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Cancer Redefinition Long Overdue

The Problem With Early Cancer Detection

Friday, July 19, 2019
Cancer and diet from NIH

Cancer and diet from NIH (Photo credit: Wikipedia)

Early cancer detection was what piqued my interest in magnetic resonance imaging (MRI) technology even before it won FDA approval.

While helping introduce it into mainstream medical practice, however, I learned of the downsides to increasingly sensitive imaging technologies like MRI.

Yes, they enable physicians to detect disease earlier in its progression. But they also detect other benign abnormalities – and the adult human body is often riddled with various lesions and other abnormalities that never pose a threat. The problem occurs in determining which are benign and which are not – and the current state of the science in this regard is far less precise than is generally understood.

Since the early days of CT and MRI in the 70’s and 80’s, imaging technologies have grown even more sensitive – perhaps even hyper-sensitive – in their ability to detect all manner of both disease, including cancer, and benign abnormalities.

But since the distinction between the two isn’t always black-and-white – and the rate at which a suspect abnormality may, or may not, develop into a pre-cancerous or cancerous condition is generally unknown – doctors generally opt for a “conservative” strategy of removing all suspect abnormalities.

But is this aggressiveness really conservative? Isn’t so-called “watchful waiting” to monitor the suspect abnormality rather than subject patients to invasive follow-up tests and toxic treatments actually far more conservative? (See “Angelina Jolie’s Brave Example – and the Other Side of the Story” for more on this).

This is a subject I also discuss in Our Healthcare Sucks in relation to its impact in promoting unnecessary follow-up tests and invasive biopsies and surgeries. But given our collective terror of “The Big C”, it’s fair to ask…  

Is It Time to Redefine Cancer?

The National Cancer Institute (NCI) has finally taken the lead by recommending sweeping changes to the nation’s approach to cancer detection and treatment. This includes no longer calling pre-cancerous conditions “cancer”.

In a study published this week in The Journal of the American Medical Association (JAMA), a study of screening program effectiveness found three categories of screenings based on their relative effectiveness. Breast and prostate screening – perhaps primary in the public consciousness – were found to be largely ineffective:

“Screening for breast cancer and prostate cancer appears to detect more cancers that are potentially clinically insignificant.”

Another study published a day later confirmed that watchful waiting of patients with abnormal lobular breast tissue – with properly coordinated imaging and laboratory analyses – would have avoided 3 out of 4 follow-up surgeries.

It’s likely, however, that these suggestions for greater moderation in our approach to cancer will fall on deaf ears – both in the medical and patient communities. Doctors will fear lawsuits if they aren’t aggressive enough and patients will fear having a “cancer” growing in their bodies. And fear is a prime motivator for much of our healthcare (See “America’s Health Scare System“).

Patients can’t generally be expected to understand that whatever abnormality – pre-cancerous or not – that may have been detected by one screening exam or another, there are likely dozens more lurking elsewhere in their bodies (see “Navigating Medical Uncertainty – Disease, Un-ease & Uncertainty“).

Doctors, however, can be expected to understand this – to put suspect abnormalities into a broader clinical perspective that might suggest more caution than is currently the norm. Their willingness to subject patients to unneeded tests and procedures  – with their own risks of infection and other complications – reflects their abandonment of the “Do no harm” foundation of medical care.

And then, of course, there’s the ever-prevalent reality of money in medicine. I’ve written previously about the lengths to which many oncologists have been willing to go to preserve and enhance their incomes. This includes increasing toxic chemotherapy dosages to offset reductions in their chemo payments ( see “Got Cancer? Too Bad“).

It’s no overstatement to suggest that Hippocrates would roll over in his grave…

Selling Cancer Screenings

I have no doubt this latest NCI initiative will precipitate a salvo of defensive outbursts from the medical establishment. Wrapped tightly in their concern for patient quality (yada, yada, yada…), expect to hear how our doctors have only their patients’ best interests at heart and how our better cancer results demonstrate that cancer screenings work and work well.

As the JAMA study suggests, however, this is more true for colon and cervical cancer screenings than it is for breast and prostate cancer screenings. It’s no surprise that some cancer screenings are more effective than others. Our willingness to fund them – and make no mistake that cancer screening is a huge industry (see “Selling Cancer Screenings With Meaningless Survival Rates“) – and to endure their follow-up interventions as patients should reflect this clinical reality.

Instead, we’ll continue to be bombarded with broad-brushed promotion of cancer screenings that may have little merit. The importance of diet, however, as evidenced by the graph at the start of this post, will continue to be given short shrift.

The JAMA study suggests that…

“The term ‘cancer’ should be reserved for lesions with a high likelihood of lethal progression if left untreated”.

But that would pull the rug out from one of healthcare’s strongest growth engines of profitability. And as demonstrated by the example of oncologists ramping up their toxic chemotherapy regimens to preserve their profits – at the expense of their patients’ shortened lives – that is simply not how American healthcare works.

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6 Awesome Comments So Far

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  1. Private Consultants
    November 26, 2013 at 6:23 am #

    Yes i do agree with you, When cancer is found, the patient’s doctor needs to know the stage, or extent, of the disease to plan the best treatment. The doctor may order various tests and exams to find out whether the cancer has spread and, if so, what parts of the body are affected. In some cases, lymph nodes near the tumor are removed and checked for cancer cells. If cancer cells are found in the lymph nodes, it may mean that the cancer has spread to other organs.

  2. Tariqul
    November 10, 2013 at 2:18 pm #

    Informative and authentic information and I am totally agree with you. We should learn how can we survive with Cancer and cancer Institute definitely can help people who are suffering this dangerous disease. Thanks for your informative article.

  3. colonoscopy in london
    October 9, 2013 at 6:05 am #

    Here i want to share unsolved problem because of earlier detection: In the last decade, numerous research and programmatic efforts have attempted to improve cancer screening practices among women from diverse race/ethnic backgrounds on the assumption that observed differences in breast cancer survival were largely due to differences in early detection practices. Recent data from the 1992 National Health Interview Survey and a 1992 survey in San Francisco Bay Area multiethnic communities indicate that rates of self-reported breast cancer screening tests among African American, Hispanic, and white women no longer differ significantly. However, there are large, persistent socioeconomic differences as reflected in educational and income levels, the recency of immigration, and English language proficiency. This emphasizes the continuing need for interventions tailored specifically for the underserved, with the racial, ethnic, and cultural composition of the intended audience informing educational messages and strategies. However, effective research interventions are complex and costly throughout the spectrum of outreach, inreach, and follow-up. Thus the generalizability of these strategies to under-funded providers and agencies in low-income communities may be limited. Therefore, as ongoing research continues to refine strategies, the application of effective community-based intervention should seek out potential partnerships with programs that provide the critical access to services. Cancer control scientists are well positioned to advocate for community-based infrastructures that facilitate translation of research into practice.

  4. Levon
    September 4, 2013 at 5:11 pm #

    great information hopefully this will bring us one step closer to the proper treatment.

  5. Name (required)
    September 2, 2013 at 3:55 am #

    I agree. Now is the time to redefine cancer. Anyway, thanks for sharing this very insightful article. Great write-up, it’s very informative.

  6. Gastroenterology in london
    August 7, 2013 at 9:07 am #

    Thanks for sharing such a health care blog with us. I would like to give some additional information about this : If you are uninsured or underinsured, the Cancer Institute may be able to help you get the cancer screenings you need. The Cancer Institute Patient Navigation program works with low income individuals who are not up to date with colon, breast, and/or cervical cancer screenings.

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