Ethics in Medicine

What’s in a name? Time to rename “cancer?”

Kristen Sparrow • November 22, 2011

I was speaking to one of my Medical School classmates at my recent reunion about this very topic. (I went to Tulane Medical School and was speaking to Dr. Oliver Sartor, a specialist and expert in Prostate Cancer.) We were discussing this because his area of expertise is prostate cancer, and there have been such dramatic and controversial developments in that field discussed here and here. that part of the problem is the terminology. Some cancers are quite indolent, most prostate cancers are for example. It would help patients make treatment decisions if those more benign cancers were not described as cancer since that term is so loaded. Often once patients get that diagnosis their reaction is to “get rid of it.” But in the case of prostate cancer, the cure can be worse than the disease.

‘Cancer’ or ‘Weird Cells’: Which Sounds Deadlier?

My friend’s mother got terrifying news after she had a mammogram. She had Stage 0 breast cancer. Cancer. That dreadful word. Of course she had to have surgery to get it out of her breast, followed by hormonal therapy.

Or did she?

Though it is impossible to say whether the treatment was necessary in this case, one thing is growing increasingly clear to many researchers: The word “cancer” is out of date, and all too often it can be unnecessarily frightening.

“Cancer” is used, these experts say, for far too many conditions that are very different in their prognoses — from “Stage 0 breast cancer,” which may be harmless if left alone, to glioblastomas, brain tumors with a dismal prognosis no matter what treatment is tried...
Now, some medical experts have recommended getting rid of the word “cancer” altogether for certain conditions that may or may not be potentially fatal…
Many medical investigators now speak in terms of the probability that a tumor is deadly. And they talk of a newly recognized risk of cancer screening — overdiagnosis. Screening can find what are actually harmless, if abnormal-looking, clusters of cells.

But since it is not known for sure whether they will develop into fatal cancers, doctors tend to treat them with the same methods that they use to treat clearly invasive cancers. Screening is finding “cancers” that did not need to be found. So maybe “cancer” is not always the right word for them.
That happened recently with Stage 0 breast cancer, also known as ductal carcinoma in situ, or D.C.I.S. It is a small accumulation of abnormal-looking cells inside the milk ducts of the breast. There’s no lump, nothing to be felt. In fact, Stage 0 was almost never detected before the advent of mammography screening.
Now, with widespread screening, this particular diagnosis accounts for about 20 percent of all breast cancers. That is, if it actually is cancer.

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