Doctors debate whether to stop calling low-risk tumors 'cancer'

By Tamara Mathias (Reuters Health) - Certain tumors labeled as "cancer" aren't life-threatening and should be called something else instead, some doctors believe. When patients receive a cancer diagnosis, they naturally become anxious. But with modern medicine, some tumors have become so treatable and so low-risk that unnecessary anxiety could be avoided if the medical community stopped referring to them as "cancer," says cancer surgeon Dr. Laura Esserman of the University of California, San Francisco. Writing in The BMJ, Esserman argues that given how widely tumors vary, both in form and severity, it is ethically unsound to frighten patients by telling them they have cancer when in fact they don't have a risky prognosis. But Dr. Murali Varma of the University Hospital of Wales, Cardiff, writing in the same issue of The BMJ in a counterpoint to Esserman, argues that renaming certain cancers is likely to be confusing and proposes education as a better way forward. "I am not against renaming cancers per se, but this has to be done very judiciously," said Varma, who specializes in making cancer diagnoses based on biopsied tissue samples. Clinically, the term "cancer" describes a disease that, if untreated, will grow relentlessly and spread to other organs, killing the patient - a definition Esserman says clearly does not apply in all cases. Many thyroid, prostate, skin and breast cancers, for example, are considered "ultralow" risk and are unlikely to be life-threatening. Patients who are needlessly worried about a cancer diagnosis might spend more on unnecessarily invasive tests and treatment that could be harmful, adds Esserman, who works at San Francisco's Carol Franc Buck Breast Care Center. About 20 percent of all new breast cancer cases are ductal carcinoma in situ (DCIS), a cluster of abnormal cells that has not invaded nearby tissues, and is rarely, if ever, fatal. Most women with low-risk DCIS "will live long and productive lives," Esserman said. "If DCIS itself is not life-threatening, then don't use a name that suggests that it is, and don't treat it the way you treat cancer." Varma, however, points out that even if low-risk tumors are renamed, there might continue to be unintended consequences if the new terminology is still unclear to patients. For example, he said, there is a current tendency to rename some low-risk tumors as "tumors of uncertain malignant potential." "Many laymen would interpret this to mean that the doctor is uncertain whether their tumor is harmless or lethal," he noted. The phrasing, however, is generally intended to reflect uncertainty about whether the tumor is benign or low risk. "Working out how to tell slow-growing cancers apart from more aggressive forms of the disease is a critical area of research, and something Cancer Research UK-funded researchers are investigating," Martin Ledwick, the organization's head information nurse, said in an email. "Research will help us understand the best approach to 'renaming' low-risk forms of cancer and how this would affect conversations between doctors and patients, and the decisions they make." SOURCE: The BMJ, online January 23, 2019.

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