For many hematologists, the term “benign hematology” has never felt quite right. Considering the actual definition of the word “benign” (“of a mild type or character that does not threaten health or life; having no significant effect; harmless”),1 many of us often remark that there is nothing benign about “benign” hematology.
In an effort to avoid trivializing the seriousness of thrombosis, bleeding disorders, hemoglobinopathies, and marrow failure, all of which are morbid and potentially fatal “benign” hematologic diseases, some have opted for the retronym “non-malignant hematology” to describe the entirety of hematology not involving blood cancers. While less obviously problematic than “benign,” “non-malignant” defines a majority of a field and its practitioners by what they are not, achieving the bare minimum utility of a descriptor (a “non-dog” pet could be a cat or a horse) and creating an unconscious perception that “nonmalignant” hematology is less important than the field from which the term is derived.
As I discussed in detail in a recent Viewpoint published in The Lancet Haematology,2 which I had the pleasure of writing with my colleagues Drs. Alison Loren and Alfred Lee, the use of these problematic descriptors dismisses patient suffering, reduces trainee interest, and diminishes the entire field of hematology. Our article makes a passionate case for universal and unambiguous adoption of another descriptor that has already been in use along with “benign” and “nonmalignant”— “classical.”
Subsequently, as was highlighted in a recent President’s Column in The Hematologist written by ASH President Dr. Jane Winter, the ASH Executive Committee voted to adopt “classical hematology” as the preferred term moving forward, instead of “benign hematology” or “non-malignant hematology.”3 ASH is currently working to update its websites, publications, and all outward-facing content by replacing “benign hematology” and “non-malignant hematology” with “classical hematology.” Speaking on behalf of myself, my coauthors, and many fellow classical, malignant, and general hematologists who feel that “benign” and “nonmalignant” have not served our field very well, we are thrilled with this positive, practical, and forward-thinking change.
Why “classical hematology?” For starters, unlike “benign,” the term is actually accurate: “classical” means “relating to the first significant period of an area of study,” and “traditional and long-established in form or style,”4 consistent with the formalization of classical hematology as a field centuries before the emergence of antineoplastic therapy or medical oncology. “Classical” is an independent descriptor with no relation or potential comparison to malignant hematology.
“Classical” also means “regarded as representing an exemplary standard,”4 imparting an air of respect toward the field clearly lacking from the “nonmalignant” and “benign” descriptors. This is a subtle but important benefit of switching to “classical.” The ongoing workforce deficits in classical hematology are well-documented, and labeling our field with a synonym for “harmless” does not exactly inspire excitement among trainees (or philanthropists looking to fund impactful research, for that matter).
Conversely, invoking the term “classical hematology” tacitly pays homage to our field’s rich history of medical and scientific advancement that touches every aspect of medicine today. It also recognizes our field’s pioneers, including (as I often proudly remind my fellows) many women and people of color.
Finally, and most importantly, “classical hematology” respects our patients. With the adoption of “classical hematology,” we should never again be asked by a patient why a disease that has threatened their life and caused great suffering is labeled “benign.”
Words matter. Following the lead of early adopter institutions and now ASH, many professional organizations, academic institutions, hospitals, and clinical practices around the world are now adopting “classical hematology” as the single preferred and uniform term for this field. We encourage you to do the same.
Hanny Al-Samkari, MD, is Assistant Professor, Division of Hematology Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
SOURCES
- Benign. Merriam-Webster Dictionary.
- Al-Samkari H, Loren AW, Lee AI. The case for classical haematology: the impact of a name and the future of a field. Lancet Haematol. 2022;9(6):e455-e459.
- Winter JN. Benign, non-malignant, or classical? The Hematologist. 2022;19(4):2.
- Classical. Oxford English Dictionary.
