The Definition of “Cancer”: JAMA Opinion Piece Triggers Medical, Scientific, and Policy Debate

With the online publication of an opinion piece in the Journal of the American Medical Association, Drs. Laura J. Esserman, Ian M. Thompson, and Brian Reid have triggered a medical, scientific, and policy debate about the definition of “cancer” and strategies for diagnosis and treating cancer.  The authors wrote for a working group that was convened by the National Cancer Institute in 2012 to address the problem of overdiagnosis of cancer, when tumors are detected through screening that would otherwise not become clinically apparent or cause death.  In the article, the authors identified several strategies for addressing overdiagnosis, which in turn leads to overtreatment.   They concluded their opinion piece, “Screening always results in identifying more indolent disease.  Although no physician has the intention to overtreat or overdiagnose cancer, screening and patient awareness have increased the chance for identifying a spectrum of cancers, some of which are not life threatening.  Policies that prevent or reduce the chance of overdiagnosis and avoid overtreatment are needed, while maintaining those gains by which early detection is a major contribution to decreasing mortality and locally advanced disease.”