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Removing the cancer label – overhaul in cancer classification proposed

Removing the cancer label – overhaul in cancer classification proposed

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Australian researchers have asked for changes in the way doctors tend to label low risk cancerous conditions as “cancer” leading to over treatment. Certain diagnoses such as localised prostate cancer or “stage 0” breast cancers need to be looked at say the researchers at the University of Sydney and Bond University to prevent aggressive treatment where it is not needed.

The researchers published their analysis in the British Medical Journal this week saying that for patients who are told they have “cancer” the choices are usually more aggressive treatments compared to patients who are told they have “abnormal lesions”. Ray Moynihan, senior research fellow at Bond University and an author of the analysis said, “The evidence suggests to us that it is time to stop telling people with a very low-risk condition that they have ‘cancer’ if they are very unlikely to be harmed.” Lead researcher Brooke Nickel from University of Sydney school of Public Health said that for many “slow growing precancerous lesions” patients could not cope with the active surveillance. In slow growing lesions the general advice is to look for changes and growth in the lesion over fixed intervals before treatment can be initiated. This form of active surveillance before treatment is called “watchful waiting”. Many patients find it difficult to “wait” before starting therapy when told they could have cancer says Nickel. “These patients report not being able to think of anything else and are driven to do anything to get rid of it. It can be terrifying, and rightly so,” Nickel said. She added, “It has been ingrained over decades that cancer is always scary and causes death… But when there is evidence that a condition is low risk and could be overdiagnosed and overtreated, calling it a cancer might do them more harm than good.”

According to Nickel, advanced diagnostic procedures and screening programs could pick up smallest of growths and abnormalities for example a precancerous form of cervical cancer called ductal carcinoma in situ (DCIS). These lesions, she explained, may not cause harm if they were left untreated but once they have been detected, it becomes hard to not treat them.

Some of the precancerous lesions and early cancers that need to be re-labelled according to the analysis include localized prostate cancer, intrathyroidal papillary thyroid cancer, low and intermediate-grade DCIS, early breast cancer lesions etc.

Senior author Kirsten McCaffery at the University of Sydney explained that active surveillance is one of the safe management options in some patients with cancer but for many patients as well as doctors there is a belief that more aggressive treatments might be needed.

However on the other hand several experts have said that renaming the cancers in their early stages could also mean that patients become careless about their follow ups and surveillance of their precancerous lesions. Many patients might be deprived of their government healthcare benefits if their disease is renamed, they add. Authors have suggested panels of cancer experts worldwide to come together to plan reclassification and relabeling of certain cancers.

According to Cancer Council chief executive Sanchia Aranda while this move could reduce overtreatment, it would also mean that patients with precancerous lesions that have a tendency to become aggressive may be undertreated. “We want patients to understand that they have potentially serious conditions that need to be monitored so they don’t walk away from medical services,” she said.

Source:

https://www.bmj.com/content/362/bmj.k3322

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