There are certain words or phrases you never want to hear come out of a doctor’s mouth: “You know, this is the first time I’ve ever tried this procedure”; “I’ve never seen one that color before”; “HOLY SHIT WAYNE, COME AND LOOK AT THIS!”; and of course, “Cancer.”
The latter, more than any other, is capable of sending you spiraling toward a deep well of online forums, WebMD articles and Reddit threads, all of which will have you begging your doctor to either cut you open or give you chemo. That’s exactly why a new analysis in the British Medical Journal recommends that the word “cancer” be dropped from some medical diagnoses. “There is an emerging body of research demonstrating that the use of more medicalised labels — including the ‘cancer’ label — can increase both concern about illness and the desire for more aggressive treatments,” says Brooke Nickel, a public health researcher at the University of Sydney, who led the analysis. “We now know from a number of studies that those who hear the term ‘cancer’ during a hypothetical diagnostic scenario, compared to those who hear a non-cancer term for the same condition, have significantly higher levels of anxiety and a greater desire for aggressive treatments, i.e. immediate surgery vs. active surveillance.”
Additionally, according to a report in The Guardian, medical technology has become so advanced in recent years that early abnormal lesions — which are often described as precancerous — can now be detected at smaller sizes than ever before. The upshot is, if you look deep enough, you’ll probably find something that could potentially become a life-threatening form of cancer, even if it’s unlikely to do so in reality. This, says Nickel, is why the current definition of cancer is out-of-date. “We now know that some cancers are non-growing, or so slow-growing that they will never cause harm to an individual if left undetected or untreated.”
One example Nickel points to is low-risk papillary thyroid cancer. “Studies show that progression to clinical disease and tumor growth in patients with small papillary thyroid cancer who choose surgery are comparable to those who monitor their condition,” says Nickel. In other words, in some low-risk forms of cancer, choosing to get cut open isn’t any more likely to save your life than doing nothing. In fact, opting to have surgery in this case is an example of overtreatment that Nickel believes is unnecessary and may in fact cause further physical or psychological harm to the individual.
Another example of overtreatment, suggests Nickel, is in patients who have localized prostate cancer. Patients often decide to have a radical prostatectomy and radiotherapy, which can result in serious adverse consequences including impotence and incontinence. “Both of which can have serious physical and psychological implications for the individual affected,” she says.
That said, Nickel explains that she’s not suggesting we leave it up to doctors to make the call on whether or not to use the C-word for very low-risk diagnoses. Instead, she’d like to see an international debate and discussion between cancer experts, patients and citizens about how low-risk cancers are defined. “If these conditions were redefined, then doctors would use the new terms that have been agreed on,” says Nickel. “However, until such a change is formally agreed on and implemented, doctors should continue to use the term cancer while also initiating discussions about the likely benign nature of these low-risk conditions, the possibility of overdiagnosis and overtreatment, and the option of less invasive management such as active surveillance.”
Of course, all of this assumes that men are even going to see their doctor in the first place…
Andrew Fiouzi
Andrew Fiouzi is a staff writer at MEL.
