5 reasons to stop calling low-risk cancers 'cancer'
What’s in a name? Plenty, according to a cancer expert who is arguing for a name change for indolent tumours, which have little chance of spreading but cause fear and apprehension in patients.
Dr Laura Esserman, director of the Carol Franc Buck Breast Care Center in San Francisco, pushes for the name change in a BMJ article, writing that patients are unnecessarily alarmed by the word 'cancer', which encompasses diseases with widely varying metastatic potential.
Many thyroid, prostate and breast cancers are ultra-low-risk lesions, yet it’s difficult to encourage a patient to watch and wait once they have been told they have cancer, she says.
“Overtreating people who are not at risk of death does not improve the lives of those at highest risk,” she writes.
“The refinement of the nomenclature for cancer is one of the most important steps we can take to improve the outcomes and quality of life of patients with cancer.”
Here are five other reasons Dr Esserman gives for a name change:
- A breast cancer diagnosis includes a range of conditions, from tumours with a high risk of early recurrence through to those with ultra low risk and survival at 10 years of 100%. “Clearly a condition that is indolent or rarely metastasises is not a cancer as clinically defined.”
- In the past, it was not possible to identify lesions with negligible risk. “Today, genomic tests inform our understanding of the risk and timing of recurrence, but we have yet to use them to change how we define cancer.”
- Through screening, incidence of ultra-low-risk prostate cancers are common. And as many as 35% of screen-detected breast cancers may also fall into the ultra-low category.
- One-quarter of all breast cancers are ductal carcinoma in situ (DCIS), up from 3% in 1985 before routine screening was introduced. Yet, DCIS is rarely, if ever, lethal. Low- and intermediate-grade DCIS could be reclassified as “indolent lesions of epithelial origin” (IDLE) without the word 'carcinoma'.
- With breast cancers, a change in nomenclature would affect what researchers investigate, allowing more focus on conditions that directly impact women’s health.
However, Dr Murali Varma of the University Hospital of Wales in Cardiff, UK, writing in the same opinion piece, says a name change is not needed as it will just create more confusion.
“Creating new entities risks confusion, so public education about the nature of cancer must be the priority,” he concludes.
More information: BMJ 2019.