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Monthly Archives: August 2013

Breast cancer (Infiltrating ductal carcinoma of the breast) dyed with H&E

Breast cancer (Infiltrating ductal carcinoma of the breast) dyed with H&E

Consider the weight of one word: “The problem for the public is that when you hear the word cancer, you think you will die unless you get treated.” This statement comes in a “Viewpoint” piece published this week in The Journal of the American Medical Association (JAMA). The next sentence: “We should reserve this term, ‘cancer,’ for those things that are highly likely to cause a problem.” The lead author is Laura J. Esserman, MD, and Director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco.  Here’s what’s behind it. Medical screening tools are at such a level that doctors commonly find “indolent tumors” in their patients.  (Tumors is a plenty scary word too, of course.)    But the vast majority of these are harmless.  If they hadn’t been found they would never have mattered. Doctors call this “over diagnosis”, and over-diagnosis “generally” leads to over-treatment which may include surgery, radiation, chemotherapy. The JAMA piece summarizes the recommendations of a working group formed after a March 2012 National Cancer Institute meeting to evaluate the problem of “overdiagnosis.”  To find ways to “lower the burden of cancer screening and treatments.” Hundreds of thousands Last week (July 29, 2013) the New York Times reported on it under the headline “Scientists Seek to Reign in Diagnoses of Cancer.”   Here is their lead: A group of experts advising the nation’s premier cancer research institution has recommended changing the definition of cancer and eliminating the word from some common diagnoses as part of sweeping changes in the nation’s approach to cancer detection and treatment. But this is the bombshell paragraph: The impetus behind the call for change is a growing concern among doctors, scientists and patient advocates that hundreds of thousands of men and women are undergoing needless and sometimes disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm. This might also help mitigate the equally significant emotional side effects:  “most people face some degree of depression, anxiety, and fear when cancer becomes part of their lives.” (American Cancer Society website) The JAMA “Viewpoint” article concludes: Physicians and patients should engage in open discussion about these complex issues. The media should better understand and communicate the message so that as a community the approach to screening can be improved.

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