Tom Wilemon, The Tennessean
Patients once diagnosed with cancer may be told in the future they’ve got an IDLE disorder. Doctors won’t be calling the patients lazy — but they will be saying their suspicious spots are.
Only the lesions that typically kill if left untreated should be classified as cancer, according to a recent editorial in the Journal of the American Medical Association written by an advisory panel to the National Cancer Institute. Too many people hear only “cancer” when diagnosed with non-growing carcinomas and end up on operating tables when they don’t need surgery, the authors said.
They contend that overdiagnosis of cancer leads to overtreatment. They have suggested dropping the word “cancer” entirely for these non-growing or slow-growing carcinomas and calling them IDLE, an acronym for “indolent lesions of epithelial origin,” which is also a synonym for their lazy behavior.
Dr. Otis W. Brawley, chief medical officer of the American Cancer Society, agrees with the panel, which includes some of the nation’s top cancer researchers. He said a new disease classification is needed for the 21st century instead of one based on what German pathologists saw under microscopes in the 1850s.
“The truth be told, this is very much kind of like racial profiling,” Brawley said. “It looks like what killed somebody 160 years ago, but that doesn’t mean it is going to grow, spread and kill. It may very well be genomically programmed to stay just a 5-millimeter lesion for the next 70 years.”
One such example is ductal carcinoma in situ. Currently considered a type of breast cancer, it is actually an IDLE condition, he said. But when women get the diagnosis, all they hear is “carcinoma” — and some frightened patients may opt to have both breasts removed, even though tumors might never develop or spread.
Dr. Jeff Patton, chief executive officer of Tennessee Oncology, said true cancer cells invade other cells, while ductal carinoma in situ cells stay within the milk duct. “As long as those cells don’t do something that hurts you, it’s not cancer,” said Patton. “It’s not just the cell itself. It is the biology of how it behaves.”
The new challenge is to develop more genotyping to better identify the multitude of cancers and distinguish the degree of danger they pose, Brawley said.
It’s a balancing act to take the suggestions from the medical panel and actually put them into practice when dealing with patients, said Patton.
“It’s a double-edged sword,” he said. “We want people to be comfortable with cancer, but we don’t want them to take it lightly.”
Research by Vanderbilt University this year revealed that men with prostate cancer experienced widespread complications after undergoing either surgery or radiation therapy. Most men are rendered impotent within two years regardless of which procedure they choose, and more than a third who opt for radiation have problems controlling bowel movements.
Dr. David Penson, the senior author, said a third or more of men with prostate cancer have slow-growing tumors that can be closely monitored. He said a tighter definition for cancer that can be lethal is a good idea.
“Whether you are using a term like IDLE, indeterminate or indolent, if you take away the word ‘cancer,’ people get to see things a lot differently,” Penson said.
Cancer diagnoses also can limit physician choices, he said, especially when a patient demands aggressive treatment for a non-growing or slow-growing form.
“You are painted in a corner,” Penson said. “It’s almost the perfect storm because you have a patient who, even though they have been told it is slow-growing and it is not a problem, they have been told they have cancer. What they want is certainty.”
If a physician refuses to offer aggressive treatment, the doctor has a chance of being sued. “What if that guy is the 1 percent (whose cancer spreads) and five years from now I have the patient’s family hollering at me and maybe even have their malpractice attorney yelling at me because the patient asked me, ‘Can I get this treated? Can you give me a guarantee?'” Penson said.