5 New Rules of Cancer

12 Million Americans are Cancer Survivors.

August 5, 2013, 3:21 PM
PHOTO: A doctor uses a digital tablet to talk to senior man.
A doctor uses a digital tablet to talk to senior man.
Getty Images

Aug. 6, 2013— -- intro: "Cancer" is one of the most terrifying words in the English language. Fortunately, as screening, diagnosis and treatment improve, there's a greater chance of surviving the disease than ever before. Click through to see how ideas and attitudes about cancer have evolved.

New Rules of Cancer Tweet Chat Today at 1 p.m., ET

quicklist: 1

category: 5 New Rules of Cancer

title: Definitions


text: Last week, an informal working group at the National Cancer Institute suggested some changes to the definition of cancer as part of an overall change in approaching, diagnosing and treating the disease.

The group recommended that premalignant conditions, such as one that affects the breast called ductal carcinoma in situ, or DCIS, should exclude the word "carcinoma." This would make the diagnosis seem less frightening for patients and, as Dr. Otis Brawley, chief medical and scientific officer at the American Cancer Society said, might discourage patients and doctors from pursuing aggressive treatment that can do more harm than good.

"Of the 12 million cancer survivors in this country, we estimate that 25 to 30 percent of them have had unnecessary treatment," Brawley said.

Brawley said that sometime in the 1980s some precancerous conditions began to be called "cancerous" by clinicians and advocates. The new recommendations are simply a return to old definitions that were more in line with true pathology, he said.

He does however, concede that the softening of definitions might be hard for some to accept. He recalled a woman who called the ACS hotline after the new recommendations were widely reported in the news; she was upset because she would no longer be considered a cancer survivor.

media: 19871899

quicklist: 2

category: 5 New Rules of Cancer

title: Screening


text: In the past few years, ideas about cancer screening have begun to shift. Last week the U.S. Preventive Services Taskforce recommended for the first time that heavy smokers be screened annually for lung cancer to cut their chances of dying of the disease.

On the other hand, the ACS now suggests less screening for prostate cancer because potential benefits may not outweigh the potential harm from testing and treatment. The ACS now recommends that starting at age 50, men speak with their doctor about the pros and cons of prostate cancer testing.

Some screening recommendations are still evolving. In 2009, the U.S. Preventive Services Taskforce recommended that women begin mammography screening at age 50 and repeat the test every two years. This was a departure from the recommendations of other professional groups such as the American Cancer Society, which for years had recommended that mammography screening begin at 40 and continue annually.

Brawley said that science changes over time, and it was not uncommon for scientists in different organizations to reach different conclusions about the latest medical findings. He mentioned that the current ACS mammography guidelines are under review and may be amended in 2014.

media: 19872217

quicklist: 3

category: 5 New Rules of Cancer

title: Prevention


text: Cancer prevention campaigns often focus on lifestyle changes. But Angelina Jolie's decision to have a double mastectomy spurred a national debate about aggressive preventive medical procedures.

Only about 5 percent of breast cancer cases can be linked to a faulty BRCA gene, such as the one Jolie possesses, according to the Centers for Disease Control and Prevention. However, as testing becomes more sensitive and widely available, experts say preventive surgery has become more common. Even though preventive surgery is not recommended for a diagnosis such as DCIS, the Journal of Clinical Oncology reported an 188 percent jump in surgery between 1998 and 2005 among women given a new diagnosis of DCIS in one breast.

Surgery isn't the only pre-emptive strike against cancer-making headlines. In 2006, the Food and Drug administration recommended girls between the ages of 9 and 26 receive the human papillomavirus, or HPV, vaccine to prevent 70 percent of all cervical cancers and other cancers from sexually transmitted diseases. In 2009, it added a recommendation for boys in the same age group.

Although the CDC reported last week that infection by a virus that can cause cervical cancer had dropped more than 50 percent in teenage girls since a vaccine against the virus was introduced, it also noted that vaccination rates had stalled at 33 percent of eligible girls, possibly because of safety concerns and fear it might encourage sexual promiscuity at a young age.

media: 19871999

quicklist: 4

category: 5 New Rules of Cancer

title: Recovery


text: Once cancer treatment ends, patients often experience a sense of relief that the worst is over. But more than half of cancer survivors report significant functional disabilities after they've completed treatment, according to Katherine Schmitz, associate professor in the division of clinical epidemiology at the University of Pennsylvania, Perelman School of Medicine. Schmitz said that some symptoms, such as lymphedema, a chronic arm swelling in those treated for breast cancer, can persist for years.

The growing medical specialty of cancer rehabilitation focuses on helping patients get back to health. Although not a new idea, Dr. Julie Silver, an associate professor at Harvard Medical School and founder of STAR, the Survivorship Training and Rehabilitation certification program for hospitals and cancer centers, said there has been a sudden interest in survivor rehab. Programs such as STAR and the University of Pennsylvania's Strength ABCs, take an individualized approach to treatment, using medicine as well as physical, occupational, speech and psychological therapy, to get survivors back on their feet.

"Just as with people who have had a stroke or any other serious illness or injury, it is critical to treat the physical and emotional impairments of people who have had cancer prior to sending them to other types of fitness or wellness programs," Silver said.

media: 19872369

quick list: 5

category: 5 New Rules of Cancer

title: Attitudes


text: Cancer will always be a scary diagnosis. Thankfully, as more people survive and thrive after receiving a cancer diagnosis, it no longer carries a death sentence. In the 1940s, only one in four of those diagnosed with cancer survived, according to the American Medical Association data. Today, survival rates stand at 50 percent.

Brawley said that although Americans remain more fearful than people in many other countries about cancer, attitudes are slowly changing.

"For years our reflex was screen, find any trace of the disease and cut it out," he said. "We now realize that might not always be the best thing. The idea of watch and wait in some cases is becoming more acceptable for patients and doctors, and that means less unnecessary treatment that could potentially do more harm than good."


quicklist: 6

category: 5 New Rules of Cancer

title: The New Rules of Cancer Tweet Chat Today at 1 p.m. ET


text: The National Cancer Institute estimates that there are nearly 12 million Americans with a history of cancer. This year, the institute predicts about 1.6 million new cases of the disease.

Join ABC Health for a tweet chat on "The New Rules of Cancer" today at 1 p.m., ET. Our chief health and medical correspondent, Dr. Richard Besser, will moderate. Top experts from the National Cancer Institute, American Cancer Society, American Association for Cancer Research and many other top clinicians and researchers from all over the country will join in to tweet their thoughts about how screening, diagnosis, treatment and attitudes about cancer have changed.

You don't have to be a highly proficient tweeter to join in. Just click here and follow these simple steps.

media: 19872143

ABC News Live

ABC News Live

24/7 coverage of breaking news and live events