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It’s counterintuitive, but catching cancer early isn’t always for the best. And the coronavirus pandemic might leave lessons for future cancer screening in its wake.

Cancer diagnoses fell off a cliff last spring, when health care was buckling under the first Covid-19 surge and patients steered clear of regular checkups. A precipitous drop in healthy people undergoing colonoscopies, mammograms, or other cancer screening tests so alarmed Ned Sharpless, director of the National Cancer Institute, that he warned in August of turning one public health crisis into many others. His concern drew power from models predicting a combined 10,000 excess deaths from breast and colorectal cancer over the next 10 years if patients continued to miss screening. 


Come January, Sharpless mused about the flip side of early detection: overdiagnosis, when asymptomatic cancers are detected that may not grow to harm the patient, and its companion overtreatment, when the surgery, chemotherapy, or radiation that follow are worse for patients than those indolent cancers would have turned out to be. The pandemic, he said, might provide an opportunity to settle a long-running controversy about how often, and in what circumstances, these downsides of cancer screening outweigh the benefits.

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