Cancer is perhaps the most frightening word a patient can hear. In a recent interview, Dr. Otis Brawley, chief medical officer for the American Cancer Society, discussed redefining cancer to reduce unnecessary treatment. The issue has been raised before but there is new emphasis on the problem. The two best examples are in breast and prostate cancer.
Thousands of women are diagnosed with breast cancer in situ every year. There are two kinds: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). LCIS is not cancer at all; it is not even a precursor to real cancer and will not become dangerous to the woman because it will not invade the tissues. It is simply an indication that the patient has a somewhat increased risk of developing invasive breast cancer in the future and many patients receive anti-hormone treatment like tamoxifen or anastrozole to reduce that risk.
DCIS is a premalignant condition that can become an invasive and dangerous cancer but it is easily treated by surgery and radiation with a near 100% cure rate. It also marks the patients with an increased risk of developing invasive breast cancer and is often also treated with anti-hormone treatment to reduce future risk.
Most men over the age of 80 have small areas of prostate cancer in their prostate glands but die with prostate cancer not from it. There is uniform agreement that men with a life expectancy of less than 10 years should not be screened for prostate cancer and a recent recommendation from the United State Preventative Task Force suggests almost no men should be screened at all since most prostate cancers will not hurt the patient or can be easily treated if they do progress and the harm of treatment exceeds the benefit. There are exceptions for men at high risk for developing prostate cancer.
What should we do about the fear that a diagnosis of cancer engenders in patients without a significant risk of dying from these conditions. Good patient education is part of it but perhaps changing the names of these conditions to something without the dreaded word “cancer” is a better answer.
Written by: Dr. Barry H. Kaplan, M.D., Ph.D.
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