnosis always equates to better outcomes.
Area of Science:
- Oncology
- Public Health
- Medical Diagnostics
Background:
- Historically, cancer diagnosis relied on symptomatic presentation.
- Modern screening and incidental detection identify asymptomatic cancers.
- This has resulted in overdiagnosis: detecting cancers unlikely to cause symptoms or death.
Approach:
- Examined cancer progression heterogeneity.
- Reviewed evidence linking earlier detection to overdiagnosis.
- Identified population signatures of overdiagnosis: rising incidence with stable mortality, and rising early-stage with stable late-stage incidence.
Key Points:
- Overdiagnosis is an unintended consequence of early cancer detection efforts.
- Population-level data, like screening trial follow-ups, reveal overdiagnosis.
- Misleading metrics such as increased survival rates can arise from overdiagnosis.
Conclusions:
- The assertion that early diagnosis is universally superior needs re-evaluation.
- Tumor biology and host response are critical prognostic factors, potentially more so than detection timing.
- Challenging the paradigm of "earlier is always better" is necessary.
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