TIME TO RETHINK THE ‘C’ WORD? CALL FOR LOW-RISK CANCERS TO BE RENAMED
▶ Researchers say terminology leading to over-reaction and over-treatment of conditions has to be changed
A new study has called for the “cancer label” to be removed from low-risk forms of the disease to prevent panicking patients from opting for unnecessarily invasive treatments.
Despite the advancements that have been made in the fight against cancer, the mere use of the word in a diagnosis can lead many patients to opt for more aggressive treatment of their condition than they might need.
Cancer remains one of the biggest causes of death in the world, but there are many lowrisk forms of the disease.
Researchers from Australia’s University of Sydney and Bond University in Queensland, and the Mayo Clinic in the US have called for the term “cancer” to be removed from the description of some thyroid tumours that are less than one centimetre, some low and intermediate grade breast cancers and localised prostate cancer.
In an analysis led by public health researcher Brooke Nickel, from the University of Sydney, which was published in the British Medical Journal yesterday, it is argued that redesignation may help to reduce over-treatment.
“For decades, cancer has been associated with death,” the study says. “This association has been ingrained in society, with public health messages that cancer screening saves lives. This promotion has been used with the best of intentions, but in part to induce feelings of fear and vulnerability in the population and then offer hope through screening.”
The study found there is mounting evidence that “disease labels affect people’s psychological responses and their decisions about management options”.
“The use of more medicalised labels can increase both concern about illness and desire for more invasive treatment,” it says.
Some tumours, such as lowrisk papillary thyroid cancer, are non-growing or so slow-growing that they would not cause harm if undetected. It is a similar story for prostate cancer, where there is evidence and concern about over-diagnosis and over-treatment.
“There is some evidence and informed speculation that melanoma, small lung cancers and certain small kidney cancers may be considered low risk and subject to similar over-diagnosis and over-treatment.”
The study says there is a “strong perception” that aggressive treatments are always required to tackle cancer, when more conservative approaches may be more suitable.
Removing the cancer label, and the fear it can spread, is a strategy for managing the care of patients who are suffering from low-risk forms of the disease.
Many diseases formerly designated as cancers have been relabelled over the past 20 years, including bladder tumours that are now known as papillary urothelial neoplasia of low malignant potential.
The study calls for World Health Organisation classification bodies, government health agencies, cancer groups and public and patients representatives to come together to discuss the issue.
Researchers also urge clinicians to initiate discussions about the probably benign nature of low-risk conditions, the possibility of over-diagnosis and over-treatment, and look into the options of less invasive management of diseases, such as active surveillance, before and after diagnostic intervention.
“New medical education curriculums can help students and clinicians gain a deeper understanding of over-diagnosis and strategies to communicate about low-risk conditions,” the study says.
“Removing cancer from a condition’s label may lead patients to reconsider the nature and extent of follow-up and question the need for additional treatments, potentially reducing over-treatment and any associated harmful psychological effects.”