Redefining Cancer: A New Approach to Early Stage Diseases

The understanding of disease biology for many cancer types has significantly advanced in recent years. However, this progress is not always mirrored in the way cancer is defined and treated. This can lead to overdiagnosis and overtreatment, particularly in cancers such as ductal carcinoma in situ (DCIS) and low-grade prostate cancer, which pose minimal risks for mortality or diminished quality of life.

Reconsidering the Definition of Early Stage Cancers

Leading experts in the field, including Laura J. Esserman, MD, MBA, and Scott Eggener, MD, propose rethinking the way cancer is defined in its earliest stages. They suggest that these conditions may be more accurately described as risk factors for malignancy rather than invasive disease. This perspective challenges the traditional approach to cancer treatment, which often involves intensive therapies that can result in physical pain, disfigurement, psychosocial distress, or financial burdens.

A more cautious and individualized approach to treatment is advocated by these experts. They emphasize the importance of exploring alternatives and clinical trials. Esserman and Eggener propose that DCIS can be considered a window of opportunity for prevention and not necessarily a disease that requires surgery. They also highlight the need for new approaches to screening, early detection, and prevention for both breast and prostate cancers.

Controversy and Potential Benefits

Redefining what is considered as 'cancer' has sparked debate among oncology experts. On one hand, there are concerns about the potential consequences of such a change. On the other hand, proponents argue that this re-evaluation could lead to positive outcomes such as reduced overdiagnosis, overtreatment, and financial strain for patients.

Importantly, this redefinition calls for a more precise and personalized approach to detecting and treating early stage cancers. It emphasizes the potential benefits such as reducing unnecessary treatments and improving patient outcomes. However, experts caution that any change in nomenclature should not affect how the disease is managed.

Progress in Cancer Treatments

Alongside these discussions, advancements in cancer treatments continue. For instance, the approval of Tagrisso with the addition of chemotherapy in the US for the treatment of adult patients with EGFR mutated advanced lung cancer is a significant step forward. Based on results from the FLAURA2 Phase III trial, this combination therapy reduced the risk of disease progression or death by 38% compared to Tagrisso monotherapy.

Challenges and Future Directions

While the discussion to redefine cancer continues, there are persistent challenges in the field. Defining and treating cancer pain, integrating new systemic therapies with radiotherapy, and understanding the role of peripheral sensory neurons (PSNs) in cancer progression are among the hurdles to be addressed. However, with ongoing research and clinical trials, there is optimism that these challenges can be overcome, leading to improved quality of life and outcomes for patients.

In conclusion, redefining cancer in its earliest stages could potentially shift the paradigm of cancer treatment. It is a controversial but significant discussion that could lead to more precise, individualized, and less burdensome treatment approaches. As the medical community continues to explore this concept, it is crucial to ensure that such changes are implemented in a way that best serves the interests of patients.