doctor: "You have cancer."
our brains: Panic! Cancer! What!? Cancer!
our mouths: "Oh . . . Uh oh! Well, is it a BAD kind of Cancer?"
It's the "Big C." It's a scary word. And fortunately there is a lot we can do with screening, advanced tools for diagnosis, and treatment in many modalities to combat the Big C.
These days, everyone gets cancer, unless something else gets them first. Cancer is part of the natural process of cells replicating, and it's all explained elegantly by the New York Times Sunday Review: Why Everyone Seems to Have Cancer.
But not all cancers will end our lives. There are "pre-cancers" and there are "early cancers," and these are often not going to hurt us, so they are okay to manage with a 'watch and wait' strategy. People can be scared into seeking aggressive treatment because they lump these "pre-cancers" in with the "very much cancers," which usually warrant a good battle in the right patient.
Sometimes it does matter if we can catch things early and treat them before they progress, like when we see changes of the cervix during pap screening; these can be treated to prevent progression to invasive cancers. That's really important, and it saves lives, but it only applies to a certain population, under certain circumstances.
Sometimes it doesn't much matter when we catch things, as we are learning with most cases of prostate cancer, for example. In recent years we have started to discover that the treatment might be worse than the disease, and maybe we shouldn't be screening for prostate cancer the way we have been.
Perhaps we should be more careful then with what we label "CANCER." That word tends to lead to a cascade of troubled thoughts, and we wind up worried about writing a will, rather than understanding what those dastardly – but potentially harmless – cells in our body are doing.
Alexandra Barratt, Professor in the Department of Public Health at University of Sydney writes:
Early cancers and pre-cancers (abnormal cells that could turn cancerous) found by screening tests, such as mammograms and PSA tests, should be renamed without (scary) words such as carcinoma or neoplasia in their title. They suggested they could be renamed IDLEs – indolent lesions of epithelial origin.
She goes on to explain the risks of overdiagnosis, the fallacy of lead-time-bias, and what we can do about all this as patients and providers, with the guidance of the National Cancer Institute.
Read more on The Conversation.