The Antidote to Overdiagnosis – Is it Oversight?


“I hope that the investigators are successful in their terminology reform efforts, I encourage them to include among their goals the search for a better understanding of why the specialty of pathology was unable to escape from its stubborn devotion to turning lesions with a low or poorly defined risk into cancer. Also, why is there no backup mechanism analogous to the US Food and Drug Administration’s review to detect and respond in a timely fashion to a systemic problem like hazardous diagnostic criteria becoming the standard of care?”

Pathologist and Author,  Elliot Foucar, addressing the work of Laura Esserman et al in The Lancet


In 2014, Dr. Laura J. Esserman and colleagues published an influential paper which proposed a new term, IDLE (Indolent Lesion of Epithelial Origin), for many types of indolent tumors which are currently being labeled as “cancers”.  Among a number of cogent points of the article is this one: ” new guidance is needed to describe and label the heterogeneous diseases currently referred to as cancer.”

As noted by  Dr.Elliot Foucar, a retired pathologist who still publishes papers about errors in pathology, it has fallen to researchers outside of the discipline of surgical pathology to call attention to the problem of cancer overdiagnosis.  Foucar blames the failure of pathologists to challenge and police their system of an expert opinion “gold standard” for the intervention by outsiders such as Esserman et al  into the problem of over treatment of indolent tumors which are labeled as cancers.

Since its publication, Esserman’s article has been cited 274 times, and has brought a significant degree of attention to the problem of overdiagnosis.