Changing the Conversation about Cancer

Doctor-patient conversations about cancer

Few words cause as strong a reaction and carry as much weight as “cancer.” Given the prevalence of cancer—and how many deaths it causes—that’s not surprising. But as doctors and scientists have known for many years, the term “cancer” comprises an enormous range of conditions, not all of them fatal.

Unfortunately for patients, according to a panel of researchers convened by the National Cancer Institute in 2012, the shock of hearing the word “cancer” can lead to overdiagnosis and overtreatment. That panel—which included Geisel faculty members William Black, MD, a professor of radiology and of community and family medicine, and H. Gilbert Welch, MD, a professor of medicine and of community and family medicine—recently published a commentary in The Lancet Oncology recommending a change to the wording used by physicians when discussing certain conditions that are now referred to as cancer but that might better be described by another term.

Treatment is given for tens of thousands of precancerious lesions that, if left alone, would never be lethal.”

“When patients hear the word cancer, most assume they have a disease that will progress, metastasize, and cause death,” they wrote. “Many physicians think so as well, and act or advise their patients accordingly. However, since many tumors do not have the unrelenting capacity for progression and death, new guidance is needed to describe and label the heterogeneous diseases currently referred to as cancer.”

For lesions that are currently referred to as cancer but that are unlikely to cause harm, the authors suggest using the phrase “indolent lesion of epithelial origin,” or IDLE.

As an example of when the term might be used, the authors discuss a number of cancer types, including thyroid cancer. They note that the incidence of thyroid cancer rose from 4.9 cases per 100,000 people in 1975 to 14.3 per 100,000 in 2009, but the death rate remained virtually unchanged. That increase in detection has been due to the detection of very small papillary cancers, which are unlikely to progress enough to cause health problems. These growths can be detected by CT scans, and once detected, there is a strong likelihood of treatment. Using a term other than cancer to refer to these lesions might help both patients and physicians take a less aggressive approach. As they write, “The words used to describe a disorder substantially affect choice of intervention.”

The net effect of overly aggressive treatment, they argue is that “treatment is given for tens of thousands of precancerious lesions that, if left alone, would never be lethal. In addition to needless morbidity, these interventions cost billions of dollars.”

Find the abstract to the full commentary here.

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