# An international body to rename indolent lesions so 'cancer' means something

Source: https://onco.cc/ideas/idea-prev-indolent-lesion-nomenclature-body/  
OnCo record `idea-prev-indolent-lesion-nomenclature-body` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some things called cancer, such as low-grade prostate lesions, almost never spread. An expert body could reclassify them, as cervical precancer was, so fewer people are overtreated.

## Summary

Cervical CIN and bladder PUNLMP are precedents for moving low-risk lesions out of the carcinoma category. Propose a WHO/IARC-convened classification group with explicit criteria (lifetime metastatic risk under 1% untreated) and a schedule to review Gleason 6, papillary microcarcinoma, low-grade DCIS, small renal masses, and Barrett's low-grade dysplasia.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Reclassification reduces active treatment of the reclassified lesions by at least 40% within five years without a measurable increase in cancer-specific mortality.
- Rationale: Words drive fear and treatment; PUNLMP shows the profession can do this.
- Proposed test: Pre/post analysis after WHO Classification of Tumours reclassification for one lesion type, Gleason 6 first.
- Maturity: speculative
- Actor: policy

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- cancers: [Prostate cancer](https://onco.cc/cancers/prostate/), [Thyroid cancer](https://onco.cc/cancers/thyroid/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- institutions: [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)
- key papers: [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/), [Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005](https://onco.cc/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/)

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