Trends in Metastatic Breast and Prostate Cancer — Lessons in Cancer Dynamics
A partir de l'analyse des courbes d'évolution de l'incidence des cancers métastatiques du sein et de la prostate aux Etats-Unis sur la période 1975-2012 et de trois paradigmes sur la progression des cancers, cet article formule des hypothèses permettant d'expliquer pourquoi l'incidence de certains cancers métastatiques, en particulier du sein, ne diminue pas malgré la mise en place de programmes de dépistage
Patients who present with metastatic cancer serve as powerful motivators for efforts to detect cancer early. Screening offers hope that cancer can be detected in an early, localized phase when it's more amenable to treatment. This hope is based on a paradigm attributed to William Stewart Halsted, which holds that cancer arises at a single location, grows there, and eventually migrates to local lymph nodes and then to more distant organs. If the Halstedian paradigm is correct, effective screening should allow cancers destined to metastasize to be identified at an earlier stage and reduce the incidence of cancers that first present as metastatic disease. Such a stage shift is typically viewed as necessary but not sufficient to enable screening to reduce mortality.