Ductal carcinoma in situ as seen under a microscope. Doctors also call D.C.I.S. “Stage 0 Breast Cancer.” But in an article Monday, a panel of national scientists argue it should no longer be labelled “cancer.” (Ed Euthman/Flickr)
What power does a word have? If the word is “cancer,” for most people it packs a wallop of emotion ranging from general anxiety to abject terror. For the last 30 years, a large industry has grown and developed with a focus on awareness and screening. The goals were laudable: get screened; catch cancer early; early diagnosis means patients dodge a death sentence.
There’s just one problem. It’s not working. This notion of screening was dependent upon the understanding of cancer 30 years ago: that cancer started from a tiny seed and steadily grew and spread until – without treatment – it killed the patient.
But today scientists know that not all cancers behave this way. Some are fast-growing, some may grow slowly, but progressively. But others are “indolent,” so slow-growing, they will never cause the patient harm.
So what certain cancer screening tests have wrought (think mammography, PSA tests) is a dramatic increase in diagnosis of early-stage disease without a corresponding decline in death rates from cancer or diagnosis of late-stage disease. Many of these early stage patients are likely “overdiagnosed” and then “overtreated” — for cancers that may never have grown and spread.
“We terrify (women) with D.C.I.S. thinking they have cancer. We could wait six months to see if something changes without making people hysterical.”
Against this backdrop, the National Cancer Institute called together a group of nationally recognized cancer doctors and researchers to review the evidence on overdiagnosis. In a Viewpoint
published Monday in JAMA, the panel calls for major changes in the way the medical world classifies and thinks of “cancer” and the way screening programs are designed.
“This article is really critical for laying the ground work for introducing what I hope will be groundbreaking changes in screening and prevention,” said lead author Dr. Laura Esserman, director of the breast care center at UC San Francisco. Continue reading