SAN FRANCISCO (KCBS) – A panel of experts advising the National Cancer Institute have proposed changing the definition of cancer, eliminating it entirely for some illnesses – particularly those that aren’t typically fatal given developments in medical science.
The recommendations were published Monday in the Journal of the American Medical Association. The authors gave two examples. One is a breast biopsy lesion called DCIS, or ductal carcinoma in situ — stage 0 breast cancer. By itself, it doesn’t harm a woman, but in some cases it goes on to invasive breast cancer. They want to get rid of the word “carcinoma.” Then there is an abnormal prostate biopsy called high grade PIN, which is a kind of a neoplasia, or an abnormal tissue growth. Sometimes it goes on to prostate cancer; sometimes it doesn’t. But in the vast majority of men, even if you go on to get prostate cancer, it doesn’t kill, so they want to get rid of the word neoplasia.
Dr. Laura Esserman, Director of the Carol Franc Buck Breast Care Center at University of California, San Francisco, and one of the lead authors of the report, explained some of the panel’s findings in an interview with KCBS.
“We used to always think that when people hear the word cancer, that that was necessarily a disease that would grow and progress and kill you if lest untreated and without aggressive treatment,” Dr. Esserman said. “But now, with our 21st century knowledge, we know that cancer is much more complicated than that and it encompasses all range of diseases, some of which are very slow-growing and won’t kill you and some of which are very aggressive and need to be treated very aggressively.”
Esserman said she understands cancer and carcinoma are highly charged words and that the opinion of the panel won’t be shared by everyone.
“We need to make more of an effort to push these ideas forward and make it more part of the dialogue. Simply saying we can’t always tell the difference doesn’t mean we can’t have a conversation with our patients,” she said. “I want the public to understand, everyone intends to do the right thing. But the public needs to understand it’s more complicated and we shouldn’t be having a one-size fits all. That’s what the whole concept of what precision medicine is, being able to tailor your treatment to biology and to your own preferences. This is going to call for shared decision making, paying more attention and really rethinking some of our strategies for early detection, where we keep the benefits, but remove some of the harms and are less aggressive about biopsying anything that we see and maybe being more judicious about the things we can follow.”
Although it’s unclear when, or if these changes will be put in place, Esserman said it is important that it is now part of the national conversation about cancer.
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