The Mighty National Cancer Institute Is Looking To Make Some Changes…
By Nurse Mark
The medical news has been full of it recently:
- Mammography Screening Linked to Overdiagnosis of Cancer
- Prostate Cancer Overdiagnosis in the United States: The Dimensions Revealed
- Low-Risk Thyroid Cancer Overdiagnosed, Overtreated
- “Rethink” of Cancer Screening Triggers Comments and Controversy
Articles such as these cross our desk on a daily basis, making us wonder whether the conventional medical world has finally discovered that not every lump or bump has to be cancer and aggressively fought, or could it be that higher powers – the insurance industry, the government – have realized that they are in danger of foundering under the expense of all this diagnosis and treatment.
The Fear Factor
There’s no doubt that cancer is a terrifying word. It conjures up visions of debilitating illness, disfiguring surgery, toxic chemotherapy treatments, agonizing side effects from radiation therapy, and ultimately a painful and undignified death after which the grieving family will be left financially ruined.
So it’s good that the NCI has recognized that not every lump and bump, and not every “unusual” spot or shadow on a high-tech scan or mammography must be called “cancer.” Many of these things are just innocent lumps and bumps and spots. And many of them, if left alone (as they would be if we didn’t know they were there) would either quietly go away on their own, or remain unchanged for years, or maybe even grow and become annoying enough that we might then choose to do something about them.
With this in mind, the NCI has proposed that doctors be a little more cautious about how they describe these things to their patients.
From a paper titled “Overdiagnosis and Overtreatment in Cancer – An Opportunity for Improvement“
The practice of oncology in the United States is in need of a host of reforms and initiatives to mitigate the problem of overdiagnosis and overtreatment of cancer, according to a working group sanctioned by the National Cancer Institute.
Perhaps most dramatically, the group says that a number of premalignant conditions, including ductal carcinoma in situ and high-grade prostatic intraepithelial neoplasia, should no longer be called “cancer.”
Instead, the conditions should be labeled something more appropriate, such as indolent lesions of epithelial origin (IDLE), the working group suggests. The Viewpoint report was published online July 29 in JAMA.
“Use of the term ‘cancer’ should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated,”
A Name Change
So, what were once give the frightening diagnosis of “cancer” are now to be called “indolent lesions.”
Indolent is from the Latin (a language your doctor might know a few words of…) In – meaning not, and Dolens – meaning pain. Indolent in this case means painless. Other definitions include “lazy,” and “slow-growing.” Lesion is defined as a localized change in a bodily organ or tissue from a wound or injury or other pathological process. A cut is a form of lesion, as is the scar that forms when it heals. A pimple is a lesion, as is a skin cancer. In other words, any lump or bump or sore can be described as a “lesion.”
Does this mean that we should now just ignore lumps and bumps and sore spots? Of course not!
What it does mean is that our doctors will hopefully now take a little more care with how they discuss these things with their patients.
Breast Cancer? Or Just a lump?
Instead of finding that little lump in a breast and striking terror into the heart of a woman with the diagnosis of “Ductal Carcinoma (cancer) In Situ” perhaps the more enlightened doctor will now say something like “Hmmm… a little lump there – perhaps an indolent lesion – let’s leave it alone and see how it is when you come back next year!”
Scandinavian countries have been taking this approach for years and have found that most of these lumps just go away on their own and never cause a problem. Those that don’t are then easily identified and treated, and thousands of women are spared unnecessary fear, diagnostic workups, and toxic treatment, disfiguring surgery and debilitating radiation therapies.
Men can likewise be spared from the ravages of medical overtreatment that comes with a diagnosis of “prostatic intraepithelial neoplasia” (neoplasm is another word to describe “cancer”). It is well-known that most men, by the time they reach their seventies, could be found to have small cancers – if one looks hard enough. Autopsy after autopsy performed on men who have died from something else (including “old age”) reveal cancers that no-one – not the man nor his doctor – ever knew about or even suspected.
Sure, We’re Finding More…
The statistics make it very clear that over the past 3 decades or so with the explosion of scans, and diagnostics and our “war on cancer” the discovery rate for all these so-called “cancers” has increased greatly – but the death rate from them has remained fairly constant – despite all the treatments being inflicted upon those unfortunate enough to be so diagnosed.
Maybe finding and aggressively “treating” all those little lumps and bumps – now to be called “indolent lesions” – really hasn’t been doing much more than tormenting the poor, terrified patients and sucking the financial life out of the medical system.
Maybe the National Cancer Institute is right – maybe it’s time for a change.
Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement
JAMA. 2013;310(8):797-798. http://jama.jamanetwork.com/article.aspx?articleid=1722196
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