ArticleThe Lancet. Oncology2014
Addressing overdiagnosis and overtreatment in cancer: a prescription for change.
Article in The Lancet. Oncology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02620852 (Enabling a Paradigm Shift), which is not on this map. Cited by 215 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Enabling a Paradigm Shift: A Preference-Tolerant RCT of Personalized vs. Annual Screening for Breast Cancer (Wisdom Study)
Who cites it
215 citing papers in PubMed, 6 syntheses or guidelines pooled it, 496 citations in OpenAlex.
- Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk.The Cochrane database of systematic reviews · 2023Pooled it
- Systematic Review and Meta-analysis of the Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Cytological Diagnosis and Thyroid Cancer Prevalence.Endocrine pathology · 2019Pooled it
- Prevalence of incidental breast cancer and precursor lesions in autopsy studies: a systematic review and meta-analysis.BMC cancer · 2017Pooled it
- Words do matter: a systematic review on how different terminology for the same condition influences management preferences.BMJ open · 2017Pooled it
- Prolaris Cell Cycle Progression Test for Localized Prostate Cancer: A Health Technology Assessment.Ontario health technology assessment series · 2017Pooled it
- Prostate Cancer Patient Perspectives on the Use of Information in Treatment Decision-Making: A Systematic Review and Qualitative Meta-synthesis.Ontario health technology assessment series · 2017Pooled it
- Population-based randomized trial of screening for clinically significant prostate cancer ProScreen: a pilot study.BJU international · 2022Trial
- Use of Molecular Tools to Identify Patients With Indolent Breast Cancers With Ultralow Risk Over 2 Decades.JAMA oncology · 2017Trial
- Trial
- Integrated Multi-Omics Reveals Cellular States and Microenvironmental Remodeling in Coexisting DCIS and IDC.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Burden of cancer in China from 1990 to 2023 and projections to 2050.Science China. Life sciences · 2026Article
- Recurrence Patterns and Overtreatment in Pure DCIS: A Retrospective Clinical and Radiological Follow-Up Study.Journal of personalized medicine · 2026Article
- Article
- Steroidogenic Acute Regulatory Protein in Breast Cancer: Mechanistic Insights into Pathogenesis and Therapeutics.International journal of molecular sciences · 2026Review
- Trends in over- and under-screening for cervical cancer after EMR implementation in rural China.NPJ digital medicine · 2026Article
- [The precautionary principle in preventive actions: considerations on an absence].Cadernos de saude publica · 2026Article
- ApoA2 isoforms as blood-based biomarkers reflecting pancreatic exocrine dysfunction for risk stratification and perioperative management of pancreatic cancer.Frontiers in oncology · 2026Review
- Diagnostic performance of Kaiser score, ADC, and their combination for BI-RADS 4 breast lesions: subgroup and misclassification analysis.Frontiers in oncology · 2026Article
- Modifying Diagnostic Terminology May Promote Evidence-Based Care.Caries research · 2025Article
- Addressing the overuse-underuse paradox in healthcare.Medicine, health care, and philosophy · 2025Article
155 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 12 institutions in 1 country.
Funding
Abstract
A vast range of disorders--from indolent to fast-growing lesions--are labelled as cancer. Therefore, we believe that several changes should be made to the approach to cancer screening and care, such as use of new terminology for indolent and precancerous disorders. We propose the term indolent lesion of epithelial origin, or IDLE, for those lesions (currently labelled as cancers) and their precursors that are unlikely to cause harm if they are left untreated. Furthermore, precursors of cancer or high-risk disorders should not have the term cancer in them. The rationale for this change in approach is that indolent lesions with low malignant potential are common, and screening brings indolent lesions and their precursors to clinical attention, which leads to overdiagnosis and, if unrecognised, possible overtreatment. To minimise that potential, new strategies should be adopted to better define and manage IDLEs. Screening guidelines should be revised to lower the chance of detection of minimal-risk IDLEs and inconsequential cancers with the same energy traditionally used to increase the sensitivity of screening tests. Changing the terminology for some of the lesions currently referred to as cancer will allow physicians to shift medicolegal notions and perceived risk to reflect the evolving understanding of biology, be more judicious about when a biopsy should be done, and organise studies and registries that offer observation or less invasive approaches for indolent disease. Emphasis on avoidance of harm while assuring benefit will improve screening and treatment of patients and will be equally effective in the prevention of death from cancer.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.