Re: The word “cancer”: how language can corrupt thought
Cancer is an emotive diagnosis and may lead to over-treatment. Screening has a proven benefit in reducing mortality1,2. Medical professionals accept that screening is inexact, yet to patients it often represents a binary outcome. Screening may lead to unnecessary treatment and associated harm3,4.
A change in nomenclature would not obviate this issue. Good medical practice is based on evidence of beneficial patient outcomes. Altering nomenclature is more likely to obfuscate clinical practice than enlighten it.
We agree that screening is not harmless, however screening programs for some cancers have led to a dramatic reduction in mortality1,2.
Outdated paternalistic medicine has been replaced with modern patient-led practice. Overtreatment of so-named “incidentalomas” may arise from patient pressure. We agree that education is likely to have a significant role in overcoming this problem.
Clarity of patient communication in cancer is essential. Physicians must clearly explain the probability of the malignant progression of “incidentalomas.” This duty remains irrespective of nomenclature.
Overtreatment increases morbidity and mortality. A simple change in nomenclature is not the solution. Well-executed, targeted screening programmes supported by appropriate educational interventions need not result in overtreatment.
1. Peirson L, Fitzpatrick-Lewis D, Ciliska D, Warren R. Screening for cervical cancer: a systematic review and meta-analysis. Systematic reviews 2013; 2: 35-.
2. Nickson C, Mason KE, English DR, Kavanagh AM. Mammographic Screening and Breast Cancer Mortality: A Case-Control Study and Meta-analysis. Cancer Epidemiology Biomarkers & Prevention 2012; 21(9): 1479-88.
3. Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L. Risks and benefits of screening asymptomatic women for ovarian cancer: A systematic review and meta-analysis. Gynecologic Oncology 2013; 130(3): 674-81.
4. Ilic D, O'Connor D, Green S, Wilt TJ. Screening for prostate cancer: an updated Cochrane systematic review. Bju International 2011; 107(6): 882-91.
Competing interests:
No competing interests
18 September 2013
Nicholas J C Record
(Medical Student)
Benjamin H J Rapaport (Medical Student)
University of Nottingham
University of Nottingham, Queen's Medical Centre, Nottingham
Rapid Response:
Re: The word “cancer”: how language can corrupt thought
Cancer is an emotive diagnosis and may lead to over-treatment. Screening has a proven benefit in reducing mortality1,2. Medical professionals accept that screening is inexact, yet to patients it often represents a binary outcome. Screening may lead to unnecessary treatment and associated harm3,4.
A change in nomenclature would not obviate this issue. Good medical practice is based on evidence of beneficial patient outcomes. Altering nomenclature is more likely to obfuscate clinical practice than enlighten it.
We agree that screening is not harmless, however screening programs for some cancers have led to a dramatic reduction in mortality1,2.
Outdated paternalistic medicine has been replaced with modern patient-led practice. Overtreatment of so-named “incidentalomas” may arise from patient pressure. We agree that education is likely to have a significant role in overcoming this problem.
Clarity of patient communication in cancer is essential. Physicians must clearly explain the probability of the malignant progression of “incidentalomas.” This duty remains irrespective of nomenclature.
Overtreatment increases morbidity and mortality. A simple change in nomenclature is not the solution. Well-executed, targeted screening programmes supported by appropriate educational interventions need not result in overtreatment.
1. Peirson L, Fitzpatrick-Lewis D, Ciliska D, Warren R. Screening for cervical cancer: a systematic review and meta-analysis. Systematic reviews 2013; 2: 35-.
2. Nickson C, Mason KE, English DR, Kavanagh AM. Mammographic Screening and Breast Cancer Mortality: A Case-Control Study and Meta-analysis. Cancer Epidemiology Biomarkers & Prevention 2012; 21(9): 1479-88.
3. Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L. Risks and benefits of screening asymptomatic women for ovarian cancer: A systematic review and meta-analysis. Gynecologic Oncology 2013; 130(3): 674-81.
4. Ilic D, O'Connor D, Green S, Wilt TJ. Screening for prostate cancer: an updated Cochrane systematic review. Bju International 2011; 107(6): 882-91.
Competing interests: No competing interests