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JAMA Researchers Argue that Aggressive Treatment for Basal Cell Carcinoma Might Not be Best Action for Elderly Patients

A recent discussion found within the pages of the Journal of the American Medial Association (JAMA) highlighted the debate about how to best treat basal cell carcinoma (BCC) in elderly patients. Most health care providers know that BCC statistics indicate that it is the most widely diagnosed cancer in the United States. Procedures to remove this basal cell cancer have doubled in the last 15 years. Yet surprisingly, according to JAMA, more than 100,000 BCCs are treated each year in individuals who die within one year. These deaths do not occur from BCC but by causes other than the skin cancer.  

According to JAMA, as the numbers of older patients increases in the next 20 years, so will surgeries and medical costs, potentially for a cancer that is likely to cause little direct harm to the diagnosed elderly individual. There is a growing debate as to whether more harm is caused by the slow-growing BCC or the adverse effects of BCC treatment in the elderly. JAMA claims that untreated BCCs do not always cause harm in very elderly patients, whereas the negative effects of treatment can affect the elderly much more rapidly. JAMA therefore hypotheses that, especially for those patients at the very end of life, a diagnosis and subsequent treatment of BCC may not always be the most beneficial course of action.  

“To diagnose or not diagnose…” has now become a hot debate in the oncology community.  JAMA researchers pointed out that it’s true that “early detection saves lives” has been a mantra for many and patients are adhering to the advice.  Yet researchers went on to argue that for slow-growing tumors (like those found in the prostate) there is a chance that the individual will be treated even though the effects of the tumor may have be minimal to none.  Researchers questioned that for elderly patients in their final years with multiple comorbidities, perhaps it may be best to follow a surveillance plan rather than jump straight into an aggressive treatment plan.  Researchers concluded that until further studies are done on risk-based screening or the rate of tumor growth, the debate will likely continue.

Sources: 1, 2

Image: Tim Hamilton

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