Friday, August 13, 2010

Medical abbreviation nightmare

In a separate essay, I discussed some of the intricacies of medical abbreviations, and I included a list of so-called "fatal" abbreviations, whose use could actually jeopardize patient care.

Here's another problem abbreviation: NSCLC

NSCLC is the abbreviation for Non-Small Cell Lung Cancer. In itself, this is a very awkward term, because it doesn't stand for a specific type of cancer, but for a group of cancers that happen not to be a specific type of cancer (i.e., not small cell lung cancer).

The two most common types of non-small cell lung cancers are squamous cell lung cancer and adenocarcinoma.

One possible abbreviation for squamous cell lung cancer is SCLC, hence NSCLC could mean, to some people, non squamous cell lung cancer.

The much-preferred abbreviation for squamous cell lung cancer is SCCL (squamous cell carcinoma of lung), which could just as easily be an abbreviation for small cell carcinoma of lung.

But let's pretend that everybody understands how to use these abbreviations, and nobody makes the most common orthographic error encountered, tranliteration, switching the positions of the C and the L (SCCL for SCLC).

There's still the problem of finding a coherent meaning in the term NSCLC. This term was invented because small cell carcinoma of lung has a clinical behaviour and a treatment that is different from all the other tumors of the lung. Small cell carcinoma of the lung, more than any other lung cancer, is likely to metastasize widely, before the primary lung tumor is detected clinically. This means that surgery for small cell carcinoma serves little purpose (because most tumors have have already metastasized at the time of surgery). Early aggressive chemotherapy makes more sense. Hence oncologists have created two major groups of lung cancer: 1) small cell cancer, and 2) everything else.

The problem now is that there are treatment differences among the NSCLCs. For example, bevacizumab (an antibody targeted against vascular endothelial growth factor and used to treat NSCLCs) seems to cause hemoptysis in some patients who have sqamous cell carcinoma of the lung. Hence, bevacizumab is currently recommended only for patients with non-squamous non-small cell carcinoma of lung (note the double negative). Hence, using abbreviations, bevacizumab is used for NSCCL NSCLC.

This illustrates just one more example of the confusing and potentially error-causing abbreviations used in medicine.

- © 2010 Jules Berman

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