The word “cancer”: how language can corrupt thought
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5328 (Published 10 September 2013) Cite this as: BMJ 2013;347:f5328
- Barbara K Dunn, medical officer1,
- Sudhir Srivastava, chief2,
- Barnett S Kramer, director3
- 1Chemoprevention Agent Development Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA
- 2Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute
- 3Division of Cancer Prevention, National Cancer Institute
- kramerb{at}mail.nih.gov
Cancer screening is a double edged tool. Screening may reduce the risk of death from the targeted cancer, as in screening for cervical (Papanicolaou test, human papillomavirus testing), colorectal (fecal blood testing, endoscopy), breast (mammography), and lung (low dose helical computed tomography) cancers. Unfortunately, other cancer screening tests in common use are of questionable value or have none at all. These include cancer antigen 125 (CA125) and transvaginal ultrasound for ovarian cancer, serum prostate specific antigen for prostate cancer, and chest radiography for lung cancer.
Regardless of their usefulness, most cancer screening tests carry an underappreciated harm—overdiagnosis, the detection of non-lethal lesions that meet the histologic criteria for cancer or cancer precursors. Two factors are required for overdiagnosis: a reservoir of occult indolent lesions and activities leading to their early detection.1 Diagnostic scanning may also show incidental findings (“incidentalomas”), another source of overdiagnosis.2 The mere labeling of such indolent lesions as “cancer” or “carcinoma in situ” is a potent driver of thought and action because it incurs fear.
The concept of early detection of disease is intuitively appealing, so screening tests are often embraced by health professionals and …