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Say 'Cancer' and You've Said a Mouthful

Hello and welcome. I am Dr. George Lundberg, at large at Medscape.

First, a disclosure: I have been a pathologist, double boarded in anatomic and clinical pathology, since 1962. I have diagnosed large numbers of cancers of very many types over that career, albeit mostly before I went into medical editing full-time in 1982.

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."

Cancer, the Emperor of All Maladies, is on track to kill some 600,000 Americans this year, despite the miracles of modern medicine[1]--a really big deal, a disease worthy of its fearful reputation.

Cancer cells -- anaplastic, dedifferentiated, capable of autonomous growth, utterly out of control until destroying their host -- are, however, not just one thing. 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. Mass efforts were launched to find cancers wherever they were and destroy them. Since the earliest cancers seemed to evolve from some identifiable premalignant conditions, wouldn't it make sense to also nip those in the bud? Sounds logical.

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."

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