Changing the Definition of Cancer

The way cancer is defined and diagnosed may radically change. A group of some of the nation’s leading cancer researchers issued controversial recommendations this week that aim to limit certain cancer screenings and eliminate the term cancer from many common diagnoses.

The recommendations, published on Monday in The Journal of the American Medical Association, are intended to reduce unnecessary diagnostic and treatment procedures that can lead to more harm than good. The report, authored by a taskforce of the National Cancer Institute, said that the fear that the term ‘cancer’ inspires motivates doctors and patients to pursue dangerous procedures that they might not actually need. This is especially relevant for people with benign, slow-growing or precancerous conditions, who are often more likely to be harmed by such procedures than healed by them.

For example, the taskforce proposes to rename precancerous conditions such as ductal carcinoma in situ, a common precursor to breast cancer, or high-grade prostatic intraepithelial neoplasia, which can precede prostate cancer. These terms currently contain words such as ‘carcinoma’ and ‘neoplasia’ which are often used synonymously with cancer. Removing such terms from those diagnoses, the authors argue, could decrease the fear associated with them and reduce the temptation to treat them like highly invasive or progressive cancers.

The taskforce recommends creating a new category that would label such conditions as IDLE (indolent lesions of epithelial origin). IDLE conditions would generally be closely monitored or treated with minimally invasive procedures, rather than more radical procedures such as mastectomies or prostate removal.

Improving cancer screening guidelines and targeting certain high-risk populations will also be an important way to reduce harm, the taskforce wrote. Such changes might include reducing the frequency of certain cancer screenings, limiting screening to high-risk populations and changing the thresholds that tests need to meet to qualify as positive.

According to a New York Times article about the new recommendations, it will likely be years before such dramatic changes would be made to cancer screening and diagnosis. However, given the taskforce’s high profile, this report “brings the discussion to a much higher level and will most likely change the national conversation about cancer, its definition, its treatment and future research.”