When the federal government says so.
Paul Hsieh, at Forbes, writes about the Feds’ desire to redefine the word ‘cancer’ to exclude certain conditions that have hitherto been called cancers. As, for instance, cancerous but slow-growing lesions. The word ‘cancer’ would now be reserved for cancers that have a reasonable likelihood of killing the patient if left untreated.
These are the conclusions put forth in a working paper published by the National Cancer Institute in July 2013. Its somewhat Orwellian title is Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement. I say ‘Orwellian’ because, while I understand the business of overtreatment, I am not sure how one can overdiagnose cancer. Perhaps they should have referred to ‘redefinition of cancer,’ but that, while making more sense to me, might have been giving away the game – whatever the game is.
The justification for the redefinition? Here is how Mr. Hsieh tells the story.
Their justification was that modern medical technology now allows doctors to detect small, slow-growing tumors that likely wouldn’t be fatal. Yet once patients are told they have a cancer, many become frightened and seek unnecessary further tests, chemotherapy, radiation, and/or surgery. By redefining the term “cancer,” the National Cancer Institute hopes to reduce patient anxiety and reduce the risks and expenses associated with supposedly unnecessary medical procedures. In technical terms, the government hopes to reduce “overdiagnosis” and “overtreatment” of cancer.
And the implications?
…while there are legitimate scientific and medical questions about the proper definition and classification of any disease (including cancer), we must be careful that that any redefinition won’t be used for inappropriate political purposes. Given the increasing government control over US health care, how the government defines medical terms can have serious economic and policy implications.
As he says: ‘how the government defines medical terms can have serious medical and policy implications.’ Examples of how medical definitions have become political footballs? Definitions of ‘pregnancy’ and ‘live birth,’ or the recent decision by the American Medical Association to define obesity a disease.
Now, I, a reasonably well, ahem, functioning 62 year-old man, ask myself the following question. We know, for instance, that prostate cancer is a very slow-growing cancer and, if confined to the prostate, presents little if any danger. That is, if the new definition is implemented, it might no longer be called cancer because, as I have heard doctors say, you will die of old age before you die of prostate cancer.
The trouble is, some types of prostate cancer can grow and metastasize rapidly and then, yes, kill you. Even if prostate ‘non-cancer’ is redefined as cancer when it begins to metastasize, my chances of survival are less than if it had been treated before it had begun to grow. As the Mayo Clinic website says: ‘Prostate cancer that is detected early — when it’s still confined to the prostate gland — has a better chance of successful treatment.’
And let us say that the metastasis occurs after I have turned 70. Will a government bureaucrat say to me: ‘Ummm… We have bigger fish to fry, old man. After all, statistically, you’re not likely to be using any of that plumbing down there any more, not for that, anyway, so I think we’ll just let it ride and use our money on someone more deserving. Uh, needful, needful, I mean needful.’
And my family doctor, provided that he is still allowed to be in business, will give me a guilty look and assure me that he’ll be with me there, all the way (and he will, too, because he really is a great guy and friend). He might even be permitted to prescribe anti-anxiety medicine to allay my ‘patient anxiety’ about having cancer that will not be treated, or at least sneak me some samples on the side.
Just wondering where all this is going. (Actually, I do know, but that is another story.)