Expert Group: New Cancer Definition Would Reduce Overdiagnosis

By Lisa Collier Cool Jul 29, 2013 154 Recommend

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In an effort to curb widespread overtreatment of cancers that are not lifethreatening, an expert group recommends a revolutionary new approach to diagnosis, including a narrower definition of the disease itself. In fact, some common disorders would no longer be called cancer at all. The new recommendations, developed by a working group of the National Cancer Institute, were published in a research paper in the Journal of the American Medical Association. The expert group reports that the fear factor associated with the word cancer contributes to excessive or even needless treatment because it often invokes the specter of an inexorably lethal process. In reality, the experts argue, cancers can follow multiple paths, not all of which progress to metastasis and death, and include indolent disease that causes no harm during the patients lifetime. Better biology alone can explain better outcomes. The Best Diet for Cancer Prevention

Cancer Screening Linked to Overtreatment

Although early diagnoses of cancer has skyrocketed during the past 30 years, theres been no corresponding drop in late-stage disease, according to the paper. In other words, screening and earlier treatment arent necessarily saving lives. Overdiagnosis and overtreatment are particularly common with cancers of the breast, prostate, lung, and thyroid and rise with increased screening for these diseases, reports study coauthor Ian M. Thompson, Jr., MD, director of the Cancer Therapy and Research Center at University of Texas Health Sciences Center at San Antonio.

Traditionally the thinking was, Lets do our best to find as many premalignant lesions as possible and treat them so people dont get cancer, says Dr. Thompson. But doctors arent very good at sitting back and informing patients in a balanced way about the options, which include active surveillance of low-risk tumors.

Same Word Used for Harmless and Highly Lethal Tumors

Patients and their families often panic as soon as the word cancer is mentioned, Dr. Thompson notes. In a lifetime, 60 to 70 percent of men will develop prostate cancer, but less than 3 percent of them will die from it. Yet were forced to use the same word for highly lethal prostate tumors and slowgrowing, pre-malignant tumors that will never cause harm. As a result, he adds, even when you explain to a man that he has a very low-risk tumor and could safely be monitored with periodic biopsies, instead of aggressive treatment, when he goes home and tells his family, the usual reaction is, Are you telling us that you have cancer and your doctor isnt doing anything about it? Crucial Cancer Precautions: Take Steps Toward Prevention

Change How Doctors and Patients Think About Cancer

The expert group recommends that the words cancer, and such medical synonyms as carcinoma or neoplasia shouldnt be used for such conditions as these: Ductal carcinoma in situ: abnormal cells in the milk ducts of the breast that are often described as the earliest form of breast cancer. High-grade prostatic intraepithelial neoplasia: abnormal cells in the prostate that are considered the most likely precursor to prostate cancer. The idea behind changing the nomenclature is that the name of a disease influences how doctors and patients think about it, says Paolo Boffetta, MD,

Director of the Institute for Translational Epidemiology and Professor of Medicine, Hematology and Medical Oncology at the Mount Sinai Medical Center. When a woman hears that she has ductal carcinoma in situ, the name implie s that this is a type of breast cancer, adds David Fishman, MD, professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai. Although physicians understand that carcinoma in situ is not cancer, patients hear carcinoma and think they need treatment, such as a mastectomy or radiation, to avoid life-threatening disease, Dr. Fishman notes. To avoid such anxiety-inducing misconceptions, the expert group recommends slow-growing or low-risk tumors be reclassified as IDLE, which stands for indolent lesions of epithelial origin.

Cancer Diagnosis Still Stuck in 19th Century

Additionally, the expert group advises several steps to transform cancer diagnosis. Currently, pathologists decide if something is cancer by using a 19thcentury technology: looking at cells under a microscope, says Dr. Fishman. The paper recommends convening a multidisciplinary effort across the pathology, imaging, surgical, advocate, and medical communities to more accurately classify tumors now called cancer and create medical criteria for IDLE conditions. One method to achieve this goal is using the molecular characteristics of abnormal cells, such as their genes and proteins, to create a new taxonomy of disease, says Dr. Fishman. This technology will allow us to tell the difference between sheep wearing wolves clothing and the real wolves. This cutting-edge technology is already used in breast cancer diagnosis. The new molecular tests are an exploding field that will transform cancer diagnosis over the next five years, adds Dr. Fishman. Ultimately, this could help patients avoid the risks and complications of unnecessary treatment, while enabling those with dangerous tumors to benefit from the best available therapies for their disease.