Should we rename low risk cancers?

Abstract

Laura J Esserman argues that patients are unnecessarily alarmed by calling low risk tumours cancer, but Murali Varma argues that alternative names can also be confusing and better education is the answer

Should Small Low-Risk Papillary Thyroid Cancer Be Called Cancer at All?

“…The key arguments lie in keeping a true pathologic definition versus reducing the psychological harm of a cancer diagnosis while increasing uptake of active surveillance. This has been a debate among physicians as well (2,6), and it is something that we have discussed within our division at my institution. Similar to those who participated in this study, my colleagues have also been divided on the topic.…”

“…To improve the consideration and adoption of active surveillance of thyroid cancers in appropriately selected patients, a change in the terminology of small PTCs has been proposed (6). This would be a similar change, but on a larger scale, to what occurred with the description of "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" that replaced what used to be termed encapsulated follicular variant of PTC.…”

Vagueness in Medicine: On Disciplinary Indistinctness, Fuzzy Phenomena, Vague Concepts, Uncertain Knowledge, and Fact-Value-Interaction

“…Practically, people can die with the condition and not from it (due to overdiagnosis). This has led to a reclassifying or renaming of diseases, for example from DCIS to Indolent Lesions of Epithelial Origin (IDLE) in order to avoid the “carcinoma” name (Esserman et al 2009 ; Esserman & Varma 2019 ).…”

Renaming low risk cancers: honest engagement with patients is more important

“…Renaming low risk cancers would be a cosmetic exercise and would not solve the underlying problem 1. The exponential rise in diagnosis of low risk cancers is the result of overdiagnosis due to overinvestigation 2…”