Too many cooks in the cancer clinic

On Tuesday, I told you about an important new report from the National Cancer Institute (NCI) questioning the benefit of some efforts at early cancer detection. The researchers found that early detection can lead to massive overdiagnosing and overtreatment. Especially when it comes to prostate and breast cancer.

So today, let’s look a little closer at the problems–and potential solutions.

Prostate cancer is very common as men get older. In fact, the majority of men over age 75 have prostate “cancer.” However, most of the time, this “silent” cancer grows very slowly. And it rarely causes any problems. As a pathologist, I recognized this fact a long time ago. And now, the inner circle of mainstream medicine is finally taking note.

The NCI panel said we waste time and money diagnosing and treating this type of “silent” cancer. Plus, the treatments themselves are often dangerous to men, even though the cancer is not.

In fact, the panel went so far as to recommend that we don’t diagnose or treat this type of prostate “cancer” as a malignant tumor. In other words, it’s not really cancer. Even when it appears “high-grade” under the microscope.

The researchers said the same holds true for certain types of breast cancer, as well. Especially ductal carcinomas of the breast.

Of course, they don’t deny that certain types of cancer can and do turn deadly. They say you should be concerned about the aggressive, “late stage,” and “fatal” prostate cancers and breast cancer that metastasize and spread quickly.

But not all cancers behave this way.

So, we must be more careful in assessing a cancer’s danger. Very often, we subject men and women to the tortures and dangers of cancer treatment, but they don’t actually have a condition that truly behaves like cancer!

In a recent interview with Medscape, my colleague, Dr. George Lundberg, explained why it’s important to assess each individual cancer carefully. He said:

For a long time, it made sense to try to eradicate all cancers, as early and as completely as possible. Mass efforts were launched to find cancers wherever they were and destroy them. Since the earliest cancers seemed to evolve from some identifiable premalignant conditions, wouldn’t it make sense to also nip those in the bud? Sounds logical.

But, as with many exuberant efforts, this one got out of control. Many lesions that were called “cancer” really were not cancers at all in behavior, and this fact began to be recognized in large numbers of patients. These unfortunate victims have experienced massive psychological and physical harm and costs without any clear benefits achieved by finding and treating their “noncancers.

The NCI researchers said that part of the problem results from too many cooks in the kitchen.

Pathologists, radiologists, surgeons, dermatologists, clinical oncologists, and even cancer “interest groups” have their own terms for describing and classifying cancer. They largely define these terms according to the different tools and technologies they use. (Like a lot of modern medicine.) And also, cancer is a “high price-tag” diagnosis, which helps attract high-cost medical care and lots of different medical specialists, each with their own sub-specialty jargon.

But we should have common terms for describing cancer. And these terms should share a fundamental understanding based on science and cancer biology. The NCI panel said this step would help us avoid some of the problems of overdiagnosing and overtreating cancer.

And here’s another part of the problem…

Science bureaucrats play statistical tricks with cancer rates to demonstrate to Congress and taxpayers that we really are “winning the war on cancer.” We have seen this go on for 30 years now.

For example, the NCI panel notes that we diagnose many more “early-stage” cancers. But there has not been a decrease in late-stage cancers. Or in cancer deaths. And this is what really counts.

Doctors pick up more “early cancers” that aren’t really cancer at all. Yet they treat these early cancers the same as late-stage cancer. So, the statistics about early detection look terrific. But we aren’t making real progress against real cancers that take away lives.

Believe it or not, back in 2009, the chief medical officer of the American Cancer Society talked about this problem in the Journal of the American Medical Association. In fact, he said, “the advantages to screening have been exaggerated.”

If all the attention to cancer screening has resulted in detecting more lesions that are not cancer in the first place, then the whole approach to controlling cancer has been misdirected.

So what do we do now to control cancer?

You may be as surprised as me to hear what the NCI panel recommended. It’s something many of us in the natural medicine world have been waiting for years to hear!

The panel proposed that we change the “concept of how to approach disease progression.”

They said ideally, we should yield to alternatives by “controlling the environment in which precancerous and cancerous conditions arise. Strategies such as diet or chemoprevention may be as effective, and are less toxic, than more ‘traditional’ cancer therapies in lower-risk tumors.”

“Chemoprevention” may sound like they are talking about chemotherapy to prevent cancer. But actually, it’s quite the opposite.

It means using vitamins, minerals, and phytochemicals to prevent cancer.

Scientists at NCI started using the term “chemoprevention” 30 years ago because it sounds “more scientific.” And, thus, more acceptable at NCI, when they started the diet and cancer research program three decades ago.

No matter what term they used, the NCI admitted that diet, vitamins, minerals, and phytochemicals can help prevent and control cancer. This is a huge step.

Remember, this same bunch refused to study vitamin C in the 1980s because they said two-time Nobel laureate Linus Pauling gave it a “bad name.”

I know; I was there–and most of them still are.

Well, it sounds like someone at the NCI at last may finally change their tune. Let’s hope, anyway.

Sources:

1. “Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement,” JAMA 2013;310(8):797-798

2. “Rethinking Screening for Breast Cancer and Prostate Cancer,” JAMA 2009;302(15):1685-1692

3. “Cancer? Not!” Medscape (www.medscape.com);      Aug 29, 2013

 

 


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