Michigan Medicine experts discuss whether active surveillance – closely monitoring but not delivering immediate treatment – could reduce overtreatment for some thyroid, prostate and breast cancers.

For certain slow–growing or low–risk cancers, do patients really need surgery or other treatments?

In a new perspective piece published in the New England Journal of Medicine, University of Michigan Comprehensive Cancer Center researchers look at whether active surveillance could be a strategy to reduce overtreatment in certain patients.

Among the groups best suited for consideration: those with low–risk thyroid cancer, prostate cancer and a form of early breast cancer called ductal carcinoma in situ, or DCIS.

Cancer treatment comes with risk: mastectomy complications and lymphedema for women with breast cancer; impotence and incontinence for men with prostate cancer; voice changes and low calcium levels for patients with thyroid cancer. And it can be costly for patients and the health care system.

By comparison, active surveillance involves monitoring patients without engaging in surgery or intensive therapies. It includes regular follow–up with patients and performing biopsies and tests when necessary. Patients who show signs of advancing cancer receive immediate treatment.

Still, many physicians and patients are reluctant to opt for active surveillance.

The perspective’s authors research the issue of overtreatment in each of the three cancer types. Megan Haymart, MD, associate professor of internal medicine, treats patients with thyroid cancer. David C. Miller, MD, professor of urology, sees patients with prostate cancer. Sarah T. Hawley, PhD, researches patient and provider preferences around breast cancer treatment.