When ‘Cancer’ Gets in the Way of Treatment

Calling DCIS “cancer” can signal to patients that they face a medical emergency requiring immediate surgery and, often, radiation. Yet studies suggest that such harsh treatments may be unnecessary and overused. Preliminary results from a trial of nearly 1,000 women with DCIS showed that, two years into the study, patients who were being actively monitored did not experience a higher rate of cancer than patients treated with surgery.

“A lot of these cancers didn’t show up yesterday, so it’s not an emergency,” said Dr. Laura J. Esserman, a surgeon and oncologist at the University of California, San Francisco’s Breast Care Center who diagnoses and treats DCIS. “It’s an emergency only because you know about it.”

To Dr. Esserman, the solution is simple. Call the condition something else: abnormal cells, low-grade lesions, stage 0 cancer, precancer, a risk factor for cancer. Renaming DCIS is an “ethical imperative,” she has argued, to spare patients undue anxiety and to shift the current treatment paradigm from invasive surgery to active monitoring (sometimes with hormone-blocking medications).

This problem goes beyond the breast. A handful of other conditions straddle this in-between space, including early-stage cancers of the lung, thyroid, esophagus, bladder, cervix, prostate and skin. Some, like early-stage prostate cancer, are still called cancer. Others have already had the word excised from their names: Abnormal cervical cells, for example, are now referred to as dysplasia.

In all of these cases, Dr. Esserman said, the word “cancer” does not reflect biological reality. Cancer “is a blight, something that will grow and take over and kill you,” she said. “If the condition is not that, then the name isn’t correct.”