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The Word “Cancer” is Changing its Meaning
April 9, 2012 - By the late 1940s we knew a great deal about acute infectious diseases. We understood that these diseases could be identified by the specific microorganisms that caused them and that they had a definite course. Further, we knew that they were accompanied by high fever, internal shivering, pain, skin eruptions or some other acute symptoms. It was also understood that these diseases could be reduced or even eliminated if an appropriate vaccine was found that would prepare the body to fend off the microorganism. Many such diseases could be treated with existing antibiotics and more were being researched.
Small pox, tuberculosis, and typhus were all on the wane. They were being conquered by powerful scientific research. It was at this time that the small medical cancer societies began to build large organizations to gather funding for the scientific study that would conquer cancer and many other diseases.
Cancer was considered to be an acute disease that often carried with it a death sentence. If “Cancer” was the diagnosis, the best one could hope for was “Remission.’’ There was no complete “Cure.” I capitalized all those words because they were all portentous and closely linked to the acute.
Most of us still think of cancer as an acute disease, and this is certainly true of late stage cancers. Yet we have begun to diagnose cancer at ever earlier stages, when they are not acute. As the New York Times reported on Oct 29, 2011 we have discovered that “many if not most cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated — they are harmless.” We are coming to see that cancer, like heart disease, is not an acute disease. Although some cancers progress to acute phases and require acute interventions most are chronic, and the response to them requires continuity of care and watchful waiting by patient and doctor.
However we are so ingrained with the earlier ideas that we still respond to the diagnosis of cancer as the “Big C.” We now know that much breast cancer and prostate cancer has been over-treated in recent years, at great personal cost to those treated, and great economic cost to the system. The rallying cry was “Find it early and get rid of all of it so that it does not spread!” The New York Times article points out that “P.S.A. screening test for prostate cancer does not save lives and causes enormous harm” to male continence and sexual capacity. Early diagnosis and over-treatment of some breast cancers seems to follow a similar pattern and so less frequent and later mammography is becoming the new norm.
We must learn to respond to these and other diseases as chronic rather than acute, and reduce the level of panic that usually accompanies such diagnoses. This means helping the system reduce its tendency to over-diagnose and over-treat them, and allowing patients to participate more fully in their diagnosis and treatment.
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