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With thyroid 'cancer' reclassified, patients can receive more appropriate treatment

Luis Fábregas
| Monday, April 25, 2016, 9:00 p.m.

In a highly unusual move, a panel of international pathologists has determined that a type of tumor in the thyroid is not cancer as they previously thought.

They've stripped the name cancer off the pesky tumor, known as encapsulated follicular variant of papillary thyroid carcinoma. It accounts for up to 20 percent of thyroid cancers diagnosed in Europe and North America.

“To my knowledge, this is the first time in the modern era a type of cancer is being reclassified as a noncancer,” said Dr. Yuri Nikiforov, director of UPMC's division of molecular and genomic pathology and one of the experts on the panel.

The reclassification has vast implications in the field of oncology because this type of tumor is treated aggressively — often with surgery or radioactive iodine. So it's entirely possible that some 10,000 patients who have this type of thyroid cancer will not have to endure potentially harmful treatment.

It is also possible that this seemingly innocuous move by a panel of 24 experts in seven countries eventually will have an effect on other types of cancer. If we're lucky, many diseases that today we call cancer might not be cancer after all.

The idea isn't new.

Doctors for years have been saying that the word cancer is incorrectly used to describe tiny lesions that might never develop into an illness. Some doctors have urged the National Cancer Institute to reconsider using the word for some pre-cancerous lesions or slow-growing cancer cells that never wind up harming a patient.

Some forms of prostate cancer grow so slowly that all it does is scare the bejesus out of older men. Sure, it can be a serious disease, but the American Cancer Society says most men diagnosed with prostate cancer do not die from it.

Problem is, people hear the word cancer and immediately think they need to pull out the big guns. Several years ago, I interviewed an oncologist who told me he was confounded by patients who insisted on treatment for early stage prostate cancer even though he told them the treatment would cause more harm than benefit, including sexual dysfunction and urinary incontinence.

Those treatments come with a very steep price. Cancer drugs alone cost more than $30 billion a year in the United States, according to the American Society of Clinical Oncology. That doesn't even include the cost of hospital stays, physicians and other treatments.

Some forms of cancer arguably need — heck, demand — aggressive treatment. They also deserve the nasty name that is cancer — with all its nasty connotations.

But cancer is big business, with high-priced drugs that sometimes offer little survival benefit. The fact that experts are willing to examine and question diagnostic criteria is a giant step in the right direction.

When I spoke to Nikiforov, he warned me that the reclassification, although significant, “doesn't mean all cancers will be reclassified.”

But he said it will have a “huge impact” as doctors identify indolent, harmless forms of cancer that don't need to be cancer.

Any way you look at it, that's progress.

Luis Fábregas is the Tribune-Review's deputy managing editor for news. Reach him at lfabregas@tribweb.com or 412-320-7998.

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