Tuesday, May 27, 2008

Precancer: treatment without detection or diagnosis

Yesterday's blog concerned precancers, and I thought I'd continue the subject.

The paradigm for treating cancer has been:

1. Detect the cancer (usually involves recognizing a sign or symptom or picking up the cancer on a screening text)

2. Diagnose the cancer (usually involves getting a tissue sample through a surgical procedure and sending the sample to a pathologist who renders a diagnosis indicating the type of tumor and its grade (level of malignancy). Diagnosis is sometimes supplemented with special studies, such as cytogenetics).

3. Stage the cancer (determining how far the tumor may have spread at the time of diagnosis)

4. Treat the cancer (one or more of surgery, chemotherapy, radiation therapy).

5. Follow-up

With precancers, we may be able to skip most of these steps, going straight to treatment. This is because the treatment for precancers can be simple and effective. If a precancer can be eradicated with a relatively non-toxic systemic drug, or if the transition from precancer to cancer can be delayed with hormonal manipulation, or if the initiation step of carcinogenesis (leading to precancer development) can be blocked with a dietary supplement or a vaccine (e.g. Gardasil for cervical precancer), why not just forego the detection/diagnosis/staging steps?

The idea of receiving medical treatment for undiagnosed diseases is not new. How many people in the U.S. take statins, even though they have no rason to think that any of their arteries are significantly blocked by atheroma (never had stroke, never had angina, never had claudication, etc.)? How many people in the U.S. are treated for hypertension even if they've never had any of the associated diseases (never had renal failure, never had stroke, etc.)? Virtually everyone in the U.S. has been vaccinated for diseases they do not have (polio, smallpox, tetanus, etc.).

Intelligent people accept treatment for diseases they do not have, because they know how bad such diseases (myocardial infarction, stroke, kidney failure, polio, etc.) can be. So why don't we start treating precancers in high-risk people who have no detected precancers?

Personally, I'd rather accept treatment for an uncertain precancer than for a certain cancer.

In future blogs, I'll discuss precancer treatments.

- Copyright (C) 2008 Jules J. Berman

key words: precancer, pre-cancer, premalignant, premalignancy, incipient neoplasia, preneoplasia, preneoplastic