For centuries, doctors diagnosed illness using their senses — by touching, poking, prodding, looking, listening, even tasting. A skilled doctor could make an amazingly accurate diagnosis about what ailed the patient by just using his eyes, ears, nose, and hands.
But today, doctors pay more attention to what pathologists find (and make up names for) under the microscope. They ignore what is right in front of them, visible with the naked eye.
Looking with the naked eye is still a key approach in my own specialty — forensic pathology. But many doctors in the other fields of medicine set it aside. It too has become victim of the reductionist, modern, “mini-micro-micro” approach to everything in medicine. In my view, it also contributes to the epidemic of overdiagnosis and overtreatment of cancer, which is now finally coming to light.
For example, as I reported yesterday, in a recent study published in the New England Journal of Medicine, researchers estimate that breast cancer was “overdiagnosed” in 1.3 million women over the past 30 years. And in 2008 alone, breast cancer was overdiagnosed in more than 70,000 women. That number accounts for almost one-third (31 percent) of all breast cancers diagnosed in 2008!
The researchers defined “overdiagnosis” as “tumors detected on screening that would never have led to clinical symptoms,” let alone death from breast cancer. So in essence, mammography created 1.3 million cases of breast cancer out of thin air. They were never there in the first place.
Sometimes a spade is just a spade
Overall, we should not call tumors “cancer” if they do not “move,” invade, metastasize, or lead to death of the patient if simply left alone. Essentially, if there is no evidence that the “cancer” cells inside the tumor are moving elsewhere in the body, it’s not really cancer.
In fact, as I explained yesterday, the word cancer comes from the Latin for crab (and Greek karkinos, for carcinoma). True cancer typically moves in the body, sideways like a crab, invading and metastasizing to other tissues.
The word tumor comes again from the Latin, which simply means a swelling or mass. A tumor does not necessarily move, and does not necessarily mean cancer. Tumor is also one of the four cardinal signs of inflammation [tumor (swelling), rubor (redness), calor (heat), and dolor (pain)].
Dolor also means sorrow or distress, as in the biblical Via Dolorosa, or the road of sorrows, followed by Christ to the Crucifixion. Tragically, imprecise cancer diagnoses puts millions of patients on their own road of sorrows when they receive a “cancer” diagnosis for something that’s not cancerous at all.
The very idea of calling a tumor “cancer” when it does not move is a contradiction in terms — an oxymoron. It’s enough to make you wish doctors still had to actually learn some Greek and Latin.
Good doctors use the word “cancer” cautiously
I know many influential doctors, who are good at understanding language. They have been calling for greater precision and accuracy for the terms thrown around when talking about tumors or cancer. In fact, my friend, George Lundberg, M.D., a distinguished pathologist who served as Editor-in-Chief of the Journal of the American Medical Association for 20 years and founding editor of Medscape, spoke out early about the importance of not calling a tumor “cancer,” when it’s not.
As a medical editor, he knows all about the importance of accuracy and precision in the language we use, just as accuracy and precision are critical in science and biostatistics. Yet, every day I see examples of flawed, reductionist thinking (not to mention abysmal English composition) in medical writing and reporting all across the board.
And the problem of cancer overdiagnosis reaches far beyond just breast cancer. Take thyroid “cancer,” for example…
I regularly read about the “dramatic spike” in thyroid cancer cases in this country. Really? More cases, or just benign tumors that were always there — now classified incorrectly as “cancer”?
The overdiagnosis epidemic is so bad, an international panel of doctors just determined that one common type of thyroid tumor, widely classified as “cancer,” isn’t really cancer at all.
Over the past three decades, the unfortunate patients with these innocent thyroid tumors underwent disfiguring neck surgery, exposure to radiation, and poisoning their thyroid glands with radioactive iodine. Then, they spent a lifetime attending regular doctor visits for synthetic “thyroid replacements.” Not to mention all the metabolic problems that result from losing a key gland of the endocrine system.
All for nothing.
10,000 a year wrongly diagnosed with thyroid cancer
The movement to correct the classification of thyroid tumors began just two years ago with Dr. Yuri Nikiforov, chairman of pathology at University of Pittsburgh. He kept telling surgeons these were very low risk tumors, which didn’t have to be treated or removed. But you know the old jokes about the propensity of surgeons to cut first and ask questions later.
Dr. Nikiforov told the New York Times last month, “That’s enough. Someone has to take responsibility to stop this madness.”
This course correction could affect about 10,000 of the nearly 65,000 patients diagnosed with thyroid “cancer” in the U.S. each year.
Unfortunately, other than the new reform of thyroid cancer, reclassifications and updates over the last 20 years that reflect the real science have only happened for bladder, cervical, and ovarian “cancer.”
So when it comes to the “big three” of the “big C” — breast, lung, and prostate cancer — nothing has been done.
Indeed, it’s time to stop the madness, Dr. Nikiforov. And approach the problem of real cancer with something other than microscopic vision.
“It’s Not Cancer: Doctors Reclassify a Thyroid Tumor,” The New York Times (www.nytimes.com), 4/14/2016