Over-diagnosis and overtreatment are increasingly recognized as a problem for patients diagnosed with conditions that are described as pre-cancer or early cancer, but which may never impair health or increase mortality. For example, thyroid cancer incidence and treatment has more than doubled in recent years, but mortality has remained unchanged—evidence that may indicate over-diagnosis.  Similarly, experts estimate that 1 in 4 patients treated for breast cancer are over-treated when abnormal conditions are treated identically to invasive breast cancer. Treatment for indolent prostate cancers raises similar concerns, as do proposed new screening protocols for several other cancers.  Cancer treatment frequently results in adverse reactions and lifelong health effects.

However, recommendations for active surveillance and other conservative approaches have had limited impact on treatment decisions. Interpreting and communicating screening and treatment recommendations that are complicated and nuanced can be challenging for patients and healthcare professionals. Our project will bring together stakeholders to build relationships, establish a communication structure, and build research capacity designed to determine and disseminate more effective approaches to communicating ambiguous screening results and treatment options. We will collaborate with patient advocacy groups and healthcare partners to create a partnership that incorporates the perspectives of stakeholders to identify and prioritize comparative effectiveness research questions that seek to maximize effective communication regarding cancer screening and treatment options.  A first step will be to determine whether our approach should focus on one type of cancer or the overlapping issues of several different types of pre-cancers and indolent cancers.