Archive | December, 2013

When a cancer’s not a cancer

12 Dec

A fascinating article on the website The Conversation discusses whether we should abandon the word “cancer”. Why? Because so many cancers these days are so minor that they won’t ever cause any harm to the patient. But the very act of using the word cancer can frighten people well out of proportion to the danger they face.

This is particularly so for cancers which are found by screening tests. The theory is that finding a cancer in the early stages improves the odds of survival. The best known examples are prostate and breast cancer.

Yet interestingly, after 30 years of screening for breast cancer in the USA, the number of minor cancers detected has doubled … but the number of advanced cancers detected has dropped by less than 10%. In other words, lots of new cancers are being found, but they were unlikely to ever cause any problems even if not discovered. The same applies – perhaps more so – to prostate cancer.

These extra “cancers” also make the figures for treatment look much better. If you “treat” all cancers – including those that aren’t nasty – your survival figures will dramatically improve.

The discussion around renaming these early or minor cancers is part of a movement in medicine against over-diagnosis and over-treatment. Doctors and patients both have a role to play – doctors need to think more clearly about the implications of conditions, and patients need to understand that medicine is not perfect, that we are always learning and re-evaluating our knowledge; and that doing more can be worse than doing less.