Call Them 'Indolentomas,' Not Cancer

Data show that unindicated mass screening and early therapy can work well with cancer of the uterine cervix[2,3] and probably of the colon.[4]Lung cancer screening in selected patients is too early to tell.[5]Such approaches fail with ovary, melanoma, breast, and prostate.

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.

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

We all owe Laura Esserman, her colleagues, and the National Cancer Institute a great debt for recently having forcefully called this mass discrepancy of professional and public behavior to the forefront of our consciousness.[6]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. Even if the word is cushioned by physicians with modifiers like "in situ," "early," "precancer," "on the way towards cancer," "caught it in time," and the like, the patent simply wants to get it out of their body. A surgical sell by a surgeon becomes really easy.

Of course, even after successful name changes, many more steps must follow to tune the transition sensibly.

Will there be missteps? Certainly. Will there be resistance to change? You bet. Will there be unintended consequences? Most assuredly. Will some of those trial lawyers jump with glee at the possibility of underdiagnosis and new opportunities at lawsuits for "failure to diagnose"? Yes, but we must use our science and professionalism on behalf of the patient's best interests and collectively tell the lawyers and the hospital risk managers to take a flying leap.

Science marches on. Let's listen to it and lead from the front.

That's my opinion. I'm Dr. George Lundberg, at Large at Medscape.


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