Doctors should avoid saying 'cancer' for minor lesions – study


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.

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.

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.”



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