A group of experts advising the nation’s premier cancer-research institution has recommended changing the very definition of cancer and eliminating the word entirely from some common diagnoses as part of sweeping changes in the nation’s approach to cancer detection and treatment.
The recommendations, from a working group of the National Cancer Institute, were published last week in the Journal of the American Medical Association.
In one example, they say that some premalignant conditions, such as one that affects the breast called ductal carcinoma in situ – which many doctors agree is not cancer – should be renamed to exclude the word carcinoma. That way, patients are less frightened and less likely to seek what might be unneeded and potentially harmful treatments that can include the surgical removal of the breast.
The group, which includes some of the top scientists in cancer research, also suggested that many lesions detected during breast, prostate, thyroid, lung and other cancer screenings should not be called cancer at all but should instead be reclassified as IDLE conditions, which stands for “indolent lesions of epithelial origin.”
While it is clear that some or all of the changes might not happen for years, and that some cancer experts will profoundly disagree, the report from such a prominent group of scientists with the clear backing of the National Cancer Institute brings the discussion to a much higher level and will most likely change the national conversation about cancer, its definition, its treatment and future research.
“We need a 21st-century definition of cancer instead of a 19th-century definition of cancer, which is what we’ve been using,” said Dr. Otis W. Brawley, chief medical officer for the American Cancer Society, who was not directly involved in the report.
The impetus behind the call for change is a growing concern among doctors, scientists and patient advocates that hundreds of thousands of men and women are undergoing needless and sometimes disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm.
“We’re still having trouble convincing people that the things that get found as a consequence of mammography and PSA testing and other screening devices are not always malignancies in the classical sense that will kill you,” said Dr. Harold Varmus, the director of the National Cancer Institute. “
Just as the general public is catching up to this idea, there are scientists who are catching up, too.”
