During my nearly four-decade-long clinical career, I’ve observed substantial transformations in how we perceive and acknowledge cancer. As a young medical professional, we customarily shied away from using the term ‘cancer’ directly with our patients. Instead, we utilised words such as ‘neoplasm’ or ‘mass’ to reveal cancer diagnoses. ‘Space occupying lesion’ was another commonly used terminology in the presence of patients. There was also a tendency among patients and their families to circumvent the use of ‘cancer’.
In my capacity as a palliative care specialist during the 1980s, it was a common occurrence for relatives to intervene and prevent me from using the term ‘cancer’. Even in informal chat, individuals often referred to it as the “Big C”. The mention of ‘cancer’ signified something overpowering, insurmountable, and often terminal. However, such usage is now outdated as many types of cancer, including various forms of breast, prostate, testicular, and thyroid cancers, when detected early, have survival rates as high as 98%.
The vocabulary we use to talk about cancer matters, as the words we use can impact how individuals manage their situation – from recognising symptoms to seeking medical aid and care. The way we discuss cancer continues to evolve.
I was particularly struck by a recent piece in CancerWorld magazine by Simon Crompton, titled “If the risk is very low, should we still call it cancer?” The crux of the author’s argument is that current advancements in medical knowledge allows us to differentiate between minor, low-risk tumours and aggressive, advanced cancers, the implications of which can be incredibly consequential. So-called ‘cancers’ vary widely in their potential to metastasise, ranging from less than a 5% likelihood of progression over two decades to a striking 75% chance of development over a period of 1-2 years.
The terminology we use to discuss illnesses influences the decisions patients make concerning treatment. There appears to be an issue whereby branding a low-risk disease as ‘cancer’ is encouraging overdiagnosis and overtreatment.
A 2019 discourse in the esteemed British Medical Journal questioned the need for a reclassification of low-risk cancers, with the industry opinions remaining divided. The suggestion for a change in naming conventions was brought forth by Laura Esserman, the breast surgeon leading the Carol Franc Buck Breast Care Centre located at the University of California, San Francisco. Esserman maintained that adjustments to definitions are essential to match the advancements in knowledge. She noted that while it was once impossible to provide a dependable identification to negligible-risk lesions, current genomic screening has influenced our perception of the possibility and period of recurrence. However, the implementation of this data to redefine cancer is yet to be seen.
A contrasting viewpoint from a histopathologist warned of the complexity alternative cancer names could introduce, advocating for education as the optimal solution.
Currently, the disagreement remains heated predominantly in the specialities of breast, thyroid and prostate cancer. Under 1% of men diagnosed with low-grade prostate cancers (Gleason Score 6) experience tumour spread or death in the 15 years following diagnosis. This statistic led a collection of North American experts to propose renaming of low-grade prostate tumours to “pre-cancer” from “cancer”, to mitigate anxiety and the compulsion for superfluous treatment.
A comparable argument is observed in relation to breast cancer. A significant percentage of women diagnosed with breast cancer annually are informed they have ductal carcinoma in situ (DCIS). A modest estimate of up to 20% of DCIS patients may progress to invasive cancer in an extended timeline of five to 40 years; majority DCIS lesions remain inactive. Yet, the over-treatment of DCIS patients persists despite its low-risk nature, prompting reconsideration of its classification.
The patients’ perspective on renaming certain cancer types also plays a substantial role. A 2023 poll involving 450 prostate cancer patients showcased their divided opinions – 35% supported changing Gleason 6 to a non-cancer, 30% were indifferent and the remaining 35% objected.
Without additional education and patients’ consensus, the renaming of cancers seems ill-timed, at least in the current scenario.