Do I Have Cancer?
Do I Have Cancer?
Yes No Don’t tell me!
When I was in University a nice break from my scientific studies was a philosophical discussion with friends in sociology and philosophy about the existence of God. It always became apparent that we had to define God before we could have the argument. Was God an external person in the heavens? Was God inside the soul of every human? The definition had to be made.
In this modern age if you have been given a diagnosis of cancer, we actually need a new definition. The disease was originally defined in 1845 by a German doctor, Rudolf Virchow, who looked at tumours taken at autopsy and said cancer is an uncontrollable growth that spreads and kills. Of course he was only looking at cancers that had killed people. He never saw the other cancers that still existed in their living bodies.
As chief medical and scientific officer of the American Cancer Society, Otis Webb Brawley, who is also a professor of oncology and epidemiology at Emory University, is the public face of the cancer establishment in the United States. After years of research, Dr. Brawley has come to the conclusion that most cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not require any treatment at all. Most cancers that have been detected with our wide variety of constant screening are actually harmless and we have been over diagnosed with this disease.
After decades in which cancer screening was promoted as an unmitigated good, as the best way for people to protect themselves from a frightening disease, a pronounced shift is underway.
Now expert groups are proposing less screening for prostate, breast and cervical cancer and have emphasized that screening comes with harms as well as benefits.
Two years ago, the influential United States Preventative Services Task Force, which evaluates evidence and publishes screening guidelines, said that women in their 40’s do not appear to benefit from mammograms and that women ages 50 to 74 years should consider having them every two years instead of every year.
In October of this year the group said the widely used P.S.A. screening test for prostate cancer does not save lives and causes enormous harm. It also concluded that Pap tests for cervical cancer should be done every three years instead of every year.
As new clinical trials have been completed, as were analysis of some of the older clinical trials (looking at them from a more modern perspective), researchers studied the risks and costs of screening more rigorously than ever before.
Two of the most recent trials of prostate cancer screening tests cast doubt on whether many lives or any are saved. It also concluded that screening leads to what can be disabling treatments for men whose cancer otherwise would never have harmed them.
A new analysis of mammography in the United States concluded that while mammograms find cancer in 138,000 women each year, as many as 120,000 to 134,000 of those women have cancers that grow so slowly that they do not need to be treated.
Certainly cancer screening is a useful tool and can help in some cases but the fact is the number of cases they help is actually very small. Meanwhile these same studies show that more harm is done by treating cancers that were otherwise just benign growths.
The problem is that most physicians are very set in their ways and are not very responsive to change. Is there any other place in this country where charts are all kept on paper and you see all those file folders in your doctor’s office. Most physicians still will not use a computer. Then we have the specialists like the urologist, radiologist and oncologists, who see patients that are sick and dying from cancer and totally resistant to the idea of doing less screening. General practitioners may agree with the new guidelines but do not want to get into arguments with their patients so they order the screening tests anyways just to save time.
Then there is the other view that cancer is a big business. All this screening and treatment generates billions of dollars of revenue for physicians, labs and the pharmaceutical industry. The injection for prostate cancer given every 3 months that medically castrates the patient costs about $1200 a shot. While someone is making money, a man is being castrated.
Nobody wants to upset the applecart that brings in the revenue and most physicians truly believe that they are doing a good thing by treating cancers that they feel would otherwise kill their patients. The more they screen, the more cancers they find, the more good they feel they are doing.
However more physicians have to listen to Dr. Brawley and ask the question; does finding the cancer lower the mortality rate?
Just last year, Dr.Richard Ablin PhD, the creator of the P.S.A test said “the P.S.A. test is a hugely expensive health disaster and should only be used as a follow up after prostate cancer treatment, not as a screening device”. The problem is that a high PSA number can be caused by an enlarged prostate, the use of ibuprofen or naproxen or by a prostate or bladder infection.
The current issue of the New England Journal of Medicine, for example, has an article by two prostate cancer specialists who note that one recent study concludes that $5.2 million must be spent on screening to prevent one prostate cancer death. And, according to the authors, Dr.Allan Brett of the University of South Carolina School of Medicine and Richard Ablin of the University of Arizona, that figure is not inclusive. The true cost is even greater.
A similar result was found by Dr.Russell Harris at the University of North Carolina but most doctors who are aware of these studies are simply confused. They have been doing it their way for a long time and are very reluctant to change.
I think that both doctors and patients are stuck in a sort of cancer time warp. They still hold to that old 1845 definition and it will take a long time before they understand the ability of the human body to live with cancers that are not harmful in the same way that we live with friendly bacteria in our bodies, 80% of which is foreign to us.
Physicians understand screening but most refuse to determine what type of cancer they have found and that is the question you should ask your oncologist. Not all cancers are malignant and the majority are benign and harmless. The question should be answered before any treatment begins. The days of surgery, radiation and chemotherapy as our first response should go the way of the Wild West in which the Sheriff shot first and then asked questions.
Follow up to my article about Jack Layton
The majority of you were very complimentary about the article but a number of you took issue with the fact that I criticized overly aggressive cancer treatment based on a P.S.A. test and no symptoms. Soon after that article was published, the very influential United States Preventative Task Force published their findings in a study which concluded that the P.S.A. screening test for prostate cancer does not save lives and in fact causes a lot of harm. A year earlier, Dr. Richard Ablin, the creator of the P.S.A. test severely criticized its overuse and said it should NOT be used to screen for prostate cancer. I feel that both these studies support my original position.
Finally the last word on prostate cancer screening comes from John Stewart, the host of a comedy show called the Daily show. He said he was very disappointed that the prostate screening tests were no longer necessary because his prostate had stayed up all night cramming for the exam.