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Drop the C-word to reduce anxiety and over-treatment, say experts

13 August 2018
Stop telling people with low-risk conditions they have ‘cancer'
Medical researchers are calling for the word 'cancer' to be dropped from some doctor-patient conversations in a bid to reduce patient anxiety and harm from over-treatment.

Time to stop telling people with low risk conditions that they have ‘cancer’ if they are unlikely to be harmed it.

 

The appeal in today’s BMJ follows mounting evidence that patients who are told they have “cancer” for low risk conditions more often choose surgery than those whose condition is described with terms such as “lesions” or “abnormal cells”.

“There is a growing body of evidence that describing a condition using more medicalised labels, including the use of the term ‘cancer’, can lead to an increased preference for more invasive treatments,” says Professor Kirsten McCaffery of the University of Sydney who co-authored the BMJ analysis with colleagues from Bond University and the Mayo Clinic in the US.

“This supports calls to remove the cancer label, where it is appropriate.”

“A prime example of this is low risk papillary thyroid cancer,” says Brooke Nickel of the University of Sydney who led the analysis.

“Studies show that progression to clinical disease and tumour growth in patients with small papillary thyroid cancer who choose surgery are comparable to those who monitor their condition.”

It's time to stop telling people with a very low risk condition that they have ‘cancer’ if they are very unlikely to be harmed by it.
Dr Ray Moynihan, Bond University

Similarly, in localised prostate cancer where active surveillance has been a recommended management option for many years, studies show that internationally most men still prefer radical prostatectomy or radiation therapy.

Active surveillance involves closely watching a patient’s condition but avoiding treatment unless there are changes in test results that show the condition is getting worse.

“While active surveillance is increasingly being recognised as a safe management option for some patients with cancer, there is still a strong belief that aggressive treatments are always needed,” says Professor McCaffery.

There is still a strong belief that aggressive treatments are always needed.
Professor Kirsten McCaffery, University of Sydney

The authors say cancer types that could be considered for re-naming include intrathyroidal papillary thyroid cancer (<1cm in size), low and intermediate grade ductal carcinoma in situ (DCIS), also often known as stage 0 breast cancer, and localised prostate cancer (Gleason ≤6).

Moves to remove the cancer label aren’t new, write the authors:

“An early example of this was when the World Health Organisation and International Society of Urological Pathologists removed the cancer label from bladder tumours. In 1998, they agreed that a condition known to rarely progress to invasive cancer should not be called ‘cancer’”.

In this change, ‘papilloma and grade 1 carcinoma of the bladder’ were reclassified as ‘papillary urothelial neoplasia of low malignant potential’.

A similar change has been made in the labelling of cervical abnormalities detected during a Pap smear, which has supported more women to follow active surveillance in preference to invasive treatments.

“The evidence suggests to us that it's time to stop telling people with a very low risk condition that they have ‘cancer’ if they are very unlikely to be harmed it,” says Dr Ray Moynihan, a Senior Research Fellow at Bond University.

Dan Gaffney

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