Redefining Cancer

A group of experts from the National Cancer Institute recently recommended changing the definition of cancer in a report published by the Journal of the American Medical Association. As implied by the report’s title, Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement, their goal is to create a shift in how doctors and patients approach cancer detection and treatment.

The recommendations are guided by a growing consensus that Americans are overtreating medical conditions that may not be as harmful as their labels suggest. The authors state that a number of conditions detected during cancer screenings for the breast, prostate, thyroid or lungs could be reclassified as “indolent lesions.” This change might reduce a pattern of overly aggressive treatment plans. As Dr. Otis Brawley, the chief medical officer for the American Cancer Society, put it, “We need a 21st century definition of cancer, instead of a 19th century definition of cancer.”

Mammogram cancer-detection technologies.  (Image: Goddard Photo and Video)

Mammogram cancer-detection technologies.
(Image: Goddard Photo and Video)

The social phenomenon of overdiagnosis can be blamed on two dynamics: First, increasingly sophisticated detection technologies increase our ability to find tissue anomalies. For example, a recent Yale study found a significant increase in MRIs for breast cancer screening, and a corresponding increase in prophylactic mastectomies among those who had MRIs over the past decade. Second, the US health care system creates perverse economic incentives for doctors to increase the number of tests and procedures they order. As a result, experts estimate that 10-30% of US health care spending is based on unnecessary interventions, representing anywhere from $250-800 billion dollars.

Shifting how we describe malignancies is a way to influence the situation. “Changing the language we use to diagnose lesions is essential to give patients confidence that they don’t have to treat every finding in a scan,” stated a professor of surgery and radiology at the University of California, San Francisco. “The problem for the public is that you hear the word cancer and you think you will die unless you get treated.”

The issue is complex because there are no clear-cut answers. To better understand the issues behind this fascinating debate, OpenCourseWare has several courses that cover the biological and anthropological factors at work.

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