New cancer definitions

[BU Pathology]

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Interesting article in the NY Times about the report from a working group of the National Cancer Institute. They suggest that certain conditions be renamed to remove the word cancer from the diagnosis and renamed as IDLE conditions, indolent lesions of epithelial orgin. The concept is that renaming indolent lesions would decrease over-treatment.

http://well.blogs.nytimes.com/2013/...es-to-cancer-detection-and-treatment/?hp&_r=0

The report also suggested that initiative of changing the nomenclature should be led by pathology (the lead author on the study is not a pathologist).

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

 

[malchik]

Of course pathologists have been pushing this for years with terminology like CIN, PIN, AIN, VIN, etc. as opposed to CIS. Now it's news because some non-pathologists decided to read their reports that no longer say "CIS"?

 

[WEBB PINKERTON]

Oh no, many women won't be able to call themselves cancer survivors anymore after they get diagnosed with DCIS

It's sad our profession causes so much overdiagnosis and overtreatment 👎

 

[deleted314957]

Interesting article in the NY Times about the report from a working group of the National Cancer Institute. They suggest that certain conditions be renamed to remove the word cancer from the diagnosis and renamed as IDLE conditions, indolent lesions of epithelial orgin. The concept is that renaming indolent lesions would decrease over-treatment.

http://well.blogs.nytimes.com/2013/...es-to-cancer-detection-and-treatment/?hp&_r=0

The report also suggested that initiative of changing the nomenclature should be led by pathology (the lead author on the study is not a pathologist).

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center

This idea is as old as the hills. 30+ years ago i wanted to call basal cells "epitheliomas" rather than "carcinomas" hoping it might help with folks getting medical insurance in the future and being less traumatizing. went over like a fart in a space suit.

 

[KLPM]

Oh no, many women won't be able to call themselves cancer survivors anymore after they get diagnosed with DCIS

It's sad our profession causes so much overdiagnosis and overtreatment 👎

Heaps of women call themselves cancer survivors after CIN3 when I was doing O+G rotation.

 

[Johnny Sunshine]

I am in favor of such changes. The word "indolent" is a bit soft, but pretty good at describing something which could be concerning but is not guaranteed to lead to malignant behavior.

I wonder if this would decrease compensation for such diagnoses... 🙄

 

[KCShaw]

I dunno, I think the article can't figure out the difference between a "label" and a "definition", and it's not clear whether the author realizes "Barrett's esophagus" doesn't have the words "cancer" or "carcinoma" in it. Physicians know, or should know, the underlying meaning of a diagnostic label. If they don't, changing the label is not going to fix that. It just might change some of the public perceptions, and perhaps their aggressiveness in choosing options presented to them or in seeking second opinions. The problems with our labeling systems aren't the use or non-use of one specific word, it's that every organ/cell of origin has its own fluctuating system which may not overlap very well with those of other systems, so everyone has to know them all individually. There are some reasons for that, good and bad, but changing the labels of a select few isn't going to educate clinicians who already should understand and should already be educating their patients -- not unless the diagnostic label becomes a fully descriptive prognostic term (Iike "...low malignant potential"), which is likely to be proven inappropriate (misleading) in a percentage of lesion types and lead to more changes in such labeling a few years later.

The odd thing is, what things look like under the microscope doesn't seem to be changing much, yet we seem to have a very hard time crafting short, consistent, descriptive diagnostic labels (not descriptive word salad just because we don't know what else to call it) so clinical treatment and prognostic evolutions can be dealt with *separately*.

 

[LADoc00]

A.) there is cry for this literally every ten years in the post WW2 era me thinks.
B.) NEVER read the NY Times. Only problems occur when you do. You begin hating yourself, join a hippy commune, regardless it never ends up well when you pick up a NYT.

 

[yaah]

I don't think you change peoples' minds by changing the names of things just to make them feel better. It might work for the lay press and such and casual observers. But once you get diagnosed with something it doesn't really matter what you call it, the treatment is going to remain the treatment. If you decide to call all 3+3 prostate cancers "borderline malignant potential" it's still the same disease. The way to decrease overtreatment is to do effective research that shows that the treatment doesn't mean anything. This is having real effects in prostate cancer diagnosis and treatment, and it had nothing to do with changing the name.

 

[malchik]

Well, the treatment is not always cut and dry. I think patient preferences have a lot to do with how aggressive oncologists and surgeons are. Words matter, particularly in our specialty whose whole point is to give something the right name. I think we should try to make the name accurately reflect the behavior of the entity, including consideration of the lay audience. I am often surprised how "lay" some clinicians are when it comes to understanding terminology, actually.

 

[KCShaw]

The trouble is that the behavior of any given entity is simply what we think today the behavior is based on prior studies. And that information changes with new studies. I don't think we do anyone any favors by changing terms based on social stigma or evolving understanding of behavior, when what we see under the microscope isn't changing. There may be value in refining certain diagnostic terms based on IHC, molecular, etc. results, or refining criteria as we notice significance in things that have always been (or not been) there, and I'm not saying our current labeling scheme is particularly good, certainly not all the way around -- I just think this isn't the reason or way to achieve an improved result.