ideasIdea
An international body to rename indolent lesions so 'cancer' means something
Some things called cancer, such as low-grade prostate lesions, almost never spread. An expert body could reclassify them, as cervical precancer was, so fewer people are overtreated.
Cervical CIN and bladder PUNLMP are precedents for moving low-risk lesions out of the carcinoma category. Propose a WHO/IARC-convened classification group with explicit criteria (lifetime metastatic risk under 1% untreated) and a schedule to review Gleason 6, papillary microcarcinoma, low-grade DCIS, small renal masses, and Barrett's low-grade dysplasia.
Hypothesis
Reclassification reduces active treatment of the reclassified lesions by at least 40% within five years without a measurable increase in cancer-specific mortality.
Rationale
Words drive fear and treatment; PUNLMP shows the profession can do this.
What would test it
Pre/post analysis after WHO Classification of Tumours reclassification for one lesion type, Gleason 6 first.
Maturity
speculative
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
5
Bottlenecks it attacks
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.