Renaming harmless cancers makes sense
Areader recently asked me to explain what’s meant by overdiagnosis. I wasn’t surprised because it (and overtreatment) is the buzz word of the moment in medical circles.
For the avoidance of doubt here’s the definition of overdiagnosis. It’s the diagnosis of a condition that, if unrecognised, wouldn’t cause symptoms or harm a patient.
The controversy is so polarised in the medical profession that steps are being taken to combat the current tendency to overdiagnose, over investigate and overtreat.
One of them is renaming low-risk cancers that are unlikely to do harm if untreated. Just the label “cancer” can take a patient down a path of tests and treatments that are unnecessary and, in some instances, injurious. Plus, just using medicalised labels can lead to more invasive interventions.
Some cancers are non-growing or so slow growing that they will never cause harm to anyone if left undetected and untreated. In these cases, results in patients who receive immediate surgery are comparable to those patients who follow active surveillance only. So do we need to redefine or relabel these harmless cancers?
It would go a long way to avoiding painful biopsies, unnecessary surgery, nasty side effects of treatment and hopefully much anxiety and debility. We could make a start with two quite common conditions presently coming under the categorisation of cancer – ductal carcinoma in situ (DCIS) of the breast and localised prostate cancer.
Neither are aggressive and neither spread. Long-term outcomes for both conditions have been shown to be excellent. Active surveillance (wait and watch) is now being internationally trialled as an alternative approach to surgery. Active surveillance is already recognised as a safe and desirable option for localised prostate cancer and it could be for small lung cancers and certain small kidney cancers.
The cancer label has already been removed from tumours that are unlikely to cause harm. An early example was the World Health Organization and International Society of Urological Pathology’s joint decision to rename bladder tumours.
Similarly with cervical smear test results which came up with a new classification for a clearer and less anxiety-causing label.
I see this as a long-awaited new way of thinking about the diagnosis and treatment of cancer. Not all cancers are the same, just the opposite, so they shouldn’t be treated in the same way. We must start thinking about a more conservative and sensible approach.