Medical Experts: Some Cancer Cases May Benefit from Watchful Waiting Over Immediate Treatment

When faced with a cancer diagnosis, many patients and doctors rush to begin aggressive treatment. However, medical experts now emphasize that for certain types of cancer, immediate intervention isn’t always the best approach.

In some cases, particularly with slow-growing tumors, watchful waiting—a strategy of active monitoring without immediate treatment—may offer better outcomes and quality of life than surgery, radiation or chemotherapy, which can cause significant side effects without improving survival rates.

“The fact that so many cancers will never kill you is not a justification for not knowing, because there is still plenty of room for ‘watchful waiting,’ as well as interventions that may improve quality of life even if they don’t extend life,” explained Dr. Marc Siegel, Fox News senior medical analyst.

Dr. Siegel added that as more targeted and personalized cancer treatments emerge with fewer severe side effects, the decision-making process becomes more nuanced. “The fact that cancers are occurring earlier is a justification for heightened screenings, not the opposite. Information is power—what you do with that information is based on clinical judgment and the art of medicine.”

Medical research has identified several cancer types where watchful waiting may be appropriate:

Low-Risk Prostate Cancer

Prostate cancers with a Gleason score of 6 (grade group 1) often warrant observation rather than immediate treatment, according to Dr. Sanoj Punnen, a urologic oncologist with Sylvester Comprehensive Cancer Center at the University of Miami Health System.

“For most low-risk cancers, we recommend initial observation and surveillance rather than immediate treatment,” Dr. Punnen said. “For high-grade tumors like Gleason 8, 9 or 10, we believe they progress quickly, so we recommend treatment to prevent the risk of metastasis.”

The approach to observation typically includes regular PSA testing, MRIs, and occasional biopsies to monitor for any progression of the disease.

Ductal Carcinoma In Situ (DCIS)

Also known as stage 0 breast cancer, DCIS is a non-invasive condition where abnormal cells are contained within the breast milk ducts. Research from Dana-Farber Cancer Institute found that active monitoring for DCIS resulted in similar quality of life and mental health outcomes over a two-year period compared to standard surgical approaches.

“These results suggest that in the short term, active monitoring is a reasonable approach to management of low-risk DCIS,” the lead researcher noted in a press release. “If longer-term follow-up supports the safety of active management from a cancer outcome standpoint, this approach could be considered as an option for women with this condition.”

Indolent Lymphomas

Non-Hodgkin lymphomas that grow and spread slowly may not require immediate treatment. The National Comprehensive Cancer Network recommends watchful waiting for asymptomatic, slow-growing follicular lymphoma to avoid unnecessary exposure to chemotherapy and immunotherapy toxicity.

According to the Lymphoma Research Foundation, “Active surveillance may be started after the initial diagnosis or after relapse, depending on the situation. Active treatment is started if the patient begins to develop lymphoma-related symptoms or if there are signs that the disease is progressing.”

Chronic Lymphocytic Leukemia (CLL)

This common adult leukemia often grows slowly, with many patients experiencing no symptoms for years. Research presented at the 2023 European Hematology Association Congress found that early treatment did not improve overall survival compared to observation in patients with early, asymptomatic CLL.

“I believe it’s fair to conclude that ‘watch-and-wait’ should remain the standard of care in the era of targeted drugs,” said researcher Dr. Petra Langerbeins when presenting the findings.

Low-Grade Endometrial Cancer

While surgery is typically the first treatment for endometrial cancer, doctors may recommend deferring surgery for patients with low-grade cancer who are elderly, frail, or have major health issues that make surgery high-risk. In some cases, hormone treatment may be used instead, particularly for “cancer that is lower-grade, low-volume and slow-growing,” according to the American Cancer Society.

Small Kidney Cancers

For kidney tumors measuring 3 centimeters or less, active surveillance may be appropriate, particularly for older patients or those with significant health complications. The American Urological Association confirms that monitoring is a valid option for small renal masses.

Data from the Delayed Intervention and Surveillance for Small Renal Masses Registry showed that patients under active surveillance had a 99% or greater cancer-specific survival rate—virtually identical to those who received immediate treatment.

Small Papillary Thyroid Cancers

Microcarcinomas—papillary thyroid tumors measuring 1 centimeter or less—may not require immediate intervention. Studies have shown that with 10 to 20 years of active surveillance, less than 10% of patients experienced significant tumor growth, only 5% developed lymph node spread, and there were no thyroid cancer deaths reported.

The American Thyroid Association now officially recommends active surveillance for very low-risk thyroid microcarcinomas.

While watchful waiting offers benefits for certain patients with low-risk tumors, experts emphasize that this approach isn’t suitable for all cancers or all patients. Cancer behavior varies widely, as do individual health factors, making personalized consultation with oncologists essential for determining the most appropriate course of care.