When Cancer is no Longer Cancer

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Siddhartha Mukherjee, 2012

 

Things change. A recently published study discusses re-evaluation of a certain type of thyroid lesion--Encapsulated Follicular Variant of Papillary Carcinoma of the Thyroid (EFVPTC). Follow up on over 100 patients who had the lesion surgically removed showed no evidence of spread or recurrence. The findings imply that EFPVTC is benign, with no need for further treatment, and tumors with this particular microscopic appearance will henceforth be given a rather lengthy name, shortened to NIFTP . Don't call it cancer! The appearance of the tumor hasn't changed, just our understanding of its behavior*. This is big and important news for patients with a lump in their throat. Similar re-evaluations have arisen or may arise in dealing with lesions in the bladder, prostate and breast.

I learned about the study in an article in the New York Times. The article is interesting reading, but what I spent more of my time examining was the Reader Comments section of the Times. I am amazed at the varying opinions, observations and hostility that this article provoked. A major thread is that Cancer-Industrial Complex (CIC) of physicians, hospitals, and Big Pharma are in the business of over-diagnosing and over-treating cancer in the interest of increasing revenue. These readers are amazed that the CIC would ever allow a study to be published that would decrease the number of cancer patients.  After all, fewer cancer patients equals fewer dollars in the hands of greedy docs, hospital administrators and pharma execs. Then there are the readers who believe a study such as this one must be supported by the government and insurance industry. Medicare, Blue Cross, Humana and others stand to save millions of dollars if there are fewer thyroid cancer patients making claims.

My view? Designations change. One way is through the use of long term follow up studies such as the one on EFVPTC. Molecular studies on the genes in tumor cells may soon do an even better job at differentiating benign tumors from malignant ones. In the meantime, I report what I see under my microscope, the "names" I use based on our current knowledge and agreed upon terminology. My goal is neither to enrich our "industry" or save the insurance company some bucks. The people whose biopsies I look at may not know my name or where my office is, but they are still my patients, and I want only the best for them.

*A reinforcement. The findings in the published article refer to only one very specific type of thyroid cancer.

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