[Treatment 'to be on the safe side': avoiding every risk in the case of malignancy or pre-malignancy]

Abstract

In a recent study in JAMA Surgery, Sagara et al. showed that patients with low-grade ductal carcinoma in situ who did not receive surgery had a similar prognosis compared to patients who did receive surgical treatment. This paper adds to a growing number of publications demonstrating that overtreatment is common in premalignant diseases. This phenomenon of a strongly-felt need for risk reduction when it comes to malignant disease is not found, for example, in cardiovascular risk management. The same conclusion can be drawn for radiotherapy in older women after breast-conserving surgery. Although multiple studies show that radiotherapy can be avoided in a selected group of patients, 98 per cent of women are still treated according to current guidelines. 'Overly' safe, but with little regard for treatment-related side effects. The study by Sagara and colleagues indicates that it is time to discuss with the patient the very small absolute benefits of our current practice regarding (pre-)malignant diseases.