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12 Aug 13 14:15

Laura Esserman is a breast cancer specialist at the university of California, San Francisco. She is the co-author of new recommendations to avoid over-diagnosis in cancer. She is also coordinating a big scale research effort to match the right drug to the right cancer patients.

I came across an interview of hers at New Scientist magazine and I am attaching the link:

In this brief discussion, she makes some interesting points on the cancer over-diagnosis problem, better determination of precancerous cases as well as why a redefinition of the word 'cancer' can help.

If it isn't life-threatening, don't call it cancer - opinion - 12 August 2013 - New Scientist

Cancer screening too often leads to scare diagnoses and unnecessary treatments. It's time to rethink our approach, says cancer specialist Laura Esserman

Category: Funding longer lives: Health/medicine

Tags: #Cancer.


Jennifer Rodney - 13 Aug 2013, 7:40 a.m.

Aspasia, thanks so much for sharing this article. Cancer has heavily affected both sides of my family tree, so I know the worst manifestation of the disease and it's a topic that comes up frequently during doctor appointments.
This past Spring, I got some results back from a routine test and the cancer word was brought up. As you might imagine, it was tough to keep perspective and the first few weeks of figuring out what was actually going on was totally emotional and overwhelming. I WISH the medical professionals I was working with had been able to communicate with greater nuance. As soon as you hear the word cancer or even pre-cancer, it's hard not to start thinking the worst. All I wanted was any drop of reassurance or clarity from a professional but it took many visits, persistent questioning, personal research and anecdotes shared by friends who had experienced something similar to understand that I was most likely dealing with a manageable situation involving abnormal cells rather than something very serious.
At the same time I was supporting a good friend who was going through radiation for breast cancer, and I could witness that the biggest challenges for her personally was trying to get a clear picture of her situation and level of risk from her medical team AND managing her own stress and fear about her illness. I fully understand that in many cases, a cancer diagnosis IS a very serious thing and it's better to err on the side of caution in all cases and be thorough in diagnosis and treatment, but I definitely support any effort for clearer communication, easier access to more information and above all less fear.

Aspasia Angelakopoulou - 13 Aug 2013, 11:26 a.m.

Hi Jennifer,

Many thanks for sharing your personal experience. I think this is very interesting and straight into the point. Even though I never had a relative or close friend experiencing the disease, I can see still see this bulk of emotions that someone feels when the word "cancer" is announced by the doctor. I think in most people's minds, in mine as well, this word is accompanied by feelings of panic and great stress...death comes to mind often as well. I agree with you that it is not a simple disease but I strongly believe that doctors should definitely make sure that they communicate results with as great clarity as possible and make the patient feel as comfortable and less panicked as possible. The patient is very vulnerable at this stage and needs as much support as possible. In the end fear and negative thinking can make things much worse.

Nicola Oliver - 11 Sep 2013, 1:40 p.m.

Thank you Aspasia and thank you also Jennifer for sharing such a personal story. This seems like a sensible approach in situations where it's really not necessary to produce unnecessary anxiety; goodness knows its stressful enough being in hospital either for appointments or as an in-patient! But clarity where cases are serious is required though not always delivered either.
I trained as a nurse in the late 1980's at a time when the communication from hospital doctors to patients and their families was,at times, quite frankly, dire. I can recall on a number of occasions when a diagnosis of cancer needed to be given to a patient. It went something like this;
'Group of doctors and senior consultant enter patients room. Junior doctors present the background case. No-one as yet has greeted the patient. Consultant turns to patient and says "you have CA colon, we will be able to perform a resection in 2 days then you will need further treatment. I will see you in 2 days." Consultant and juniors sweep out of the room. Patient turns to nurse to asks, " what does that mean?" Nurse not permitted to have that sort of conversation with a patient (giving a diagnosis) and arranges for a junior doctor to come back and explain, but doc gets way-laid in the Accident and Emergency department. Conversation never takes place. Patient undergoes surgery, discharged home and does not know they have a diagnosis of bowel cancer.'
Certainly progress has been made, with greater sensitivity and a much more collaborative, multi-disciplinary team approach where patients needs are at the centre but it has taken a real culture shift but I'm not convinced it's filtered through across the board considering some of my own recent experiences. To be able to make the next big shift in how clinicians then categorise disease could be another 20+ years away; I hope not.

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