Doctors should avoid saying ‘cancer’ for minor lesions – study

[helvella]

The Guardian has posted an article on use of the word "cancer" - and specifically questions use of the term for some thyroid cancers.

I'd very much appreciate you replying with your opinions.

Would you prefer the word cancer to be used - and then be given a proper explanation? Or some term such as "pre-cancer"? Any particular terms that you would find more acceptable?

You might also consider hopping over to the Guardian and leaving a comment there. Probably more likely to be read by those who are involved than replies here. (Comments are usually only open for a number of hours or days. So go quickly if you intend leaving comments. )

Doctors should avoid saying ‘cancer’ for minor lesions – study

Researchers say patients are scared into invasive treatments for conditions unlikely to do harm

Medical technology is now so advanced that early abnormal cell changes and lesions, sometimes described as “pre-cancers”, can be detected at much smaller sizes than could never have been found clinically. However, for some types of cancers, these early changes or lesions will never go on to cause harm in the patient’s lifetime. But identifying these changes can cause distress and prompt patients to undergo treatment to get rid of them.

“The use of more medicalised labels can increase both concern about illness and desire for more invasive treatment,” the analysis said.

“For decades cancer has been associated with death. This association has been ingrained in society with public health messaging that cancer screening saves lives. This promotion has been used with the best of intentions, but in part deployed to induce feelings of fear and vulnerability in the population and then offer hope through screening.

“Although the label needs to be biologically accurate, it also needs to be something patients can understand and that will not induce disproportionate concern.”

The analysis was led by Brooke Nickel from the University of Sydney. Researchers from Bond University in Queensland and the Mayo Clinic in the US also contributed.

A prime example of the negative impact of using the word cancer was seen in low risk papillary thyroid cancer, Nickel said.

“Studies show that progression to clinical disease and tumour growth in patients with small papillary thyroid cancer who choose surgery are comparable to those who monitor their condition,” she said.

Similarly, in localised prostate cancer where active surveillance has been a recommended management option for many years, studies show that internationally most men still prefer radical prostatectomy or radiation therapy.

“While active surveillance is increasingly being recognised as a safe management option for some patients with cancer, there is still a strong belief that aggressive treatments are always needed,” a co-author of the study, Prof Kirsten McCaffery, said.

Cancer Council Australia’s CEO, Prof Sanchia Aranda, said the cancer label had already been removed from other tumours that evidence had clearly shown to be largely harmless. Alternative labelling of cervical abnormalities detected during a pap smear had led more women to follow active surveillance in preference to invasive treatments.

“We would support the authors’ call for a global round table to agree on the literature, and what the best term for some of these conditions should be,” Aranda said.

The word “cancer” should be dropped from some medical diagnoses because the term can scare people into invasive treatments they do not need, Australian and US researchers say.

An analysis published by the British Medical Journal on Monday described “cancer” as particularly problematic when used to describe some thyroid cancers less than 1cm in size, some low and intermediate grade breast cancers, and localised prostate cancer.

Aranda agreed that low and intermediate grade breast cancers, called ductal carcinoma in situ (DCIS), were “one of the biggest problems” when it came to over-treatment and over-diagnosis.

“It was assumed when these lesions were first able to be diagnosed that they would all become invasive cancers,” Aranda said.

“It’s becoming clearer that they won’t. For every woman helped with prevention with a DCIS removal, more women will have had unnecessary surgery.

“Mammography is detecting smaller and smaller lesions, which has outstripped our ability to know what they will become and what to do with them.”

theguardian.com/society/201...

[silverfox7]

Difficult to say what I'm thinking and put it across! To start off then I've been treated for cancer but at the same time I was told what had been detected I was also told what would happen next and as cancer problems go it was treatable and I hope the passage of time shows this. But I found the article a bit like having a foot in two areas. I feel you can't compare the past with what is happening for the future. So we shouldn't be dwelling on the fear there used to be when describing present day treatment. We should be saying that for many cancers treatment is continually being modified as lesions are found earlier through advanced techniques and many have a postitive outcome because of this. We still need potential patients to be cancer aware and get early advice and treatment and promote early diagnosis.

[Hidden]

I suppose language has to change as research advances. I think every patient should be given full details of every medical condition diagnosed and the language used in their medical notes explained.

[LAHs]

Well in my humble opinion if a lesion is cancerous the doc should say something like, "You appear to have a cancerous lesion, it is not known how aggressive this is, it might take 50 years to become a problem or it might take 1 year, we will test again in 3 months, then again in 6 months to measure it's rate of growth if it's growing at all. We will then take appropriate action if needed, in the mean time don't worry about it".

Since thinking about medical terms I always had a problem with the word "lesion". Before this, I first and lastly encountered the word on geology field trips. When the professor pointed out a small lesion in a rock it was usually a small crack! I was therefore mystified by it's use in biology where it means: a morbid change in the functioning or texture of an organ.

But call a spade a spade I think, just qualify it with reasonableness, after all, aren't skin tags, dark spots, or moles "slightly cancerous"? We don't get all bent out of shape over those.

[helvella Administrator Thyroid UK in reply to LAHs]

We see part of the problem with the word "tumour" - often quickly followed by "a BENIGN tumour" - in many parts of the body. Springing to mind is the non-cancerous tumour behind much hyperparathyroidism.