More is Not Always Better
27 September 2018
‘More research is needed’ is a frequently used final sentence in scientific articles. But more - of the same - research is not always necessary. Nonetheless, this happens more often than we want.
On September 14, Prof. Carla van Gils gave her inaugural speech. Her drive: to detect cancer at an earlier stage to prevent that patients die from the disease, or to ensure that they require less severe treatment than if the cancer is detected at a later stage; in short, optimally using cancer screening.
Her inaugural lecture ‘More is Not Always Better’ was a plea for better screening and against overdiagnosis. It was also an appeal to researchers not to continue with more and more research into new risk factors or biomarkers, but to first take the right follow-up steps. So that promising research findings are actually translated into concrete, tailor-made screening, prevention and treatment methods.
As an example, she mentioned ‘dense breast tissue’. We have known for many years that population screening does not work well enough in women with dense breast tissue. Whereas it is precisely these women who are more likely to develop breast cancer. Therefore, in 2012 the DENSE trial was started. The aim is to see whether screening using MRI can help women with very dense breast tissue, and whether personalized screening is the solution. But at the same time, we want to make sure this does not just lead to ‘overdiagnosis’.
Because with MRI screening, you may be able to help women with dense breast tissue, but you will also find slow-growing, non-aggressive cancers that will not be fatal. These cancers would never have come to light without this type of screening. The more you screen, the more you detect.
Currently, a lot of research is conducted into predicting as accurately as possible who has the highest risk of cancer and for whom screening offers the most benefits, which may make the disadvantages of screening more acceptable. Research into the use of big data to predict who has a high or low risk is now in full swing and will have to prove itself in the coming years. The quality and completeness of the data and a good understanding of how data are generated play a crucial role in this. With her research, Van Gils aims to explore how this development can be utilized to detect cancer early on or to detect a return of cancer in people who have had cancer before.
With the example of the DENSE trial, Van Gils shows what needs to be done to ensure that more promising research findings actually benefit patients: ‘First of all, I advocate more funding for long-term research programs to really put research findings into practice. Secondly, I call for freeing up clinical physicians so they can participate in research based on the clinical problems they and their patients identify. But most of all, I call on al medical researchers to take a step back and reflect. Because we are the ones who are responsible for initiating every next step in research.’
The DENSE trial is a joint study by the Julius Center and Radiology department of the UMC Utrecht and seven other major hospitals, screening organizations and the National Reference Center for Breast Cancer Screening.
The full inaugural lecture of Prof. Carla van Gils.