Rethinking the word 'cancer': Study calls for low risk forms of the disease to be renamed

New research argues terming minor conditions cancerous can lead to unnecessary treatments

Dr. Christian Hinrichs (R), an investigator at the National Cancer Institute in immunotherapy for HPV+ cancers, shows patient Fred Janick, a survivor of metastatic cancer, the difference between his CT scan showing cancerous tumors (R) and a clean scan after treatment (L), after a day of medical exams showing no recurrence of cancer, at the National Institutes of Health (NIH) in Bethesda, Maryland, February 8, 2018.
Experimental trials are ongoing at the National Institutes of Health Clinical Center, a US government-funded research hospital where doctors are trying to partially replace patients' immune systems with T-cells that would specifically attack cancers caused by the human papillomavirus (HPV), a common sexually transmitted infection. A person's T-cells will naturally try to kill off any invader, including cancer, but usually fall short because tumors can mutate, hide, or simply overpower the immune system.
Immunotherapies that have seen widespread success, such as chimeric antigen receptor (CAR-T) cell therapies, mainly target blood cancers like lymphoma, myeloma and leukemia, which have a tumor antigen -- like a flag or a signal -- on the surface of the cells so it is easy for immune cells to find and target the harmful cells. But many common cancers lack this clear, surface signal. Hinrichs' approach focuses on HPV tumors because they contain viral antigens that the immune system can easily recognize.
 / AFP PHOTO / SAUL LOEB

A new study has called for the "cancer label" to be removed from low risk forms of the disease to prevent panicking patients from opting for unnecessarily invasive treatments.

Despite the advancements that have been made in the fight against cancer, the mere use of the word in a diagnosis can lead many to opt for more aggressive treatments than they might need, according to a new study.

Cancer remains one of the biggest causes of death in the Middle East and the world, but there many low risk cancers which pose relatively little harm.

Researchers from Australia's University of Sydney and Bond University in Queensland and the Mayo Clinic in the United States have called for the term "cancer" to be removed from the description of some thyroid cancers which are less than 1cm in size, some low and intermediate grade breast cancers, and localised prostate cancer.

In an analysis led by Brooke Nickel from the University of Sydney, published in the British Medical Journal on Monday, it is argued that this may help reduce over diagnosis and overtreatment.

The study states: "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."

The study found there is mounting evidence that “disease labels affect people’s psychological responses and their decisions about management options."

“The use of more medicalised labels can increase both concern about illness and desire for more invasive treatment,” the study states.

Some cancers, such as low risk papillary thyroid cancer, are non-growing or so slow growing that they will never cause harm if left undetected.

It is a similar story for prostate cancer where there is evidence and concern about overdiagnosis and overtreatment.

In addition to these cancers, “there is some evidence and informed speculation that melanoma, small lung cancers, and certain small kidney cancers may be considered low risk and subject to similar overdiagnosis and overtreatment.”

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The study asserts that there remains a "strong perception" that aggressive treatments are always required to tackle cancer, when more conservative approaches may be more suitable.

Removing the cancer label, and the fear it can spread, is cited as a strategy for managing the care of patients who are suffering from low risk forms of the disease.

Many diseases formerly branded as cancers have been relabeled over the last 20 years, including bladder tumours which are now known as papillary urothelial neoplasia of low malignant potential.

The study calls for World Health Organisation classification bodies, government health agencies, cancer groups and public and patients representatives to come together to discuss the issue.

Researchers also urge clinicians to initiate discussions about the likely benign nature of low risk conditions, the possibility of over diagnosis and overtreatment, and look into the options of less invasive management of diseases, such as active surveillance, both before and after diagnostic interventions

“New medical education curriculums can help students and clinicians gain a deeper understanding of overdiagnosis and strategies to communicate about low risk conditions,” the study states.

“Removing cancer from a condition’s label may lead patients to reconsider the nature and extent of follow-up and question the need for additional treatments, potentially reducing overtreatment and any associated harmful psychological effects.”

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