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Would it help if we came up with different names for some cancers—names that don’t include the word “cancer”?

In a commentary published online last week in JAMA, three physicians suggest giving it a try. The article, titled “Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement,” takes particular aim at cancer screening. It says:

Physicians, patients, and the general public must recognize that overdiagnosis is common and occurs more frequently with cancer screening.

To help reduce overdiagnosis and overtreatment of cancers that, if ignored, wouldn’t bother the patient, the authors propose, “Use of the term ‘cancer’ should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated.”

They suggest that ductal carcinoma in situ (commonly detected by mammography), high-grade prostatic intraepithelial neoplasia, and other “premalignant conditions … should not be labeled as cancers or neoplasia.” They also want to reclassify “indolent or low-risk lesions” as “indolent lesions of epithelial origin,” or IDLE. The idea is to prevent patients from freaking out at the word “cancer.”

Of course, before you reclassify indolent or low-risk lesions, you have to know exactly which lesions fit those categories—and, more crucially from the patient’s standpoint, which don’t. “Molecular diagnostic tools that identify indolent or low-risk lesions need to be adopted and validated,” the commentary says. Yes, absolutely. But so far, we don’t have such tools. And if you’re the patient, you don’t really care what your doctor calls the lesion; you just want to be sure it truly is indolent before you agree to a treatment course of “watchful waiting.”

There’s a real problem here, as the commentary points out: “National data demonstrate significant increases in early-stage disease, without a proportional decline in later-stage disease.” Screening has succeeded marvelously in its goal of “early detection,” but that hasn’t necessarily translated into successfully treating cancer before it progresses to later stages.

Laura J. Esserman, MD, director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco, is the commentary’s lead author. When she appeared last week on NPR’s Science Friday radio show, she put it this way:

The goal of all the early detection programs was simply to catch cancer early, and that would solve all the problems. And, unfortunately, it’s going to be a little bit more complicated.

Indeed. Will changing some of the terminology make it less complicated? Maybe, as long as you can be reasonably sure a disease-formerly-known-as-cancer, which you now call “IDLE,” really will stay idle. Otherwise, a proliferation of terms will probably just lead to a proliferation of confusion.

Related CME seminar (up to 24 AMA PRA Category 1 credits): Chicago International Breast Course and The Society for the Advancement of Women’s Imaging


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