by
Carol Ko, Staff Writer | September 09, 2013
From the September 2013 issue of HealthCare Business News magazine
July was a big month for cancer detection. A working group of experts at the National Cancer Institute called for changing the definition of cancer to exclude certain common forms of the disease that are unlikely to cause harm.
This bold recommendation, if widely adopted, would drastically change the way cancers are detected, screened and diagnosed. Most significantly, it would rein in overdiagnosis and overtreatment in national screening programs such as mammography — a phenomenon which a growing consensus of researchers recognize as a real medical problem.
Dr. Barnett Kramer, director of the National Cancer Institute’s Division of Cancer Prevention, spoke with DOTmed Business News about the shifting definition of cancer and its implications for health care.
Cancer redefined
“The definition of cancer and precancer has been changing under our very noses,” says Kramer. Currently, pathologists are using a definition of cancer largely unchanged from the 1850s, when a group of German pathologists did the first biopsies on people who had died of cancer. They could be confident the aberrant cells they observed were life-threatening because they were causing serious symptoms and had spread throughout the entire body.
Enter the era of screening. Better, more sensitive screening technology means doctors are now able to pick up tiny, slow-growing lesions that are unlikely to cause harm. “But since they fulfill the cancer definition created 150 years ago, we sometimes take a mental shortcut,” Kramer says.
The working group’s recommendations would rename these slow-growing lesions so both patient and doctor can immediately recognize that it has a low chance of being life-threatening. For example, certain urinary track lesions formerly called “carcinoma in situ” have already been renamed to “urinary lesions of low malignant potential.”
“The label itself can raise lots of fear,” says Kramer. “If it has the word cancer in it, there’s a well-known phenomenon that language can corrupt thought and drive action. Changing the terminology would lead to more informed decision-making at the personal level.”
