Is it cancer: should precancerous lesions be renamed?
Cancer screening has become a routine procedure in many peoples lives. Mammograms, prostate exams, colonoscopy, Pap smears or cervical cytology are common place, with many of these tests performed yearly. For some cancers, screening efforts have been successful and led to a decrease in mortality. Certainly, this is the case for colorectal and cervical cancer. For other cancers, however, screening has increased the detection, but has not resulted in a reduction in mortality from the disease. Sadly, this is the case for breast and prostate cancers. One reason for this latter scenario is the detection of pre-cancerous lesions.
What are precancerous lesions? These are abnormal cells growing in the breast or prostate tissue that may or may not develop into cancer at some later time. They are called ductal carcinoma in situ (DCIS in breast tissues) or high grade prostatic intraepithelial neoplasia (PIN in prostate tissues). Will these abnormal cells develop into a cancer? Will they metastasize to other organs and turn deadly? The short answer is maybe. DCIS and PIN are not cancer and they may never be a problem for patients, but overdiagnosis leads to overtreatment. Identification of these precancerous lesions had led to treatment for many people that may not be necessary at all.
Recently, the National Cancer Institute convened a panel of experts to discuss overdiagnosis and overtreatment in cancer patients. This panel concluded that overdiagnosis was indeed a significant problem and that labeling of lesions such as DCIS or PIN as pre-cancerous had led to overtreatment resulting in unwanted side-effects and complications. Their suggestion is to rename these lesions to remove the name cancer. If they are not cancer, they should not be referred to as such. Instead, the panel suggests referring to them as indolent lesions of epithelial origin (IDLE) conditions. Along with this designation, clinicians can monitor the growth of these lesions to see how and if they change.
Recommendations published by the NCI Panel can be found in the Journal of the American Medical Association (JAMA) at jama.com.
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