Experts from the National Cancer Institute on Monday recommended redefining cancer to eliminate its association with slow-growing, premalignant lesions and to prevent overdiagnosis and overtreatment.
The new recommendations are likely to spark debate among physicians and scientists. Outlined in the Journal of the American Medical Association, the experts advise removing the word “carcinoma” from ductal carcinoma in situ of the breast. Most doctors agree the condition is not cancer and renaming it could avoid unnecessary treatments such as surgery to remove the breast.
In addition, lesions found during screenings of the breast, prostate, thyroid and lung, among others, should be termed “indolent lesions of epithelial origin,” or, more simply IDLE.
“Screening for breast cancer and prostate cancer appears to detect more cancers that are potentially clinically insignificant,” the experts wrote. “Lung cancer may follow this pattern if high-risk screening is adopted. Barrett esophagus and ductal carcinoma of the breast are examples for which the detection and removal of lesions considered precancerous have not led to lower incidence of invasive cancer.”
In contrast, screening for colon and cervical cancer has been effective. Early detection and removal of precancerous lesions have reduced incidence of the cancers, particularly late-stage disease.
The push to redefine cancer follows concern that certain diagnoses are creating anxiety in patients and leading to more aggressive treatment approaches than needed. The phenomenon has occurred over the past 30 years as awareness and screening has increased markedly.
The three experts writing for JAMA are part of a working group of the National Cancer Institute and were primarily addressing the problem of overdiagnosis, which they said generally leads to overtreatment.
In recent years, advances in screening technology have made spotting “incidentalomas” more common. The term refers to incidental findings on medical scans that are unlikely to harm a patient. But doctors and patients often want to biopsy the finding and then may treat and remove it. The experience can take a psychological toll on patients and put them at risk associated with surgery.
Physicians, though, are unable to distinguish between benign or slow-growing tumors and aggressive forms of many cancers. As a result, most treat cancer preventatively, as if it were to become aggressive.
“An ideal screening intervention focuses on detection of disease that will ultimately cause harm, that is more likely to be cured if detected early, and for which curative treatments are more effective in early-stage disease,” the experts wrote. “Understanding the biology of individual cancers is necessary to optimize early detection programs and tailor treatments accordingly.”
The experts suggest physicians and patients discuss these complex issues surrounding early detection and treatment plans.