Thursday, November 27, 2014
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Cancer by any other name...Is it still deadly?

Cancer screening isn't working. That's what a study panel from the National Cancer Institute concluded in a new article published recently in The Journal of the American Medical Association.

Cancer by any other name...Is it still deadly?

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Cancer screening isn’t working. That’s what a study panel from the National Cancer Institute concluded in a new article published recently in The Journal of the American Medical Association.

Cancer kills thousands of people in the United States each year. A total of 580,350 cancer deaths are projected to occur in the United States in 2013.  That comes to about 1,600 people per day.       

Early detection resulting from some cancer screening tests (like mammography) has dramatically increased public awareness of the disease. However, screening has also increased findings of “incidentalomas”. That is the name given to incidental findings of cancer-like conditions detected during screening that are unlikely to cause harm.

What early screening hasn’t done is decrease the cancer death rate, according to the panel. The sharp increase in diagnosis of early-stage cancers has not resulted in a corresponding decline in death rates or in diagnosis of late-stage disease.

Instead, the early screening has resulted in what many in the medical community are calling “overdiagnoses” and then “overtreatment”.  Patients are lining up for sometimes harmful and unnecessary treatments for lesions that are not likely to ever cause harm.

According to the panel, the problem lies in the way cancer is defined. The short definition is that “cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it can result in death.”

Clearly, “death” is the word that has caused widespread fear and anxiety associated with findings of cancer. What doctors are increasingly discovering is that every cancer does not lead to death. In fact, every finding that seems to be cancer often isn’t - at least not in the way we have come to view it.

Some cancer is fast-growing and aggressive. Some grows slowly but progressively. Then there are the “indolent” ones, slow-growing and nonaggressive. They show up on cancer screens but are likely never to cause the patient harm.

The large amount of indolent detection, coupled with the overaggressive and sometimes harmful overtreatment of these lesions led the panel to advocate for overhauling the way cancer is classified and treated.

The panel called for dropping the word “cancer” from pre-cancerous conditions. It specifically mentioned two conditions in this regard: prostatic intraephithelial neoplasia, currently classified as a kind of prostate cancer, and D.C.I.S. — ductal carcinoma in situ — currently classified as a kind of breast cancer.

The shift in thinking would restrict use of the word “cancer” to tumors with a “reasonable likelihood of lethal progression if left untreated.” In other words, clinicians should refer to cancer only when speaking about the kinds of tumors that can kill you.

Not everyone agrees. Dr. Larry Norton, the medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center, is not comfortable with this change in word use. He says that changing the name doesn’t solve anything. He argues that the issue is that doctors cannot tell patients which cancers will kill them and which ones will not. 

This dispute comes on the heels of a U.S. Preventive Services Task Force recommendation endorsing the use of low-dose CT scans to detect lung cancer in high-risk individuals.  The panel’s idea is similar - aim attention at those who are most likely to develop a deadly form of the disease, not at those who shouldn’t be concerned.

Whether your doctor uses the word “cancer” or “premalignant lesion”, the wording matters. As a patient, it is important to pay attention to the terms your doctor uses. You should also ask a lot of questions about anything you don’t understand. Make sure that you and your doctor are speaking the same language.


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About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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