Redefining cancer

An article published Monday in the The Journal of the American Medical Association should initiate a needed discussion about how doctors define and treat some forms of cancer. Yet the instant debate set off by the article shows what a challenging conservation this will be, literally touching on matters of life and death, a debate further complicated by the high cost of health care in this country.

The article is authored by some of the top scientists in cancer research, working as a study group under the auspices of the National Cancer Institute. Their recommendation is that some premalignant conditions that are slow growing and unlikely to cause harm and so should no longer be identified as "carcinoma," in other words, cancer.

The rationale is that as screening improves doctors are spotting more of these largely benign lesions. Defined as cancers, they are aggressively treated, leading to surgeries and other invasive treatments that may be unnecessary and are potentially more harmful than the disease. Examples cited include some forms of breast and prostate cancers that now often result in surgical removals, when monitoring may be the better option.

"We need a 21st-century definition of cancer instead of a 19th -century definition of cancer, which is what we've been using," Dr. Otis W. Brawley, chief medical officer for the American Cancer Society, told the New York Times.

Yet while the discussion is important, change will, and should, come slowly. Some cancer experts note that while medicine has a better handle on which forms of cancer tend to be more or less destructive, doctors cannot say with absolute certainty if what they are looking at will be slow growing. Removing the terminology of "cancer" from some of these diseases could cause its own problems.

This discussion again focuses attention on the importance of doctor-patient communication. While hearing the word cancer can certainly cloud a patient's thoughts, it is critically important that patients learn and understand the implications of that diagnosis and the options available.

The debate also shows the need for continued research to find better ways of confidently identifying slow-growing, non-threatening tumors.

Over treatment is costly and not in the best interests of patients. It makes sense to explore safe ways to reduce it.

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