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The term ‘cancer’ should be dropped for some low-grade lesions

The word 'cancer' scares some patients into invasive treatments for conditions unlikely to do harm, doctors argue

Ingrid Torjesen

Monday, 13 August 2018

The word “cancer” should be dropped from some medical diagnoses because for decades the term has been associated with death and it can scare people into having invasive treatments they do not need, an analysis* published in The BMJ argues.

The analysis written by Australian and US researchers points out that some low and intermediate-grade breast cancers, small thyroid cancers and localised prostate cancer would be better monitored than treated aggressively with treatments that could do patients harm.

In recent years medical technology has advanced to a stage where early abnormal cell changes and very small lesions, sometimes described as “pre-cancers”, which could never have been found clinically and many will never go on to cause harm in the patient’s lifetime.

“The use of more medicalised labels can increase both concern about illness and desire for more invasive treatment,” the analysis says.

“For decades cancer has been associated with death. This association has been ingrained in society with public health messaging that cancer screening saves lives. This promotion has been used with the best of intentions, but in part deployed to induce feelings of fear and vulnerability in the population and then offer hope through screening.”

A prime example is low risk papillary thyroid cancer, they say.

“These small papillary thyroid cancers are increasingly being detected because of new technologies, increased access to health services, and thyroid cancer screening. Studies show that rates of metastases, progression to clinical disease, and tumour growth in patients with small papillary thyroid cancer who receive immediate surgery are comparable with those in patients who follow active surveillance.”

Low risk ductal carcinoma in situ and localised prostate cancer are also examples, they add.

“Detection strategies have become controversial as long-term outcomes for both conditions have been shown to be excellent and there is evidence and concern about overdiagnosis and overtreatment.”

Various names have been proposed to help convey the favourable prognosis of low risk lesions, they say, including indolent lesions of low malignant potential, abnormal cells, and microtumour.

“Although the label needs to be biologically accurate, it also needs to be something patients can understand and that will not induce disproportionate concern.”

*Nickel B, Moynihan R, Barratt A, et al. Renaming low risk conditions labelled as cancer BMJ 2018; 362: k3322

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