Not Everything We Call Cancer Should Be Called Cancer
By Laura Esserman and Scott Eggener
Dr. Esserman is a surgeon and breast cancer oncologist at the University of California, San Francisco. Dr. Eggener is a surgeon and urologic oncologist at the University of Chicago.
“…..Let’s look at two examples. For prostate cancer, a biopsy showing a grade of Gleason 6 (also known as Grade Group 1) is considered low or very low risk. In breast cancer, diagnosis of ductal carcinoma in situ, or DCIS, is similarly low or very low risk, representing the very earliest, noninvasive stage of the disease.
These findings make up about 20 percent to 25 percent of all prostate and breast cancer diagnoses in the United States, involving about 100,000 people annually. These patients are routinely treated with surgery or radiation even though their conditions are not life threatening and cause no symptoms at the time they are spotted. To our knowledge, neither Gleason 6 nor DCIS spreads to other parts of the body unless more aggressive forms of cancer develop or are simultaneously present. They are more accurately explained as risk factors for prostate or breast cancers with malignant potential.”
Really? Thoughts?
Don
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Dont08759
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This is why guidelines generally advise active surveillance for men whose biopsy result was either all benign or "low volume" Gleason 3+3= Grade group 1. There is at least one study which found few, if any, pCa deaths for men whose prostatectomy pathology showed nothing worse than 3+3. Nevertheless, the question remains.....how frequently does 3+3 progress to 3+4 or higher Gleason grade? Even for 3+4 low volume, AS is often offered.
So, yes, understandable how some Docs might view 3+3 as "just" a risk factor, and not actually the metastatic potential we usually associate with the word cancer!
While a cancer diagnosis is a scary thing for anyone to absorb, I feel like you can soften it too much. On message boards like this, I sometimes see posts from people who would prefer to not undergo a treatment that will save or at least prolong life. They seem to be in denial and able to minimize the situation for themselves (without the help of doctors). Of course, I’d prefer to not do radiation or have a RALP or generally have cancer, but I have things I want to do and people to take care, so I’m going to do whatever I can to live. I’m going to learn as much as I can and be proactive about treatment.
The bell shape curve drives a lot of life. 3+3 and 3+4 may be statistically low risk but what if you are in that left hand shoulder which there are patient's who always are. I used to tell residents that a large part of training was for recognizing that rare zebra when it occurred. From this forum alone you realize how many people have had progression despite the 3+3 or 3+4 initial diagnosis. This disease is not a single entity and starts with complex varied genetics. You need to respect that from the get go and be vigilant.
Dermatologists are not hesitant to call conditions like squamous cell carcinoma cancer, though it is easily dealt with, so why mince words when cancer is clearly present? Be clear about what needs to follow, but I'd prefer to see people being given a clear idea about what they are dealing with. And not every G6 is "harmless".
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