Alternative Medicine and Cancer

 

 

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  A Deceptive Breast Cancer Testimonial

A person I will call "Sandra"  disliked something I said on a newsgroup and emailed me privately.    Here is most of the exchange:

Sandra: I cured myself of BC 5 years ago-- turned down all conventional therapy. Former RN too. there are many like me-- I have a long list of others who have down the same. The tide is turning . Please try not to discourage others.    --------    RN"  <real name withheld -PM>

PM: Tell me more about your history. I assume you had an excision-biopsy?

Sandra: Why?

PM: I take it from this response that you did have an excision biopsy, and if so, it is not true that you had no conventional medical treatment.

Lumpectomy alone will cure many breast cancers, and this is not widely enough known. The 12 year cancer-free survival rate (i.e. %age of patients alive and cancer free at 12 years) of women with breast cancers up to 4 cm in size treated by lumpectomy (adequate excision-biopsy) alone is over fifty per cent.<See references 1 & 2 below>

So, if you had an excision biopsy, there was perhaps a 50% chance that you already had no residual cancer, especially if your cancer was small in size and stage 1.

The reason radiotherapy is normally advised after lumpectomy is that otherwise cancer grows back in the breast in 30-40% of cases, necessitating mastectomy. Chemotherapy is also often advised in higher risk patients, as it can improve the long-term survival by ten per cent or more, although in America it is perhaps used in less high risk patients than other countries. <Update:   with more modern anthracine-based chemotherapy yearly death rates from breast cancer are reduced by 20% to 38%, depending on age-PJM -see reference 3> 

 These treatments are precautionary and are *not needed for cure in all cases*.  

<Some snipped text transferred to the addendum below>

Sandra: No excisional biopsy! I won't waste my time with you. Please do not email again-- I will delete. I talk to many women's groups and have a strong medical background. Your approach is very sad and must be dscouraging to women you come in contact with. End fo discussion!

Despite her reluctance to admit it,   Sandra has indeed had  an excision-biopsy in the form of a lumpectomy.  (Nowadays, lumpectomy  means a more formal, thorough removal of a breast cancer than is necessarily meant by excision-biopsy,  but the significance is much the same for present purposes.) 

Here is "Sandra's" testimonial as it appears on the Internet.  I include some spiteful allusions to conventional treatment.

"After I found the lump in _________ ____ <date removed -PJM > I had my first mammogram (something I was opposed to because of excess radiation, false positives, missed diagnoses, etc.), then a lumpectomy (removal) to determine that it was indeed cancer. They wanted me to have more surgery to remove 33% of my precious lymph nodes, burn me with six weeks of radiation, poison me with chemotherapy (suppressing my immune system even more), and then take a maintenance dose of the dangerous, side-effect laden Tamoxifen for five years, a drug an oncologist friend said he wouldn't let his wife take. "

Are women's groups really inviting this person to talk to them?!!   The tale about the Tamoxifen is also suspect, as a few years of taking this drug (or more modern equivalents) has been proved to  substantially improve breast cancer survival in post-menopausal women, and  with side effects that are trivial when compared to dying of breast cancer. Perhaps the oncologist is being quoted out of context, if there is any truth at all to this assertion.   (Update: Tamoxifen reduces the breast cancer mortality rates at fifteen years  by 30% in estrogen receptor positive women -  Reference 3)

The Reality

This is  one of the commonest kinds of  misleading breast cancer testimonial nowadays.   It is enabled by the present stepwise approach to breast cancer management, wherein lumpectomy is a usual initial diagnostic/therapeutic  step towards  breast conservation ( avoiding mastectomy).  

The studies <1,2>  that predict a favourable outcome for many with lumpectomy alone predict misery for others.  The women on the wrong side of the gamble, those trying to cope with  persistent cancer  either eventually have to accept further medical care, usually mastectomy, or can be observed making  fleeting visits  to their old Internet stamping grounds,  asking for advice  on what to do about the pain or smelly discharge, or regarding what last-ditch methods they should try, having by now used most of the treatments on offer.  I have placed an excerpt from one example in an addendum below.  

Amazingly, some of these unfortunate women still fly the "alternative" flag, remaining proud that they have have "treated" their breast cancer "without using any conventional methods".  This is a tribute to the occasional success of malicious propaganda  that claims, despite mountains of evidence to the contrary, that medical treatment of cancer doesn't work or makes things worse.   The truth is that the prognosis for cure of breast cancer is very good, especially if found early via screening.   In fact,  even when all stages of the disease are included [4] 80% of  women with breast cancer survive for ten years,  with most of these being cured permanently.

Dr Lorraine Day, who sells videos explaining how she "cured herself"  of breast cancer ( http://www.drday.com  ),  is ironically another who lost this gamble.   It is quite obvious that her breast cancer was permitted to grow to the  size shown in her photographs  because she rejected the further conventional treatments advised after initial excision-biopsy, and, moreover, while using her first choices in  "alternative" treatments!  Her story becomes extremely murky thereafter, but she admits to further surgery at minimum.

You can find more examples of the results of neglected breast cancer, almost certainly as the result of similar unwise treatment choices  at http://www.vci.org/breastcancer1.htm  , but you need  a strong stomach.  Such cases help explain why doctors are prepared to go to great lengths to ensure that cancer of the breast is under control from the word go.  They can't always prevent later death from metastatic disease, but with modern treatment no woman should ever have to die from uncontrolled cancer in the breast or suffer its many miseries.   

There is an additional great tragedy here.  The kind of breast cancer that allows the patient live on while reaching such a state  is of a less aggressive,  often slow growing,  late metastasizing variety.    It is the easiest kind to cure! 

What can doctors do to help?

Even fifty years ago most women with breast cancer would have automatically had the  dreaded radical mastectomy.  That operation had evolved because lesser operations too often failed to control the more advanced  cancers of early last century.    

Breast cancer treatment has since been entirely directed at developing  less invasive treatments and the tailoring of  treatments to the  individual patient, where possible.  Hence such developments as sentinel node biopsy to replace axillary dissection as a treatment/staging procedure,  and breast conservation itself. These objectives have been helped immeasurably by the very much earlier breast cancers doctors get to treat these days, through greater public awareness and mammographic screening.   

There is a long way to go.   Doctors still  have to treat some patients unnecessarily heavily, to prevent intolerable outcomes for a few.  If this were only understood, or at least not grossly  misrepresented, in certain circles!    The next major development  is very  likely to be  the ability to safely select out patients who are likely to be cured by partial mastectomy or lumpectomy alone.  

The medical profession  could perhaps help minimise unwise patient choices by explaining  to the public exactly why they do what they do.  

Can they also outline to patients what gambles  may reasonably be undertaken by those  who have deep fears of certain kinds of medical treatment?    Some conventional treatment, especially  adequate surgery,  will usually be infinitely better than none at all. 

Or, there may be a choice of roughly equivalent treatments.   A patient who is terrified of radiotherapy  may find simple mastectomy with immediate breast reconstruction an acceptable alternative to the standard lumpectomy plus radiotherapy.  With early  breast cancer the cure rate will be the same, although the  breast reconstruction may be less satisfactory cosmetically.   

The patient always has the right to determine their own fate and run their own risks.   Treatment is by their choice, but ideally only after full and trustworthy informed consent.  It is with the latter that "alternative" sources habitually fall short when not frankly mendacious.   

References

1. Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456-61. 

2. Clarke M, Collins R, Godwin J, Gray R, Peto R. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. Early Breast Cancer Trialists' Collaborative Group. N Engl J Med 1995;333:1444-55.

3. M Clarke, R Collins, S Darby, C Davies, et al.  Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials
 The Lancet.  May  14-May 20, 2005.Vol.365, Iss. 9472; pg. 1687

4. American Cancer Society.  Cancer Facts and Figures 2007  http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf

Addenda

The other side of the story---

"I was diagnosed with bc five years ago and have not had any surgery, chemo, or radiation. I changed my diet (veggies only), periodically detox, use coffee enemas, get colonics and ear candling to cleanse lymph system, and do Hulda Clark's parasite removal regimen. I also have viewed Dr. Clark's tapes, take herbs and supplements, pray a lot, and do visualizations and affirmations.

I felt great for 4 1/2 years and never missed one day of work. I had no pain until last winter when I applied Cansema to the area <presumably because of a recurrent lump-PJM>. After the eschar fell off, the area became raw (ulcerated) and grew tremendously (6 x 3 cm). Because of the pain, I finally saw a medical doctor in February."

 

The snipped text from my email

PM "So, where do you fit in? Did you have some other, proven, active cancer which went away with your chosen treatments? If not, can you justify making this claim to women who may unwisely risk their lives on alternative treatments through your testimonial? I note that your Internet posts make this claim. Convince me it is justified, if you can..

If the above applies to you, you remain at some risk of recurrent disease, but I would not advise further treatment now. Most recurrences, either local or distant, occur within the first five years and your prognosis remains very good. Make sure you are well checked for local recurrence or second breast cancers, though."

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