The business of cancer

How more cancer screenings and the uptick in diagnoses is doing more harm than good

Few things in life are more frightening than a cancer diagnosis. Just hearing the words, “You have cancer,” can throw a person into a devastating tailspin—taking their loved ones along with them.

So imagine hearing those words when they’re not actually true. Imagine having your life turned upside-down and facing mortality eye-to-eye, only to find out what you have isn’t really cancer… it’s a case of mistaken identity, or false labeling.

That’s just what’s happening to countless people around the country every day. They are receiving the shocking and demoralizing news that they have cancer—a life-threatening illness—when they actually have something that has no chance of ever killing them.

Not all “cancer” is created equal

So how is this happening? It all comes down to what you call things, and our medical establishment has taken to calling things “cancer” even when they’re not.

In dermatology, for instance, pathologists have long observed relatively benign tumors as only “Grade ½” based on the benign appearance of the cells. Normally cancer cells are graded on a scale of one to four, so a half-grade is meant to register that cells don’t really look like cancer—and they don’t behave like it either.

But instead of just removing these skin growths and letting their patients go on with their day, dermatologists put the fear of death in them by calling them cancer. (As it is, they already get a lot of practice putting the fear of death into their patients when it comes to the sun). The truth is most skin cancers are relatively benign growths and do not cause long-term problems if they’re removed. So why call these growths that don’t even meet the pathological requirements for the lowest level— Grade 1—cancer?

Even the National Cancer Institute (NCI) is starting to wake up to this problem. A working group they recently sanctioned just advised the medical community that the “use of the term cancer should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated.”

Translation? If it can’t kill a person, STOP calling it cancer!

The far-reaching effects of cancer scares

These unnecessary cancer diagnoses have effects far beyond the initial scare. Many cancers are being treated that don’t need to be. And as we all know, treatment isn’t benign in itself.

For those “Grade ½” skin lesions, treatment is simple (removal with local anesthetic, if that). But for other so-called “cancers,” people are put through major surgery, toxic chemotherapy, and/or radiation.

Take prostate cancer, the most common cancer in men. As men get older, they become more likely to develop an “occult cancer” of the prostate. But in most cases, this “cancer” is so slow-growing and silent that it never causes problems. In fact, if it’s not discovered by overeager screening, it probably will go unnoticed—unless it shows up as an “incidental” finding at an autopsy of a man who has died in advanced old age of some other cause. If such a cancer is caught, however, you can count on aggressive, invasive and unnecessary treatment, not to mention mental anguish.

Cancer treatments remain among the most toxic, dangerous treatments still practiced anywhere since the Middle Ages—with many side effects of their own. They can even cause secondary cancers. So the cancer you went in for won’t kill you, but here’s another one that probably will!

When I was a medical resident, my next-door neighbor in Philadelphia was a retired fireman who came down with lymphoma.

He was treated with a new “miracle” cancer drug, Adriamycin (a chemotherapeutic agent originally developed from algae in the Adriatic Sea). He was cured of the cancer, but the Adriamycin destroyed his heart muscle and he quickly died—albeit “cancer-free.” Knowing what we now know, I suspect the drug totally destroyed the cellular respiration function in the mitochondria, causing the heart to go first.

That’s just one story, but there are lots more like it. And beyond its effects on individuals like my neighbor, this “over-diagnosis/over-treatment crisis” makes us less healthy as a society.

Just think of the epidemic of vitamin D deficiency that has resulted from our being kept out of the sun for fear of skin cancers (91 percent of which don’t really behave like cancer at all).

We now realize that lack of vitamin D can contribute to other, typically more serious, cancers (and heart disease, and respiratory diseases, and more).1 So again, we’re trading a relatively minor health concern for a major one.

Of course, the over-diagnosis/ over-treatment crisis wouldn’t be possible without another, equally problematic aspect of modern oncology.

Cancer screening paves the way for problems

The concept of cancer screening in the United States has become highly problematic over the past three decades. For example, the medical establishment pushes dangerous, expensive and overused procedures such as colonoscopy , while virtually ignoring screening for lung cancer which causes far more cancer deaths. (Refer back to the October and November issues of Insiders’ Cures for more on colon cancer and lung cancer screening.)

Then, added to that, screening is identifying more of what doctors have been calling “early cancers,” but which we now realize are not cancers at all. From a distance, it looks like the system has been catching more cancers and preventing more deaths due to cancer. But these statistics are misleading if the additional cancers were not going to cause death in the first place. It’s all part of the statistical trickery used to create the illusion of some progress in the “war on cancer.”

This numbers game makes us think we’re getting ahead of cancer. But all we are really doing is just diagnosing more “non-cancers” and calling it a success when they don’t kill us.

Here’s an example: Breast cancer screening has led to an overall increase in incidence of new “cases,” because both cancers and non-cancers are being detected. So when cancer death rates stay the same or decrease, despite a supposed increase in incidence, it allows the government to claim a false sense of victory.

The same is happening with prostate cancer and others.

And all the while, the real goal—to reduce the rates of late-stage cancers and cancer deaths—remains elusive.

Screening practices and programs designed for that purpose have not met their goals. All we have done is to increase detection of “early-stage” cancer but without any decline in “late-stage” cancer. If cancer is defined as a disease that will lead to death if untreated, then detecting an “early” cancer that would have never led to death is not detecting cancer at all.

And we have accomplished nothing.

When does screening make sense?

We need to understand and appreciate the biology of different cancers. If a cancer is very fast- growing, then no screening can realistically be effective when it comes to the population as a whole. If it is slower-growing, as with colon polyps that take a long time (15 years on average) to develop into colon cancer, then less frequent screening can be effective.

If growth is very slow (for example, exceeding human life expectancy, such as “occult” cancer of prostate) then screening is actually harmful because it detects lesions that need not and should not be treated.

The one unqualified success story we’ve seen with screening is for cervical cancer. Cervical cancer used to be one of the top causes of cancer deaths in women. But from 1955 to 1992, the cancer death rate has declined by almost 70 percent—thanks to widespread, easy, and effective screening.2 No other cancer screening has shown anywhere near these kinds of positive results.

Given this sad state of affairs, what else is the NCI-approved panel I mentioned above proposing?

A common-sense solution

The practice of oncology in the United States is in serious need of a host of reforms to address the problems of over-diagnosis and over- treatment.

The advisory panel laid out a plan for dealing with this problem. First, as I mentioned earlier, it specifically advised that a number of “pre-malignant” conditions should no longer be called “cancer.” This includes the common intra-ductal carcinoma of the breast (within the breast ducts) and even “high-grade” intraepithelial neoplasia of the prostate.

Instead, a different category of growth or tumor should be recognized and labeled appropriately as “non-cancer.” Doesn’t that sound less frightening? The panel suggests using such terms as “indolent lesions of epithelial origin” or IDLE.

A big part of the problem is all the medical sub-specialties involved in cancer. Each has its own terminology largely based upon the technologies they use, rather than a fundamental understanding of the biology of cancer. The use of new tools for diagnosing or treating diseases has driven the creation and practice of different medical specialties, each of which has developed exclusive uses of these technologies. This state of affairs calls to mind the admonition, “If your only tool is a hammer, then you see every problem as a nail.”

Another result of medical sub- specialization is the different terminologies in use across the spectrum of pathology, radiology, surgery, and other medical specialities as well as the general community.

The panel has recommended that a body such as the Institute of Medicine determine what we should call these lesions now called cancer.

Then—in order to actually affect the rates of late-stage cancers and cancer deaths—all the other “pre-malignant” lesions must be tracked separately by government statisticians, instead of being lumped together with cancer. That’s the only way we’ll get an accurate view of what is and is not causing real cancer. This would vastly improve the quality of our cancer statistics, on which our national health policies are based.

Another proposal focuses on reducing over-diagnosis by reducing the use of low-yield diagnostic tests, reducing the frequency of screenings, focusing on high-risk populations, and raising requirements for taking a biopsy.

Finally, the panel recommended alternatives to treatment by focusing on the environment in which tumors arise. Strategies such as diet or chemoprevention (reducing the risk of cancer by specific micronutrient vitamins and minerals) may be as effective, and are less toxic, than traditional therapies.

Of course, given misplaced priorities for cancer research funding, the oncology community still has a long way to go before understanding the right doses, forms, and micronutrients to use. But some research is beginning to emerge that may point us in the right direction. In another article this month, for instance, I describe a study that found higher intake of vitamins C, D, and E was associated with lower risk of breast cancer death or recurrence.

What you can do

The first thing patients and doctors alike need to do is be aware of the problem of over-diagnosis. Then you can make informed decisions.

But regardless of how long it takes the mainstream medical community to change its ways in regards to cancer, there are a couple of things you can do right now to significantly reduce your risk of ever facing a cancer diagnosis.

First and foremost, it’s important to remember that individual cancer cells continuously arise in the body. But a healthy immune system eliminates them before they can cause trouble. So keeping your immune system balanced and operating at peak performance should be your No. 1 priority. And the very best way to do that is to eat a nutritious diet that includes a variety of produce, protein, and, yes, even some fat, especially omega-3s.

For those cancer cells that do survive, the only way they can grow into a life-threatening tumor is by hijacking your body’s blood supply. It diverts blood vessels from other parts of the body and pulls them into the tumor. This stolen blood supplies nutrients to the growing tumor. This process is called angiogenesis. And there are many safe, natural ways to stop it. I covered these approaches in detail in the July 2013 issue of Insiders’ Cures.

Sources:

1. Vitamin D deficiency and mortality risk in the general population: a meta-analysis of prospective cohort studies. Am J Clin Nutr. 2013(97):782-793.

2. American Cancer Society. What are the key statistics about cervical cancer? http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics. Updated April 11, 2013. Accessed October 16, 2013.


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