US experts propose renaming cancers not likely to kill

U.S. cancer experts from some of the nation's cancer research institutions are advising some changes in the way cancer is defined and detected. The working group of the National Cancer Institute, which includes some of the top scientists in cancer research, recommend some premalignant conditions, such as ductal carcinoma in situ, which many doctors agree is not cancer -- although many women have been told was breast cancer -- should be renamed to exclude the word carcinoma, The New York Times reported. By renaming the premalignant condition, patients might be less frightened and less likely to seek what might be unneeded and potentially harmful treatments such as surgical removal of the breast, the group said. The group also suggested many lesions detected during breast, prostate, thyroid, lung and other cancer screenings should not be called cancer at all but should instead be reclassified as IDLE conditions, for "indolent lesions of epithelial origin." The motivation for the change is the concern that hundreds of thousands of U.S. men and women are undergoing needless, disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm. However, Dr. Larry Norton, the medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center, who was not part of the group, said the larger problem is that doctors cannot tell patients with certainty which cancers will not progress and which cancers will kill them. "Which cases of D.C.I.S. -- ductal carcinoma in situ -- will turn into an aggressive cancer and which ones won't?" he asked. "I wish we knew that. We don't have very accurate ways of looking at tissue and looking at tumors under the microscope and knowing with great certainty that it is a slow-growing cancer." For example, when a common Pap smear finding called "cervical intraepithelial neoplasia" was reclassified as a low-grade lesion rather than a malignancy, women were more willing to submit to observation rather than demanding treatment, said Dr. Laura J. Esserman, the lead author of the report. The findings were published in the Journal of the American Medical Association.