In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away.
Even though nearly all the tumors turned out to be cancer, they rarely proved fatal. And surgery roughly doubled patients' risk of developing heart problems or dying of other causes, doctors found.
After five years, 24 percent of those who had surgery had died, compared with only 13 percent of those who chose monitoring. Just 3 percent of people in each group died of kidney cancer.
The study involved only people 66 and older, but half of all kidney cancers occur in that age group. Younger people with longer life expectancies should still be offered surgery, doctors stressed.
The study was observational, not an experiment in which some people were given surgery and others were monitored, so it cannot prove which approach is best. Yet it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared. Surgery is the standard treatment now.
"I think it should change care" and older patients should be told "that they don't necessarily need to have the kidney tumor removed," said Dr. William Huang of New York University Langone Medical Center. "If the treatment doesn't improve cancer outcomes, then we should consider leaving them alone."
Huang led the study and will give results at a medical meeting in Orlando, Fla., later this week. The research was discussed yesterday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.
In the United States, about 65,000 new cases of kidney cancer and 13,700 deaths from the disease are expected this year. Two-thirds of cases are diagnosed at the local stage, when five-year survival is more than 90 percent.
However, most kidney tumors these days are found not because they cause symptoms, but are spotted by accident when people are having an X-ray or other imaging test for something else, like back trouble or chest pain.
Cancer experts increasingly question the need to treat certain slow-growing cancers that are not causing symptoms -- prostate cancer in particular.