Laura Esserman and Scott Eggener, Not Everything We Call Cancer Should Be Called Cancer, NYTimes, Aug. 30, 2023:
Some cancers have extraordinarily low risks of altering the quality or length of life but get lumped in with those that do. And that often leads to unnecessary treatment, disfigurement, side effects and a constellation of other psychological, relationship and financial issues.
We are oncologists with expertise in prostate and breast cancers. We believe the medical community must reconsider what we call cancer in its earliest manifestations. So do a growing number of cancer experts around the world.
The word “cancer” is attributed to Hippocrates 2,500 years ago, though the disease was described by the Egyptians 2,500 years earlier. Then tumors could be seen or felt. Today, we also identify cancer based on blood samples, biopsies or surgically removed specimens meeting specific criteria under the microscope. But as newer and more sensitive technologies come into use, we are increasingly identifying medical conditions that might have gone undetected without any issues. This phenomenon of overdiagnosis is a well-documented consequence of screenings for breast and prostate cancer.
Early detection of cancer sounds intuitively attractive and in many cases saves lives. But automatically calling something cancer can lead to aggressive treatment, even if the cancer in question is unlikely to cause problems. For many cancers, the term simply doesn’t match how the disease behaves. As cancer surgeons, knowing what we now know, we wish we could go back and undiagnose or reclassify a significant proportion of our patients.
After giving examples from prostate and breast cancers, the authors observe:
Renaming very low-risk cancers would make it easier to persuade patients when it’s appropriate to adopt monitoring and risk reduction as their approaches. Early-stage “cancers” that meet the microscopic definition of the disease (what a pathologist sees through the microscope) but not the clinical definition (a condition that is highly likely to grow and cause symptoms and has the potential to kill a person) could be designated as IDLE (indolent lesion of epithelial origin) or preneoplasia — anything but the dreaded C-word.
They go on to note at the very end:
Changing the label would make matters considerably less stressful for patients and their families. It would greatly reduce unnecessary treatment. The financial and psychological benefits for patients would be profound. Screening for life-threatening cancers would improve.
Some doctors who disagree with us argue that early-stage cancer patients may have regions of their prostate or breast with unsampled, riskier cancers that may pose a threat and should be treated accordingly. But it should not be routine, as it is now, to treat based on what might have been missed. We have many tools at our disposal to accurately diagnose patients. We should use them.
By modifying the names of early-stage prostate and breast “cancer” to appropriately reflect how they behave, we’d reduce unnecessary treatments and their side effects and improve screening, prevention and care.
I note that I have a minor interest in this subject – above and beyond that fact that I am 75 and that my father died of complications from cancer surgery – because enormous sums have been poured into cancer research without commensurate clinical benefits. Are we missing some very basic knowledge?
* * * * *
2... Which inspires me to repost my vicious critique of the cancer industry: https://t.co/cMIbWzNVOH
— John Horgan (@Horganism) September 3, 2023
No comments:
Post a Comment