Beating Cancer: Does Early Detection Help?

I’ve often wondered whether modern medicine’s approach to cancer makes any sense. The usual routine: You have a pain. Your doctor sends you to a specialist for diagnosis. You are told you’ve got a deadly disease. And the rest of your life is ruined by surgery; chemotherapy, radiation, and the horror of thinking you are going to die. I’ve been thinking about this a lot lately, because of my father’s recent death from lung cancer and two other battles that friends are waging now.
When I see the pain and suffering they are enduring – and notice the nonchalant (see Word to the Wise, below), almost smug, manner in which their doctors deliver the news and treat them – I wonder if it wouldn’t be better if they had never been told at all. I think about these people and I can imagine their response: “I’d rather fight it. Even if my chances are slim, I’m glad I have a chance to try to beat it.” That perspective is based on a common perception: that early detection can prevent cancer.
It’s a belief that’s been drummed into our heads by the medical industry since I was a kid. And like many other commonly held medical beliefs, it is widely held without, apparently, a shred of evidence. A recent Wall Street Journal essay by Sharon Begley made this point: “Nothing has greater intuitive appeal than the claim that cancer screening leads to early detection, which leads to longer survival. Whether it is the PSA test for prostate cancer, mammograms, endoscopies for colon cancer or – in the wake of Peter Jennings’ untimely death – X-ray screening for lung cancer, intuition screams that the earlier a cancer is caught, the better the odds that you’ll be alive in five years.”
For a long time this was, as I suggested, a widely held professional view based on intuition, not proof. In recent years, scientists have been attempting to substantiate it with studies. But the data that is evolving from these studies is contradicting expectations. The impact of cancer screening on reducing cancer mortality, a spokesman for the National Cancer Institute (NCI) told Begley, “still isn’t proven.”
Here’s what is being learned: Many cancerous tumors don’t cause cancer – or they take so long to develop that the patient can live a full life waiting for them to activate. These slow-growing tumors – “indolent” tumors, scientists call them – occur with neuroblastomas (cancer of the nervous system), prostate cancer, lung cancer, and even breast cancer. I asked Jon Herring, ETR’s Health Editor, to look into the latest research on this subject.
Here’s some of what he found:
Breast Cancer
In 2002, The New England Journal of Medicine published a long-term follow-up study of women who had mastectomies compared to women who simply had the lump itself removed (lumpectomy). After 20 years, the death rates from all causes and the death rates from breast cancer were virtually identical for both groups of women. In other words, the radical surgery so often performed did not increase survivability at all compared to the more minor procedure.
Prostate Cancer
The Agency for Healthcare Policy Research produced evidence showing that men who had their prostate gland removed had an average survival of 14 years after surgery. This appears to suggest the surgery provides life-extending benefits – until you consider what happened to the men who did nothing. The men who chose “watchful waiting” over surgery also lived an average of 14 years after diagnosis. Apparently, the surgery does not increase survivability – though it certainly does increase the risk of complications.
In fact, the credit many cancer survivors attribute to early detection and treatment is often likely due to the fact that their tumors were indolent, and thus wouldn’t have killed them even without the treatment. How common is this? “Over-diagnosis of cancer as a result of screening is the rule rather than the exception,” the NCI representative told Begley.
Over-diagnosis, Begley points out, is different than “false positives.” A false positive is an incorrect diagnosis: You are told that you have tested positive for a cancerous tumor, but the test was wrong. False positives cause unnecessary stress and grief, not to mention the pain, suffering, and financial costs of unnecessary procedures. But over-diagnosis is “arguably worse” than false positives, because it affects so many people. Over-diagnosis not only leads to a huge number of unnecessary procedures, it has another negative effect.
As Begley points out: It creates a false perception “of progress in the war on cancer.” “Let’s say that, as a result of such a screening, a patient begins treatment on August 26, 2005. She does well, and celebrates her five-year survival rate on August 26, 2010. If she succumbs to a recurrence or a spread of her initial cancer in, say, 2015, she still counts as a five-year survivor. But if she had a slow-growing cancer, she might have made it to 2015 anyway, without early diagnosis and treatment. She is scored as a victory for cancer warriors, but in fact they didn’t buy her a single extra day of life. All she got was more years knowing she had a dread disease.”
Thus, the improvement that studies have been attributing to early detection may be simply because screening methods have improved and more of these slow-growing tumors are being spotted. Spotting an increased number of indolent tumors means that the number of five-year cancer survivors will go up too – since indolent tumors don’t kill you in five years. In the lungs, for instance, CT scans are detecting almost as many lung lesions in non-smokers as they find in smokers. But most of the lesions in non-smokers are indolent.
By adding those indolent tumors into the data pool, a greater number of five-year lung cancer survivors are listed. But there are no fewer deaths, a Mayo Clinic study reported. According to Jon, the same trends are evident with skin cancer, which is now diagnosed at double the rate it was in 1986. An article in The New York Times suggests that instead of an epidemic in skin cancer, perhaps we are “experiencing an epidemic of skin cancer screening.” Undoubtedly, mention of the word “pre-cancerous” has scared countless people into having harmless moles removed.
Renowned dermatologist Dr. A. Bernard Ackerman, emeritus director of the Ackerman Academy of Dermatopathology in New York, believes that dermatologists have gone too far. Regarding their “excessive zeal” in diagnosing melanoma, he said: “There has been a mania for taking off these moles that are of no consequence. We’re talking about billions and billions of dollars being spent, based on hype.” This would be fine … if it led to fewer deaths. But according to a study published in The British Medical Journal, it has not. Researchers at Dartmouth analyzed changes in the incidence of melanoma.
Here is what they found: Since 1986, skin biopsies have risen by 250%. The incidence of early-stage melanoma has risen by the same amount. However, there was no change in the melanoma death rate or incidence of the later stages of the disease It is a delusion to equate longer survival rates to progress. What matters is the number of actual deaths. And that number has not been reduced by most forms of early-detection and treatment. So what does this mean?
First, we have to recognize that much of what we take for granted in modern medicine is simply false. Second, we have to recognize that a number of widely practiced medical treatments have no medical basis and may not have any beneficial effect … except to fatten doctors’ wallets. Third, we must accept responsibility for our own health. And that means not relying on what we are told just because the government, the AMA, or some other “trustworthy” institution says it’s so. Relying on yourself is tough. But when it comes to staying alive, it’s foolish to do anything else.
[Ed. Note. Mark Morgan Ford was the creator of Early To Rise. In 2011, Mark retired from ETR and now writes the Palm Beach Letter. His advice, in our opinion, continues to get better and better with every essay, particularly in the controversial ones we have shared today. We encourage you to read everything you can that has been written by Mark.]