When is 'cancer' not cancer?

In a recent article, Dr. George Lundberg, editor of Medscape General Medicine, cautioned that doctors and patients should distinguish between cancers that will likely be aggressive and "cancers" that will not.


Here is an interesting excerpt:

"Pathologists never can really predict how any one cancer will behave. But after many decades of matching histologic patterns with the natural history of diseases, we are actually pretty good at predicting which lesions will be really bad actors and which seem likely to lie around indolently.

"Starting about 1965, I practiced and taught that 'When you say cancer, you are saying a mouthful. Be very careful. By that diagnosis, you, the pathologist, are giving any clinician license to treat that patient and his or her cancer with whatever treatment might then be in vogue, including cutting it out, shooting ray guns at it, or poisoning the cancer and the patient.'
"...We are learning more every day that cancer is many different diseases, even thousands or tens of thousands of different diseases.
"For a long time, it made sense to try to eradicate all cancers, as early and as completely as possible..But, as with many exuberant efforts, this one got out of control. Many lesions that were called 'cancer' really were not cancers at all in behavior, and this fact began to be recognized in large numbers of patients. These unfortunate victims have experienced massive psychological and physical harm and costs without any clear benefits achieved by finding and treating their 'noncancers.' 

"Cure rates from aggressive therapy on those 'indolentomas' are 100%. But, so would the outcomes have been of nondiscovery---100% cure of nondisease."

Lundberg thanked Dr. Laura Esserman of the University of California-San Francisco and the National Cancer Institute for "recently having forcefully called this mass discrepancy of professional and public behavior to the forefront of our consciousness. Ceasing to name lesions that are most likely indolentomas by that fearsome word 'cancer' is the first step. Almost any patient who hears the word 'cancer' applied to their pathologic findings experiences their hair catching on fire." 

In an interview with National Public Radio, Esserman, a breast cancer surgeon, said: "Many of these precancerous lesions are not going to go on to become cancer. I don't think we should label it as cancer. I think we should call it a 'ductal lesion.' I think people would be much more willing to be calm about it."