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Renaming low risk conditions labelled as cancer

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3322 (Published 12 August 2018) Cite this as: BMJ 2018;362:k3322
  1. Brooke Nickel, PhD candidate12,
  2. Ray Moynihan, senior research fellow13,
  3. Alexandra Barratt, professor of public health1,
  4. Juan P Brito, assistant professor of medicine4,
  5. Kirsten McCaffery, professorial research fellow12
  1. 1Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
  2. 2Sydney Health Literacy Lab, Sydney School of Public Health, University of Sydney, New South Wales, Australia
  3. 3Centre for Research in Evidence Based Practice, Bond University, Queensland, Australia
  4. 4Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, MN, USA
  1. Correspondence to: K McCaffery kirsten.mccaffery{at}sydney.edu.au

Removing the cancer label in low risk conditions that are unlikely to cause harm if left untreated may help reduce overdiagnosis and overtreatment, argue Brooke Nickel and colleagues

Evidence is mounting that disease labels affect people’s psychological responses and their decisions about management options.1 The use of more medicalised labels can increase both concern about illness and desire for more invasive treatment. For low risk lesions where there is evidence of overdiagnosis and previous calls to replace the term cancer,2345 we consider the potential implications of removing the cancer label and how this may be achieved.

Our changing understanding of the prognosis of cancers

Some cancers are non-growing or so slow growing that they will never cause harm if left undetected.6 A prime example is low risk papillary thyroid cancer. Autopsy studies show a large reservoir of undetected papillary thyroid cancer that never causes harm,7 and the incidence of thyroid cancer has risen substantially in many developed countries. This rise has been predominantly driven by an increase in small papillary thyroid cancers, with mortality remaining largely unchanged.8 These small papillary thyroid cancers are increasingly being detected because of new technologies, increased access to health services, and thyroid cancer screening.4 Studies show that rates of metastases, progression to clinical disease, and tumour growth in patients with small papillary thyroid cancer who receive immediate surgery are comparable with those in patients who follow active surveillance.910

Likewise, for both low risk ductal carcinoma in situ (DCIS) and localised prostate cancer, detection strategies have become controversial as long term outcomes for both conditions have been shown to be excellent1112 and there is evidence and concern about overdiagnosis and overtreament.6 Given the potential harms of overtreatment of DCIS, active surveillance is now being trialled internationally as an alternative approach. …

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