Should 'Cancer' Be Dropped From The Name of the Low Risk Lesions

The name 'Cancer' invokes so many emotions in every patient who hears this word.  Anything that they hear after that is in a fog of this emotion. Even us, doctors have the same reaction if we are faced with this diagnosis.  The best description that I could find about this is in the book "When Breath Becomes Air" by Paul Kalanithi.

There are two examples where we have either changed the name or should be possibly thinking about the change.

Breast cancer, or should I say Ductal Carcinoma in Situ (DCIS) is the best example.  In the example of low-grade carcinoma in situ, 30-50% of these lesions will progress to cancer within 30 years.  Many women with this condition will never progress to develop cancer, and quite a few of the women will likely dye of other causes by the time DCIS progresses to cancer.  In these women, any surgical treatment will lead to more complications than leaving DCIS alone.  So why do we as doctors do this?  On the one hand, we have patients who are not happy to sit on this risk, as they think they have cancer.  

On the other hand, so far all the recommendations for treatment of DCIS are - surgery first.   I have had patients who are in their late 70s or 80 with an incidental diagnosis of a small area (<1cm) of DCIS with few medical problems that I have suggested that maybe we could just "keep an eye on this" with regular mammograms.  I have so far not had a patient who wanted to do this, they all wanted to have surgery.  They often say:" Doctor, this is cancer or it will become cancer and I cannot wait for this to develop into one.  I just want it all out."

The other condition is the micropapillary thyroid cancer - papillary thyroid cancer that is size less than 1cm.  We know from studies in Japan where they are observing many patients that it is safe to wait to see whether these cancers will grow and then remove it.  I have yet to find a patient who is happy to have surveillance of their papillary thyroid cancer.  They hear the word cancer and they all want it out.

In one condition we were successful in changing the name of encapsulated follicular variant of papillary thyroid carcinoma (EFCPTC) to non-invasive follicular neoplasm with papillary like features (NIFTP).  This diagnosis can only be made by excising half of the thyroid that contains this lesion.  Previously we have often proceeded to remove the remaining half of the thyroid, but after this change and knowledge that these growths are very rarely going to spread, we now know that we do not need to remove further thyroid and that we can safely discharge these patients from follow-up.

There have been several debates to try and drop the name cancer from certain DCIS condition, but so far this has not happened.

What do you think?  Should we drop the cancer out of the name?

​In my opinion, we should be looking into this as at the moment we are overtreating many women who have DCIS.  All this treatment leads to lower quality of life for these women and leads to increased stress levels.

If we as doctors have a huge reaction to hearing the name cancer, and we know much more about the subject, how can we ever expect that educating patient will not provoke such a reaction?  Educating patients helps, but I believe changing the name helps as well.  Change in name automatically leads to lower stress levels, as patients straight away know the prognosis of their condition is not as serious as it is not cancer.

I am personally looking forwards the study results from the Yale University by Dr Shelley Huang (COMET) which will let us know if it is safe to observe women with DCIS.

We as doctors also have a responsibility not to over-treat patients as part of our Hippocratic Oath (PRIMUM NON-NOCERE).