NLM Director’s Comments Transcript
Cancer Redefined?: 08/05/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

A group of scientific advisors to the National Cancer Institute (NCI) recommended the use of the word ‘cancer’ to describe some diseases should be curtailed, advocated more disclosure about cancer screening risks, and suggested new strategies to reduce the overdiagnosis of indolent (slow developing) cancers, in a stimulating commentary recently published in the Journal of the American Medical Association.
The commentary’s authors (who participated in an innovative 2012 NCI scientific advisory meeting) provide some background to their recommendations by explaining (and we quote): ‘the word ‘cancer’ often involves the specter of an inexorably lethal process; however, cancers are heterogeneous (differ) and can follow multiple paths, not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient’s lifetime’ (end of quote).
The commentary’s authors add (and we quote): “Although no physician has the intention to overtreat or overdiagnose cancer, screening and patient awareness have increased the chance of identifying a spectrum of cancers, some of which are not life threatening’ (end of quote).
To respond creatively, the authors suggest the term ‘cancer’ should be used less frequently (and we quote): ‘reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated’ (end of quote).
The commentary’s authors also suggest a substitute for the word ‘carcinoma’ should be found to refer to the lowest grade tumors and more benign-appearing lesions that are detected during breast, prostate, thyroid, lung and other cancer screenings.
The authors add (and we quote): ‘A multidisciplinary effort across the pathology, imaging, surgical, advocate, and medical communities could be convened by an independent group (e.g. the Institute of Medicine) to revise the taxonomy of lesions now called cancer and to create reclassification criteria for IDLE (or indolent) conditions’ (end of quote).
Among several recommendations, the commentary’s three authors additionally suggest there should be increased disclosure about cancer screenings that detect harmless lesions -- because medical interventions for unnecessary clinical procedures can cause harm. The authors emphasize some cancer screenings’ unhealthy risks need to be more acknowledged by health care providers as well as better understood by patients and the public.
The authors emphasize increased public awareness might reduce patient requests for some cancer screening procedures and decrease questionable medical interventions to remove harmless lesions.
The commentary’s authors also suggest new strategies to reduce the overdiagnosis of indolent (slow developing) diseases. They write (and we quote): ‘Strategies to reduce detection of indolent disease include reducing low-yield diagnostic evaluations appropriately, reducing frequency of screening examinations, focusing screening on high-risk populations, raising thresholds for recall and biopsy, and testing the safety and efficacy of risk-based screening approaches to improve selection of patients for cancer screening’ (end of quote).
The authors conclude the term ‘cancer’ needs redefinition --and how some information about cancer is conveyed requires an overhaul. The authors find the aforementioned steps are needed to improve public understanding, and refocus medical practice on procedures aligned with screening’s original goals -- the early detection of harmful cancers to improve patient outcomes.
Meanwhile, MedlinePlus.gov’s cancer health topic page provides comprehensive information about cancer’s diagnosis/symptoms, prevention/screening, and treatment.
NCI provides an overview of cancer screening within the ‘prevention/screening’ section of MedlinePlus.gov’s cancer health topic page.
A helpful website (from the American Cancer Society) helps you talk to your doctor about cancer and is available within the ‘related issues’ section of MedlinePlus.gov’s cancer health topic page.
MedlinePlus.gov’s cancer health topic page also contains research summaries, which are available in the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about cancer as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s cancer health topic page, type ‘cancer’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘cancer (National Library of Medicine).’ MedlinePlus.gov additionally features health topic pages on most types of cancer (such as thyroid, breast, cervical, prostate, and lung) as well as a health topic page devoted to living with cancer.
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