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Hardin Jones and Cancer: the "Untreated Patients Live Four Times Longer" claim

The extraordinary claim that untreated cancer patients live four times longer than conventionally treated patients can be found on numerous web sites e.g. http://www.brwwellness.com/ten.htm .  Here an anonymous author says ----- 

Excerpts below quote a speech by Dr. Hardin Jones, a prominent cancer researcher and former professor at the Donner Lab of Medical Physics at the University of California (at both Berkeley and Davis.)    Dr. Hardin Jones published these statistics in his article in Transactions, New York Academy of Science, series 2, v. 18, n.3, p.322. 

Write us for others who collected their own cancer survival statistics, and who accuse official studies of being "doctored" or skewed by drug sponsors, to show some benefits for chemotherapy.    "My studies have proved conclusively that cancer patients who refuse chemotherapy and radiation actually live up to FOUR TIMES LONGER THAN TREATED CASES."

 

I decided to find out what this was all about.  Some were quoting this as a reason to avoid cancer treatment.

I have tracked down the Hardin Jones  presentation to the Academy of Science in 1956 (!!!).   It is to this that all web sites repeating the claim refer.   It contains numerous statistics on treated and untreated cancers, the most detailed of which refer to breast cancer.    I have obtained a copy of this paper and there is no such statement anywhere within it!!

What did Hardin Jones really say?

He most definitely had a dim view of the cancer treatment of his day, saying: "It is most likely that, in terms of life expectancy, the chance of survival is no better with than without treatment, and there is the possibility that treatment may make the survival time of cancer less" (page 331).   But that is as far as he goes.   

Hardin Jones also offered no evidence at all in support of his conjecture that survival could be impaired by treatment. On the contrary, several of the studies he quotes suggest quite marked survival benefits for treated patients over untreated, but he challenges such interpretations for a variety of reasons that I am unable to fully check without the original papers. Some may well be valid considering the nature of this data; some are probably not (see below).  

He also conceded that cancer treatment might have important palliative and symptomatic benefits, even if survival is not guaranteed, saying that "life itself may terminate abruptly" as the result of the effects of untreated cancer (p331).

Other statements attributed to him, e.g. that he and his wife would never accept conventional treatments for cancer, must have been made elsewhere, if genuine. No other sources are offered, however.

How right was Hardin Jones?

Hardin Jones' views (the documented ones, as opposed to the alleged) were actually not far off the planet once he is placed in the context of his times.  It happens that in the late fifties and early sixties there was some 'therapeutic nihilism' in relation to the treatment of cancer, especially breast cancer.

 Despite numerous trials of different surgical operations for breast cancer, with and without radiotherapy,  survival rates stayed frustratingly much the same (chemotherapy was still in its infancy and not mentioned at all in the Transactions paper - another area where truth seems to have been dealt with rather loosely).  

In addition, death rates of treated breast cancer patients did not seem to level out at those of the normal population at five or even ten years, as might be expected if patients surviving for that long were likely to be then cured. 

Hardin Jones used this and other data to build a whole statistical theory proposing that "--- the death rate for all kinds of cancer remains nearly fixed from the moment when cancer is identified ---" (p314).

It was becoming apparent to oncologists that breast cancer could metastasise (spread to distant parts of the body) much earlier than generally thought, and that, rather unusually among cancers, the tiny occult (hidden) metastases could remain dormant for years before making themselves known.   Breast cancer patients thus had to be followed up for very much longer than the usual five or ten years before they could be pronounced cured, and on the data available at that time it was difficult to know how many were being permanently cured. The biology of the disease, rather than the treatment, appeared to be the main determinant of survival.

At about this time it was also asked whether removal of or radiation of the axillary lymph nodes might be reducing defences against breast cancer, but a "watch and wait" policy was also found not to improve survival and later research suggests a failure to treat the axilla actually makes prognosis worse [3].

Some Modern Implications

The lessons learnt in those days explain the modern interest in screening programs, designed to discover cancers before they have a chance to metastasise (spread to other parts of the body).   Nearly all solid cancers would in theory be curable if they could only be caught early enough, but some very aggressive cancers metastasise before either the onset of symptoms or present screening technology can reveal their presence. And once having spread beyond the scope of surgery or radiotherapy, most kinds of cancer are very difficult to cure.

Another modern trend is to include adjuvant systemic (additional whole-body) treatments such as chemotherapy, hormonal antagonists or immunotherapy in the initial treatment of cancers,  when the pathological findings suggest there is already a significant risk of occult distant spread.  This is producing quite substantial improvements in the survival rates of some cancers [10,11]

The most direct evidence for the combined worth of such measures is that death rates from breast cancer are clearly declining for the first time ever, despite an ever-increasing incidence. This is shown by independent statistics from the USA [4], England[12], Sweden [5] and the Netherlands [6]. 

Also, now that breast cancers are being found much earlier, less radical treatments are possible. Breast conservation is now possible in over half of new patients.

How wrong was Hardin Jones?

While Hardin Jones was part right, his data and his overly pessimistic views are very much a product of his times.

One obvious indication of this is that the overall five year survival from breast cancer in the studies he examined was a dreadful 25 per cent, whereas NCI statistics for 2002 give an overall (all comers) five year survival of about 80% [4]. Some of this difference will be simply due to "lead time bias" i.e. longer survival simply due to most cases being diagnosed earlier in the course of their illness, but it illustrates the very different times.

Hardin Jones was working with data from very early in the last century, mainly from four studies containing the remarkable numbers of 651, 100, 64, and 100 untreated breast cancer patients along with a treated group. These were published in 1926 (!), 1937, (no reference given), and 1937 respectively.  With the advanced cancers generally treated in those days, it is likely that most of these patients would be incurable even today.

None of the studies he examined were properly controlled trials. Well-planned clinical studies of any kind were still rare in those times, and it would also have been quite unethical even then to randomise very destructive cancers to a "no treatment" group, as demanded by any reliable  comparison of treated with untreated patients.

Where, then, did the untreated patients come from? They were those who "refused operation or who had already advanced to an inoperable state" (p321). There are innumerable possible misleading influences in such studies.  One is that breast cancers reaching a very advanced and inoperable state locally will include many slow growing, locally malignant cancers with little metastatic potential,  where survival can be surprisingly long, if also made utterly miserable by enormous malignant masses, ulcers or cancer-en-cuirasse.  

Nevertheless, as pointed out above, it is likely that even in the treated breast cancer groups the natural biology of the cancer was mainly determining length of survival (as applies with many cancers today), and treatment played a largely palliative role.  It is also fairly certain in hindsight that the apparent survival benefits from treatment in some of the studies e.g. of cancer of the cervix were real effects, and Hardin Jones very reluctantly does allow this possibility (p323).

The primary objective of medical treatment has always been to cure the patient permanently of their cancer, with palliation a close second.  Hardin Jones was determined to argue that cancer always went its own way regardless of treatment, and dismissed contrary evidence whenever found.  He even dismissed data favouring the cure of some subgroups of cancer patients, such as a survival curve identical to that of a normal population, by suggesting that they represented "cases with a milder type of disease than is usually reported" (p323). Even if true, that may simply mean that those cancers have been caught before they have been able to metastasise.  That remains a primary objective in the treatment of solid cancers and the implications for the patient are the same.

Hardin Jones made a number of such judgements while never himself ever being involved in cancer treatment or clinical research.  He was a physiologist and statistician, attached at the time to the Atomic Energy Commission in Berkeley, California.

What does later research tell us about cancer cure rates?

Different cancers behave very differently. Sometimes "five (or six, or ten etc) year disease-free survival rates" closely approximate the true cure rate of cancer. Sometimes they do not. Cancer types that are uniformly aggressive in behaviour will almost invariably result in death within five years if left untreated, and any survivors at that time can be regarded as almost certainly permanently cured.  Significant five year disease-free survivals from such poor prognosis cancers as lung, stomach and even a few from pancreatic cancer, show that treatment can save lives in most contexts.

The fifty per cent of all comers with colon cancer who are alive and well at five years can also be regarded as permanently cured. Long-term follow-up has confirmed the clinical observation that recurrence of colon cancer virtually never occurs after five years,  with age-adjusted survival rates at ten years being the same as at five years [7].

Breast cancers being much more variable in behaviour, we ideally refer to twenty year survival rates for an impression of the number of ultimate survivors. This is in excess of 80 or 90% for stage 1 cancers, depending on grade and type [8], although very rare recurrences after even 30 or 40 years suggest that the true cure rate will be slightly less. Survival rates diminish rapidly with more advanced stages.

 Those with more serious breast cancers chosen for adjuvant chemotherapy have ten per cent or more survival advantage at ten years over those who do not have chemotherapy [9], contrary to claims in some 'alternative' medical circles about the adverse effects of chemotherapy on immune defences against cancer.

Melanoma is another potentially lethal cancer that can flare up after many years of dormancy, but which also has extremely high cure rates when treated in its earlier stages.

Metastatic cancer remains difficult to cure, but some types are regularly cured by modern chemotherapy e.g. testicular cancer.

Overview of results of present cancer treatment

Cancer incidence and mortality statistics from sources such as the National Centre for Health Statistics and the National Cancer Institute [4] suggest that overall, about fifty per cent of patients presenting with cancer of all types and stages (excluding easily cured skin cancers) are permanently cured. 

A similar picture is suggested by combining the results of numerous individual studies of specific common cancer types, excellent overall cure rates with some cancers such as cervix, leukemias, lymphomata, melanoma, and childhood cancers being counter-balanced by poor results with lung, pancreas, stomach and a few others. Colon cancer is at the average, with 5YSR and 10YSR of51% and 49% overall [7] (should be better nowadays with the wider use of endoscopy). For a more detailed examination of cancer survival rates see: http://www.home.gil.com.au/~moringa/cancercuredraft.htm.

Nothing to crow about, but a much better picture than some sources imply. Progress is being made. Hardin Jones would have been forced to reach different conclusions if he lived today.

Peter Moran, MB, BS, BSc (Med), FRACS, FRCS(Eng)

Queensland Australia

moringaATgil.com.au

References

1. http://www.brwwellness.com/ten.htm Last accessed Dec 2 2003. or http://tinyurl.com/2ownf

2. Paper "illustrated by lantern slides" presented at a meeting of the Section Of Biology of the New York Academy of Sciences on January 9, 1956.

3. Bland KI, Scott-Conner CEH, Menck H, Winchester DP. Axillary dissection in breast-conserving surgery for stage i and ii breast cancer: a national cancer data base study of patterns of omission and implications for survival. J Am Coll Surg 1999;188:586-596

4. Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002. CA Cancer J Clin. 2002: 23-47 Also: Weir HK, Thun MJ, Hankey BF, Ries LA, Howe HL, Wingo PA, Jemal A, Ward E, Anderson RN, Edwards BK Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst. 2003 Sep 3;95(17):1276-99

5. Laszlo Tabar, Ming-Fang Yen, Bedrich Vitak, Hsiu-Hsi Tony Chen, Robert A Smith, Stephen W Duffy. Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet 2003;361:1405-10

6. Suzie J Otto, Jacques Fracheboud, Caspar W N Looman, Mireille J M Broeders, Rob Boer, Jan H C L Hendriks, Andr L M Verbeek, Harry J de Koning, and the National Evaluation Team for Breast Cancer Screening. Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review. Lancet 2003;361:1411-7

7. McLeish JA, Thursfield VJ, Giles GG. Survival From Colorectal Cancer in Victoria: 10-year follow up of the 1987 management survey. ANZ J. Surg. 2002,72: 352-356

8. Rosen PP, Groshen S, Kinne DW, Norton L. Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol; 11(11):2090-100 1993

9. Early Breast Cancer Trialists' Collaborative Group: Polychemotherapy for early breast cancer: An overview of the randomised trials. Lancet 352:930-942, 1998

Also: "Systemic therapy and survival after breast cancer." New England Journal of Medicine. 1994;330:805-810

10 A. Haydon Adjuvant chemotherapy in colon cancer: what is the evidence?
 Internal Medicine Journal Volume 33 Issue 3 Page 119 - 124

11. 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

12  http://www.statistics.gov.uk/cci/nugget.asp?id=575  (Large PDF file)

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