Symposium voorafgaand aan het uitspreken van de oratie van prof. dr. Jelle Wesseling.
It is my privilege to invite you to the symposium ‘Finding the balance between over- and undertreatment’, two grand challenges in current cancer diagnosis and treatment. By spotlighting these areas, we aim to discover new ways to advance the quality of cancer care.
First, clinicians should realign attention and efforts to avoid overdiagnosis and, as a consequence, overtreatment to achieve optimal patient care. Overdiagnosis, defined as the detection of a “disease” that will never manifest symptoms nor lead to death during a patient's expected ordinary lifetime, can be the by-product of screening for early forms of disease. While screening saves lives for some, it may inadvertently turn others into patients, leading to treatments with no benefit and that perhaps do harm. Since most people who are diagnosed are respectively treated, it is difficult to assess whether overdiagnosis has occurred in an individual, emphasizing an area of clinical imprecision in need of reform.
Second, the burden of ineffective treatment of cancer should be prevented. Even though treatment strives for the optimal benefit-to-harm ratio, multiple patients (number needed to treat ~ NNT) often undergo standard treatment for the benefit of only one. Obviously, we should design strategies to distinguish patients that will benefit from a particular treatment from those that will not, saving them the burden of often toxic, but needless treatment.
The symposium aims to explain and discuss ways to understand and address these challenges, combining expertise from epidemiology, screening, surgery, pathology, genomics and policymaking. I look forward to your participation and vivid discussions in our ongoing efforts to improve current clinical practice for the benefit of many.
- Understand the concepts of overdiagnosis, overtreatment, and ineffective treatment.
- Understand the concept and impact of ‘number needed to treat’ (NNT).
- Explore epidemiological and translational methodology on how overdiagnosis can be identified and quantified.
- Explore translational, clinical, and policy strategies on how overdiagnosis, overtreatment, and ineffective (toxic) treatment can be reduced.
- Learn about patient perspectives and how they should be incorporated into optimizing oncology health care.
High incidence of breast cancer in the Netherlands: does screening matter?
Prof. Dr. Carla van Gils, PhD, epidemiologist at the Julius Center, University Medical Center Utrecht.
Goal: Acquire knowledge about the pros and cons of screening from the epidemiologist perspective, focusing on the ‘sensitivity-specificity challenge.
How to reduce breast surgery?
Prof. Dr. Alastair Thompson, MD PhD, Breast Surgical Oncologist at Baylor College of Medicine, Houston, Texas, USA.
Goal: Learn how to minimize the burden of surgical treatment for harmless breast cancer precursor lesions, thereby preventing overtreatment of such lesions.
Less might be more in gynecological oncology
Dr. Tjalling Bosse, gynecological pathologist at the Leiden University Medical Center.
Goal: Learn how to improve the analysis and classification of analysis of the gynecological malignancies can minimize toxic treatment for gynecological cancer with a relatively favorable prognosis, without compromising adequate treatment for more aggressive disease.
How to avoid ineffective systemic breast cancer treatment?
Prof. Dr. Andrew Tutt, Breast Medical Oncologist at the Institute of Cancer Research and King’s College, London, UK.
Goal: Know how identify and treat patients with breast cancer with homologous recombination (HR) deficiency, i.e. defective for DNA double strand break repair. This will allow us to target this defect specifically, leading to better cure, and, at the same time, spare many women with HR proficient breast cancer ineffective, but burdensome treatment.
How to nail down the mutations that matter?
Dr. Serena Nik-Zainal is clinical geneticist at the University of Cambridge, UK.
Goal: Understand the impact of mutational processes on the initiation and progression of breast cancer, thereby providing essential information which treatment is likely to be effective and which one is not.
How to distinguish harmless from hazardous Ductal Carcinoma In Situ?
Lindy Visser, PhD student at the Division of Molecular Pathology in the lab of Jelle Wesseling at the Antoni van Leeuwenhoek Hospital – Netherlands Cancer Institute.
Goal: Understand and apply how to distinguish harmless from potentially hazardous Ductal Carcinoma In Situ, a very common precursor of breast cancer.
The patient perspective is essential for the real balance
Mr. Ellen Verschuur, patient representative for the Dutch Society of Breast Cancer (‘Borstkankervereniging Nederland’).
Goal: Understand how patients can be centrally involved in addressing the overtreatment vs. undertreatment balance and how this relates to optimizing communication between health care providers and patients.
How to generate healthy health care?
Prof. Dr. Ab Klink, former Minister of Health, Welfare and Sport in the Dutch government, and currently member of the Board of Directors of the Health Insurance Company ‘VGZ’.
Goal: Learn how policy makers are essential in improving cost-effectiveness in general and in conquering overtreatment in particular.
You gotta move!
Prof. Dr. Pieter Wesseling, pathologist in neuro-oncology at the Free University Medical Center in Amsterdam as well as at the Princess Maxima Center Pediatric Oncology Center Utrecht.
Goal: Put the various preceding seminars in a wider, more societal context and try get a vision across how to move on.
Host and moderators
Prof. Dr. Vincent Smit, MD PhD, head of the Department of Pathology, Leiden University Medical Center.
Host of the symposium.
Dr. Esther Lips, PhD, staff scientist at the Division of Molecular Pathology in the lab of Jelle Wesseling at the Antoni van Leeuwenhoek Hospital – Netherlands Cancer Institute, Amsterdam.
Moderator of the symposium.
Danielle Cohen, PhD MD, pathology fellow at Leiden University Medical Center, the Netherlands. Esther and Danielle will moderate the symposium.
Moderator of the symposium
Prof. Dr. Vincent Smit
Prof. Dr. Carla van Gils
Prof. Dr. Alastair Thompson
Dr. Tjalling Bosse
Prof. Dr. Andrew Tutt
Dr. Serena Nik-Zainal
Drs. Lindy Visser
Mr. Ellen Verschuur
Prof. Dr. Ab Klink
Prof. Dr. Pieter Wesseling
Prof. Dr. Vincent Smit