Is it cancer: should precancerous lesions be renamed?

Judy Keen
Aug 20, 2013

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.

Picture available from: https://commons.wikimedia.org/wiki/File:Small_cell_lung_cancer_-_cytolog...

 

Judy Keen

Judy is a S&T Alumni Fellow (HEHS, 2012-2014). She blogs about the latest cancer research, increasing the access to the scientific literature, and graduate education. Follow Judy on twitter @judykeenphd or at judykeenphd.com

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Comments (2)

Stephanie Byng (not verified)
August 20, 2013 at 2:17 pm
I wonder if renaming the lesions will really help. I remember when STDs changed to STIs, and even though I understand the reasoning behind the change, I can't seem to get the new name to stick. Does changing the name, really change the behavior to the problem?
Anonymous (not verified)
August 21, 2013 at 9:31 am
Changing the name to more accurately reflect the condition may change behavior. I guess it is up to other health care professionals to accept that change as well. Overdiagnosis and overtreatment is a problem that can potentially lead to serious problems, unintended side-effects and a decline in quality of life. People will have to weigh the consequences and risk for each individual condition, but should be aware what could happen with unnecessary

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