Experts call for redefinition of 'cancer' - WXOW News 19 La Crosse, WI – News, Weather and Sports |

Experts call for redefinition of 'cancer'

Posted:
  • HealthMore>>

  • Group says world is losing battle against Ebola

    Group says world is losing battle against Ebola

    Tuesday, September 2 2014 10:24 PM EDT2014-09-03 02:24:10 GMT
    The U.N. is warning that food prices are rising in countries hit by Ebola and that it'll get worse because many farmers won't be able to access fields during the upcoming harvests of rice and corn.More >>
    The international group Doctors Without Borders warned Tuesday that the world is losing the battle against Ebola and lamented that treatment centers in West Africa have been "reduced to places where people go to die alone."More >>
  • Preschools latest to take on green movement

    Preschools latest to take on green movement

    Tuesday, September 2 2014 6:21 PM EDT2014-09-02 22:21:33 GMT
    A new Oklahoma City preschool is staying away from plastic toys, serving only vegan and gluten-free food, and focusing on teaching children early about living a healthy lifestyle.More >>
    Three-year-old Clara Centola seems unconcerned by the adults around her as she works at a mini-kitchen, deciding which cloth-toy fruits and vegetables to serve her imaginary guests. There are no plastic fast-food replicas...More >>
  • Ill UK boy's parents freed from custody in Spain

    Ill UK boy's parents freed from custody in Spain

    Tuesday, September 2 2014 5:24 PM EDT2014-09-02 21:24:05 GMT
    U.K. Deputy Prime Minister Nick Clegg says it is inappropriate to throw the full weight of the law at a family who spirited their ill 5-year-old child out of the country in order for him to receive a revolutionary...More >>
    The British parents who took their critically ill child for treatment abroad without doctors' consent were released from custody in Spain on Tuesday after authorities in the United Kingdom dropped charges of child...More >>

TUESDAY, July 30 (HealthDay News) -- A panel of experts commissioned by the U.S. National Cancer Institute says that the word "cancer" may need to be redefined to prevent overdiagnosis and overtreatment of conditions that are often not lethal.

Writing in the July 29 online edition of the Journal of the American Medical Association, the experts say that widespread cancer screening programs turn up too many growths that would not progress to a lethal stage and are considered "indolent."

Most patients do not understand that distinction, however, and "the word 'cancer' often invokes the specter of an inexorably lethal process," wrote Drs. Laura Esserman of the University of California, San Francisco, Dr. Ian Thompson Jr. of the University of Texas Health Science Center at San Antonio, and Dr. Brian Reid of the Fred Hutchinson Cancer Research Institute in Seattle.

Cancer can take "multiple pathways," the three say, "not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient's lifetime."

This re-examination of what constitutes a cancer diagnosis has been spurred by the explosion over the past few decades of sophisticated screening measures such as the mammogram, colonoscopy and the PSA blood test (for prostate cancer). All were heralded as potentially lifesaving, and many predicted that widespread adoption of these tests would catch disease early and cause cancer rates to fall.

But the cancer screening story has turned out differently, the panel noted, because many of the lesions picked up on screening have turned out to be indolent.

"Screening for breast cancer and prostate cancer appears to detect more cancers that are potentially clinically insignificant," the experts said. The same might be said for screens for thyroid cancers and melanomas -- certainly, lives have been saved because tumors were detected and treated, but "the detection of indolent disease" has risen, too, the panelists wrote.

Issues like this have played out in recent years. The United States Preventive Services Task Force, an influential government panel, caused a furor in 2009 when it called for the abandonment of regular mammography screening for women under 50, reasoning that the benefits of screening for younger women were outweighed by the risks. The same panel also rejected the widespread use of the PSA test, noting that it too often picked up slow-growing lesions that might never harm men's health.

According to the experts writing in JAMA, the best-case scenario for cancer screening is when the tumor is slow-growing but also typically progressive. Colon cancer often acts in this way, the team noted, and colonoscopy has become an "effective" screening program.

In the meantime, however, "overdiagnosis" occurs. The experts say a redefinition of cancer may be needed to quell patient fears over indolent lesions and curb overdiagnosis and overtreatment.

"Use of the term 'cancer' should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated," they wrote. Other growths would be classified in a lesser category, "indolent lesions of epithelial origin" (IDLE).

A change in mindset may also be needed for patients and health care workers alike. "Physicians, patents and the general public must recognize that overdiagnosis is common and occurs more frequently with cancer screening," the team wrote.

The recommendations are sure to spur debate, but one outside expert said that debate may be what is needed on this issue.

"We're still having trouble convincing people that the things that get found as a consequence of mammography and PSA testing and other screening devices are not always malignancies in the classical sense that will kill you," Dr. Harold Varmus, director of the National Cancer Institute, told The New York Times. "Just as the general public is catching up to this idea, there are scientists who are catching up, too."

But not everyone agrees. Dr. Larry Norton is medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center in New York City. He said the problem is that even some relatively indolent breast growths, such as ductal carcinoma in situ (DCIS), can go on to become progressive, lethal cancers.

"Which cases of DCIS will turn into an aggressive cancer and which ones won't?" he told the Times. "I wish we knew that. We don't have very accurate ways of looking at tissue and looking at tumors under the microscope and knowing with great certainty that it is a slow-growing cancer."

More information

There's more on cancer detection and diagnosis at the U.S. National Cancer Institute.

Powered by WorldNow
All content © Copyright 2000 - 2014 WorldNow and WXOW. All Rights Reserved.
For more information on this site, please read our Privacy Policy, Terms of Service and Mobile Privacy Policy & Terms of Service.

Persons with disabilities who need assistance with issues relating to the content of this station's public inspection file should contact Administrative Assistant Theresa Wopat at 507-895-9969. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, at 888-835-5322 (TTY) or at fccinfo@fcc.gov.