ideasIdea
Test whether calling Gleason 6 'not cancer' changes what men choose
Gleason 6 prostate lesions do not metastasise. A trial could show whether describing them without the word cancer leads more men to choose monitoring.
Survey experiments show terminology shifts preference; no randomised trial has tested it in real diagnoses. Propose a trial embedded in diagnostic clinics: pathology report and consultation script using 'cancer' versus 'indolent lesion of epithelial origin', with active surveillance uptake, anxiety, and two-year treatment as endpoints.
Hypothesis
Non-cancer terminology increases active surveillance uptake by at least 10 percentage points and reduces anxiety without reducing adherence to follow-up.
Rationale
The biology is settled; the behavioural question is testable at low cost.
What would test it
600-man RCT in five centres.
Maturity
speculative
Who has to act
research
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
- Patients lack understanding, navigation and agency · Most patients cannot understand their options, find trials, or push back, so decisions are made for them.