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What's in a name? A look into the other c-word
By: Dallas Bastian in News, Top Stories August 14, 2018	0
Patients who are told they have cancer for low risk conditions are more likely to choose surgery than whose who hear different terms for their diagnosis.
To curb this trend, academics are calling for the removal of the 'cancer' label – where appropriate.
Bond University senior research fellow Dr Ray Moynihan put it flatly: "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."
Writing in the BMJ, Moynihan, along with researchers from the University of Sydney and the Mayo Clinic in the US, said the call follows a growing body of evidence that describing a condition using terms like 'cancer' can lead to an increased preference for more invasive treatments.
The BMJ analysis pointed to a study of 394 women to highlight this impact. The research found that when ductal carcinoma in situ (DCIS) was described as a non-invasive cancer, just under half (47 per cent) of the women preferred surgery over non-surgical treatment options such as medication or active surveillance, whereas just a third (34 per cent) preferred surgery when it was described as a 'breast lesion' and 31 per cent when it was described as 'abnormal cells'.
Co-author Professor Kirsten McCaffery from the University of Sydney said 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.
The authors added the way clinicians categorise conditions and recommend treatments may also be influenced by labels.
"Several factors may drive them to overdiagnose and overtreat, albeit unconsciously," they wrote. "According to a recent review of the literature, potential drivers of overdiagnosis include fear of litigation or missing disease, an overemphasis on the need to diagnose, a lack of awareness of potential iatrogenic harms, and the challenge of doing nothing rather than something.
"Removing the cancer label from low risk conditions may help shift clinicians' perspectives and enable them to feel more comfortable recommending less invasive options to patients."
The authors added that change requires discussions between key cancer classification and staging groups, health agencies, cancer societies, consumer groups and citizens.
They also noted that while any alternative label – indolent lesions of low malignant potential (IDLE), abnormal cells and microtumour are among the various names previously proposed – needs to be biologically accurate, it also needs to be something patients can understand and that will not create disproportionate concern.
"Ultimately removing the cancer label will create controversy and take time," their analysis read. "If done through a broad multistakeholder process, however, it should help ensure appropriate evidenced based care for future and current patients.
"Although it remains unclear exactly how best to move forward, we cannot continue to tell many people they have cancer when that label may be doing them more harm than good."
BMJ cancer diagnosis overtreatment 2018-08-14
Dallas Bastian
Tagged with: BMJ cancer diagnosis overtreatment