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March 21, 2019

Disease Labels and Clear Communication With Patients—A Rose by Any Other Name Would Smell as Sweet

Author Affiliations
  • 1Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
JAMA Oncol. 2019;5(6):784-785. doi:10.1001/jamaoncol.2019.0053

Shakespeare’s quote from Romeo and Juliet, “a rose by any other name would smell as sweet,” is often used to indicate that a name does not affect the entity to which it applies. A cancer is a cancer, whether it is called a nodule, mass, tumor, neoplasm, or cancer. If there are malignant cells in the specimen, it is a cancer. The physician must know what the specimen contains, what the diagnosis portends, what the therapeutic options are, and the associated benefits and risks. Even tiny carcinoma in situ lesions are still carcinoma, and if left untreated, historical precedent of each cancer type suggests the ability to progress over time to invasive disease. In rare cases, neoplasms with low malignant potential fall into the zones between benign, atypical, or other and classically and overtly malignant, such as an ovarian tumor of borderline or low malignant potential1 or the premalignant serrated colon polyp that carries a high risk of transformation.2 These neoplasms also have malignant potential over time. The oncologist’s charge is to take the time and use the appropriate language to convey accurately risks and recommendations to the patient and to allow the patient to make an informed decision, minimally influenced by emotion.3 This is not always an easy task, especially in an era when the time physicians spend with patients is an ever-shrinking resource. Is using euphemisms or alternative language considered withholding information or downplaying the diagnosis?