"Cancer
lies dormant in all of us. Like all living organisms, our bodies are
making defective cells all the time. That's how tumors are born. But
our bodies are also equipped with a number of mechanisms which detect
and keep such cells in check. In the West one person in four will die
of cancer--but three in four will not: THEIR DEFENSE MECHANISMS WILL
HOLD OUT."
-Dr. David Servan-Schreiber, Psychiatry Professor, Univ. of Pittsburgh-
This week's big medical story is swirling with controversy. Is it possible that cancer can just disappear on its own? Is mammography enabling us to diagnose breast cancer "too early", risking unnecessary treatment?
Dr. Per-Henrik Zahl from the Norwegian Institute of Public Health in Oslo, Norway was able to analyze the number of breast cancers that were diagnosed in 2 different groups of women with similar risk factors to help answer these questions:
Dr. Per-Henrik Zahl from the Norwegian Institute of Public Health in Oslo, Norway was able to analyze the number of breast cancers that were diagnosed in 2 different groups of women with similar risk factors to help answer these questions:
- One group of 109,784 women was followed for 6 years (1992-97) and had one mammogram at the end of 6 years.
- The other group of 119,472 women was followed for 6 years (1996-2001) and had regular mammograms.
The authors expected that both groups would have roughly the same number of breast cancers detected. The surprising result was that:
The women who had regular mammograms had 22% more cancers.
- For every 100,000 women who were regularly screened, there were 1,909 diagnosed with invasive breast cancer.
- For every 100,000 women who were only screened at the end of 6 years of being followed, there were 1,565 diagnosed with invasive breast cancer.
The authors carefully considered all the possible explanations for the differences in the numbers of cancers diagnosed, and they believe the most likely explanation is:
Except for this particular study, it would be impossible to document any large-scale natural regression of breast cancer, because when breast cancer is diagnosed it is almost always treated. Watch & wait isn't a viable option when it comes to breast cancer, because physicians right now have no way to know which cancers will be aggressive & fatal, and which are "nothing to worry about".
Drs. Robert Kaplan & Franz Porzsolt, writing an editorial about the study's conclusions, note:
"There are some women who had cancer at one point, and who later don't have the cancer". (study author: HG Welch)
"The hypothesis suggests that about 20% of the women in the multiple screen group received unnecessary treatment because their tumors would have disappeared on their own." (editorial authors: RM Kaplan; F Porzsolt)
This is about spontaneous cancer regression--the body's natural defenses arresting the cancers' growth and the risks of diagnosing cancer "too early". In case you are wondering: rest assured that the cancers had nothing to do with the mammography.
"The hypothesis suggests that about 20% of the women in the multiple screen group received unnecessary treatment because their tumors would have disappeared on their own." (editorial authors: RM Kaplan; F Porzsolt)
This is about spontaneous cancer regression--the body's natural defenses arresting the cancers' growth and the risks of diagnosing cancer "too early". In case you are wondering: rest assured that the cancers had nothing to do with the mammography.
Except for this particular study, it would be impossible to document any large-scale natural regression of breast cancer, because when breast cancer is diagnosed it is almost always treated. Watch & wait isn't a viable option when it comes to breast cancer, because physicians right now have no way to know which cancers will be aggressive & fatal, and which are "nothing to worry about".
Drs. Robert Kaplan & Franz Porzsolt, writing an editorial about the study's conclusions, note:
"Not many years ago it was commonly believed that most patients with untreated breast cancer eventually die of breast cancer. Today there is increasing evidence that a considerable proportion of breast cancer cases are not life threatening to their hosts."
"We know from autopsy studies that a significant number of women die without knowing that they had breast cancer (including ductal carcinoma in situ)."
"If the spontaneous remission hypothesis is credible, it should cause a major re-evaluation in the approach to breast cancer research & treatment."
"We know from autopsy studies that a significant number of women die without knowing that they had breast cancer (including ductal carcinoma in situ)."
"If the spontaneous remission hypothesis is credible, it should cause a major re-evaluation in the approach to breast cancer research & treatment."
Some physicians welcomed these findings because they are in line with their own worries about the risks of "too early" mass breast cancer screening--especially when we don't really know which cancers are dangerous, and which are not. Perhaps this is just the impetus we need to figure out which types need aggressive treatment, and which types do not.
Other doctors believe the study is flawed, the interpretations are incorrect & mammograms save lives.
To read the full study in the Archives of Internal Medicine click here.
To read Gina Kolata's NYT story on the study click here.
How Do I Look at This Study?
According to Dr. Karla Kerlikowske, MD, an associate professor in the departments of medicine, epidemiology and biostatistics at the University of California-San Francisco and the director of Womens Veterans Comprehensive Health Center at the San Francisco VA Medical Center recommends:
Answers by Dr.Karla Kerliowske, Dr. Janet Allan, with the US Preventive Service Task Force & Dr. Marcie Richardson, practicing obstetrician with Harvard Vanguard Medical Associates in Boston
Dr. KERLIKOWSKE: Well, it's not a very sensitive or specific test, and what that means is that a fairly high percentage of women will have an abnormal result and not have cancer. But you have to do additional testing to figure that out. So a woman gets a screening mammogram, and anywhere between 5 and 10 percent will be told it's abnormal. But of that 5 to 10 percent, only 5 percent of those will have cancer 95 percent will not. So if you have a hundred women, 95 are going to get all these additional tests, which could be additional imaging, ultrasound, biopsy, just to tell them that they don't have cancer. And for many women, that creates anxiety and worry and sort of labels them as this person with an abnormal mammogram.
I think the second risk is detecting tumors that you would otherwise find and treat them and it would never impact on a woman's life expectancy. And those can be not only low-grade invasive cancers, but this preneoplastic lesion called ductal carcinoma in situ. So I think a particular for instance, if you're a 75-year-old woman and you're going to have a mammogram and you find this ductal carcinoma in situ lesion, and once you discover it, you have to treat it, that woman is undergo treatment for something that will have absolutely zero impact on her life expectancy.
FLATOW: Something akin to what a man would have with a prostate problem late in life.
Dr. KERLIKOWSKE: Exactly. And I think what's interesting is that the paradigm for breast cancer--people have often thought it's very similar to cervical cancer and colon cancer. In cervical cancer, finding a dysplastic lesion that would go on to be invasive cancer has been noted to be a good thing. There's been a dramatic decrease in cervical cancer mortality. And the same with colon cancer. If you find a preneoplastic polyp, it decreases your chances of getting colon cancer. And I think many people thought the same thing would happen with ductal carcinoma in situ, but, you know, now we just know that's a completely different entity. It's not this linear progression of, oh, you get DCIS and then you go on and get invasive cancer. So we sort of created a whole new disease entity by doing mammography, and it's unclear whether that's helpful or not.
Dr. ALLAN: And, Ira, that's why I think that although this debate may raise uncertainty and some anxiety, I think it's very positive for women because I think we have sometimes glossed over some of the harms of screening, and that's, again, why we think that women need to participate in making decisions about being screened for breast cancer, because there are some harms, as Dr. Kerlikowske has outlined. And for some women, they're fine. They want to do it. They want to have a mammogram every year, and they don't mind the abnormal screenings that they're going to have and the follow-up. But for other women, they do not want to do this. And so I think it's really important that women know about these harms.
Dr. RICHARDSON: I mean, if you have 10 mammograms 10 years in a row, the chance that you're going to have to have some sort of follow-up or some other additional intervention is really substantial.
Dr. ALLAN: Twenty-three percent actually of women...
Parting Thoughts from Dr. David Servan-Schreiber on the Synergistic Effects of Diet, Exercise & Stress Reduction on Cancer
Other doctors believe the study is flawed, the interpretations are incorrect & mammograms save lives.
To read the full study in the Archives of Internal Medicine click here.
To read Gina Kolata's NYT story on the study click here.
How Do I Look at This Study?
- I find the results a hopeful motivating message that perhaps our bodies can take care of errant cancer cells, given the right circumstances: wholesome diet, adequate exercise, stress reduction, Vitamin D (known to stop cancer cell growth) or some other unknown modifying factors.
- I still plan to have my yearly mammogram--I'm not about to take any chances!
- If I were diagnosed with cancer I would absolutely treat it.
- I recommend reading Dr. David Servan-Schreiber's book, Anti-Cancer. A New Way of Life to anyone interested in what they can do to prevent cancer--prevent a recurrence--or to supplement their treatment if they are diagnosed with cancer. My summary of his book is here.
- The knowledge that some cancers can spontaneously regress is an incredible motivator to continue to modify my lifestyle. For example, Servan-Schreiber details the top foods that inhibit breast cancer cell growth: garlic, leeks, scallions, brussel sprouts, cauliflower, cabbage, & kale. Yes, I will continue to juice. My "why I juice" post is here.
- I'm not into radical lifestyles, like raw food, but Shelly Abegg's story is certainly inspirational. She was diagnosed with advanced Stage III breast cancer seven years ago. She had the surgery, but tests revealed the cancer had spread beyond the surgical margins. That was back in 2001 & she's still alive.
- For additional inspiration, read Kris Carr's story, "Fearless" in Natural Health, Apr. 2008. She's the "Crazy, Sexy, Cancer" lady, who was diagnosed with a rare form of untreatable Stage IV liver cancer at age 31, five years ago. She's followed by the best oncology expert in the country for her type of cancer, but she certainly took matters into her own hands, as well, because there is no conventional treatment for this type of cancer. Five years later she's still alive & thriving.
- The Archives of Internal Medicine study is just one more piece to solving the cancer puzzle. Back in December 2001, the conservative, but well-respected Cochrane Breast Cancer Group looked over 7 completed studies on the benefits of screening mammography for breast cancer---this study group included a half a million women. They concluded that "the results did not show a survival benefit for mass screening for breast cancer." I'm not about to forgo my mammogram, but it's something to consider, nevertheless.
- Based on the Cochrane 2001 study, Ira Flatow, the host of NPR's Science Friday asked 3 breast cancer experts to comment on the following questions (Mar. 1, 2002):
According to Dr. Karla Kerlikowske, MD, an associate professor in the departments of medicine, epidemiology and biostatistics at the University of California-San Francisco and the director of Womens Veterans Comprehensive Health Center at the San Francisco VA Medical Center recommends:
- Vigorous exercise. (Read my post on diet exercise & breast cancer here.)
- Cut down on alcohol consumption
- Maintain ideal body weight
- Read Dr. Servan-Schreiber's recommendations in his book Anti-Cancer. A New Way of Life. (my comment)
Answers by Dr.Karla Kerliowske, Dr. Janet Allan, with the US Preventive Service Task Force & Dr. Marcie Richardson, practicing obstetrician with Harvard Vanguard Medical Associates in Boston
Dr. KERLIKOWSKE: Well, it's not a very sensitive or specific test, and what that means is that a fairly high percentage of women will have an abnormal result and not have cancer. But you have to do additional testing to figure that out. So a woman gets a screening mammogram, and anywhere between 5 and 10 percent will be told it's abnormal. But of that 5 to 10 percent, only 5 percent of those will have cancer 95 percent will not. So if you have a hundred women, 95 are going to get all these additional tests, which could be additional imaging, ultrasound, biopsy, just to tell them that they don't have cancer. And for many women, that creates anxiety and worry and sort of labels them as this person with an abnormal mammogram.
I think the second risk is detecting tumors that you would otherwise find and treat them and it would never impact on a woman's life expectancy. And those can be not only low-grade invasive cancers, but this preneoplastic lesion called ductal carcinoma in situ. So I think a particular for instance, if you're a 75-year-old woman and you're going to have a mammogram and you find this ductal carcinoma in situ lesion, and once you discover it, you have to treat it, that woman is undergo treatment for something that will have absolutely zero impact on her life expectancy.
FLATOW: Something akin to what a man would have with a prostate problem late in life.
Dr. KERLIKOWSKE: Exactly. And I think what's interesting is that the paradigm for breast cancer--people have often thought it's very similar to cervical cancer and colon cancer. In cervical cancer, finding a dysplastic lesion that would go on to be invasive cancer has been noted to be a good thing. There's been a dramatic decrease in cervical cancer mortality. And the same with colon cancer. If you find a preneoplastic polyp, it decreases your chances of getting colon cancer. And I think many people thought the same thing would happen with ductal carcinoma in situ, but, you know, now we just know that's a completely different entity. It's not this linear progression of, oh, you get DCIS and then you go on and get invasive cancer. So we sort of created a whole new disease entity by doing mammography, and it's unclear whether that's helpful or not.
Dr. ALLAN: And, Ira, that's why I think that although this debate may raise uncertainty and some anxiety, I think it's very positive for women because I think we have sometimes glossed over some of the harms of screening, and that's, again, why we think that women need to participate in making decisions about being screened for breast cancer, because there are some harms, as Dr. Kerlikowske has outlined. And for some women, they're fine. They want to do it. They want to have a mammogram every year, and they don't mind the abnormal screenings that they're going to have and the follow-up. But for other women, they do not want to do this. And so I think it's really important that women know about these harms.
Dr. RICHARDSON: I mean, if you have 10 mammograms 10 years in a row, the chance that you're going to have to have some sort of follow-up or some other additional intervention is really substantial.
Dr. ALLAN: Twenty-three percent actually of women...
Parting Thoughts from Dr. David Servan-Schreiber on the Synergistic Effects of Diet, Exercise & Stress Reduction on Cancer
"Fortunately, we can begin to protect ourselves against the biological mechanisms of cancer without adopting to the letter all the methods that have a positive effect. The body is a huge system in equilibrium, where each function interacts with all the others. Alter just one of these functions and the whole is inevitably affected. Thus, each of us can choose where we want to start: with diet, physical exercise, psychological work...."
"We discover that increasing awareness in one domain almost automatically leads to progress in others. At Cornell, the researcher T. Colin Campbell (read my Campbell summary here.) observed, for example, that rats on a diet of vegetable rather than animal proteins started to exercise more, as if the balance in their diet made physical exercise easier. In the same way, the practice of meditation or yoga links awareness to the body. Little by little, we lose the taste for an unbalanced diet--whose "heaviness" on the stomach and overall impact begin to weigh on the body. We lose the taste for tobacco--whose effect on breathing and on an accelerating heartbeat becomes more tangible...We lose our attraction to alcohol, whose influence on clear thinking and fluid movement is more easily detected."
"Health is a whole...Every step taken toward greater equilibrium makes the next ones easier."
"We discover that increasing awareness in one domain almost automatically leads to progress in others. At Cornell, the researcher T. Colin Campbell (read my Campbell summary here.) observed, for example, that rats on a diet of vegetable rather than animal proteins started to exercise more, as if the balance in their diet made physical exercise easier. In the same way, the practice of meditation or yoga links awareness to the body. Little by little, we lose the taste for an unbalanced diet--whose "heaviness" on the stomach and overall impact begin to weigh on the body. We lose the taste for tobacco--whose effect on breathing and on an accelerating heartbeat becomes more tangible...We lose our attraction to alcohol, whose influence on clear thinking and fluid movement is more easily detected."
"Health is a whole...Every step taken toward greater equilibrium makes the next ones easier."
.
I'd like to suggest one more Breast Cancer Prevention Tip: Eat Less Omega-6 Fat.
WHY: In October 2008, a large case-control study (nearly 1700 women), showed that women with a genetic susceptibility had a nearly 2-fold increase in breast cancer risk if they ate a high omega-6 fat diet (>17.4 grams of linoleic acid/day).
Yet when genetically susceptible women ate a lower omega-6 fat diet, there was no increase in cancer risk, which may indicate that the “cancer-gene-machine” did not get switched on. This appears to be a modifiable risk factor. It may also be the reason that previous studies show an association with diets low in omega-6 fat with a reduction of all-cause mortality, which includes cancer.
HOW: Omega-6 fats are the most commonly eaten polyunsaturated fat in the USA. The highest sources in the American diet are soybean oil, corn oil and cottonseed oil. You'll find them as the primary fat ingredient in: margarine, salad dressing, mayonnaise, processed foods and many "heart-healthy" foods. Instead, choose foods that use primarily olive oil, canola oil, flax oil or high-oleic oils. When possible choose free-range meats as they have a lower omega-6 fat content (since these animals graze on a diet of grasses which is lower in omega-6 fats, rather than the conventional corn-based diet.)
(Here's more info on the study:
http://omega-6-omega-3-balance.omegaoptimize.com/2008/10/10/breast-cancer-gene-and-omega6-fat.aspx)
Posted by: Evelyn Tribole, MS, RD | November 30, 2008 at 06:50 PM
I have been reading Servan-Shrieber's book this week, after buying it for myself as a birthday present. After being diagnosed with Stage III breast cancer in May of 2007 I have focused on evidence-based approaches for preventing recurrence. I've implemented most of the suggestions made in the book already, but it's always helpful to hear these messages again, both for the hope they inspire and to stay on track with the health behavior changes I've made in the interest of survival.
This blog seems like a great resource and I look forward to reading more.
Posted by: Paige Westerfield | December 21, 2008 at 05:38 PM
Paige,
I wish you courage, strength, good fortune & good medical care in your cancer fight. I was very impressed with Servan-Schreiber's book--his common sense, his research & his nutrition/environmental/psychological/stress-reduction/medical approach. Look--who wouldn't want to pull out all the stops in the face of illness!
I'm sure you've probably seen Kris Carr's Crazy Sexy Cancer DVD & book--Yes, she can be a little too perky--but whatever she's doing is certainly working for her. She, too uses common sense, sees the best medical expert in the field, but is doing everything she can to stay healthy. I know it's anecdotal evidence...but it's working for her.
Is there anything in particular that you're doing that seems to help? I would be very interested to know. Stay well!
And last point--like you--I find it very reinforcing to hear over & over again that healthy behaviors work!!
Posted by: The Healthy Librarian | December 23, 2008 at 11:59 AM