Exaggerated benefits of early diagnosis

Irish Cancer Society exaggerates the benefits of early diagnosis and treatment.

 

What the Irish Cancer Society tells us:

In an article published in The Irish Times on 31st January, 2018, Irish Cancer Society head of research Dr Robert O’Connor said a recent report shows Irish survival rates “across a lot of cancers continues to increase”. This was due, he said, to improved research, better diagnosis, more modern treatments in chemotherapy and radiotherapy and enhanced co-ordination of services.

What the Society doesn’t tell us:

Increases in survival is not “because of more modern treatments” according to this American Cancer Society study.
It found that Colorectal cancer patients who improve their diet and lifestyle survive longer with a 42 per cent reduced risk of death than those who do not make the changes.

Even with no treatment at all, some cancer patients live for a number of years. For example, in the case of liver cancer, median survival without treatment of stage 0 or A is 3 years (Annals of Oncology).

Also, improved survival rates over the past 21 years are possibly no better than can be accounted for by:

• overdiagnosis
• lead time bias
Patient empowerment including:
• greater access to information via internet, books etc
• more awareness about the benefits of supplements
• more awareness about the importance of diet and lifestyle for recovery
• more awareness about alternative, integrative and complementary treatments

• access to Complementary therapies in Ireland
• access to alternative treatments at cancer centers abroad
• access to integrative treatments at cancer centers abroad

• greater access to life-saving information Cancer Coaches
• other factors

Overdiagnosis. Some cancers that are diagnosed early do not develop symptoms requiring treatment, while others grow so slowly that the patient outlives the cancer and dies of other causes. Many of these are treated unnecessarily, leading to inflated survival rates.

The authors of this study which looked at cancer overdiagnosis stated:
We estimate the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen–detected prostate cancers.

This Article, published in 2012 in the New England Journal of Medicine, found: 31% of all breast cancers are over-diagnosed.

This 2016 review concluded:
· At least 20% of Breast Cancer patients, if left untreated would be alive after 5 years
·
limited evidence suggests that around 10% of screen detected Breast Cancers may regress.

The National Cancer Institute’s Breast Cancer Screening (PDQ®) –Health Professional Version (updated June 1, 2018) includes the following admission:

Theoretically, in a given population, the detection of more breast cancers at an early stage would result in a subsequent reduction in the incidence of advanced-stage cancers. This has not occurred in any of the populations studied to date. Thus, the detection of more early stage cancers likely represents overdiagnosis. A population-based study in the Netherlands showed that about one-half of all screen-detected breast cancers, including DCIS, would represent overdiagnosis and is consistent with other studies, which showed substantial rates of overdiagnosis associated with screening.

A study published in 2017 in the New England Journal of Medicine involving thousands of breast cancer cases, concluded that a significant proportion of tumors detected through mammography are not small because they are found early.

Instead, the tumors are small because they are biologically prone to slow growth.

In an interview with National Public Radio, Donald Lannin, a professor of surgery at the Yale School of Medicine, who led the study, said “It takes 15 or 20 years for [these small tumors] to cause any problems. And you can kind of imagine that a lot of patients will die of something else over that 15 or 20 years.

That means a significant proportion of women who get screened for breast cancer with a mammogram go through biopsies, surgery, chemotherapy, radiation — and experience a lot of stress — for tumors that may never pose a health threat.

In the same interview, H. Gilbert Welch, a professor of medicine, community and family medicine at Dartmouth College, who was not involved in the study, said “It appears that screening disproportionately finds good cancers — cancers that may be better off not found,”.

“I think that we all need to realize that we’ve probably oversold the idea that looking for cancer early is the best way to avoid it,” Welch says. “Mammography’s a really close call. It’s a choice. We’ve exaggerated its benefit and we’ve sort of understated its harms.”

What the discoverer of PSA Test says:

Article New York Times (Nov. 25, 2014) by By Richard J. Ablin.

In 1970 I discovered the prostate-specific antigen, or PSA, which is now the most widely used tool in prostate screenings. But there has been a growing concern about whether the use of the PSA test has led to overdiagnosis and overtreatment, with millions of unnecessary surgeries, complications and deaths.

The Great Prostate HoaxBook blurb
Every year, more than a million men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, resulting in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. How did we get to a point where so many unnecessary tests and surgeries are being done? In The Great Prostate Hoax, Richard J. Ablin exposes how a discovery he made in 1970, the prostate-specific antigen (PSA), was co-opted by the pharmaceutical industry into a multibillion-dollar business. He shows how his discovery of PSA was never meant to be used for screening prostate cancer, and yet nonetheless the test was patented and eventually approved by the FDA in 1994.

The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster.
Richard J. Ablin, PhD with Ronald Piana
St. Martin’s Press

Lead Time Bias. Survival rates don’t simply depend on when someone dies but also on when their cancer is detected. Earlier detection will therefore always lead to improved survival rate statistics, even if it doesn’t lead to delayed death. These survival rates don’t prove that cancer patients are living longer; but rather that they are living with cancer for longer.

This study surveyed 406 women with breast cancer in Ireland. It found that over half (55.7%) used some kind of complementary or alternative therapy.

Lead Time Bias

From the video Lead Time Bias by H Gilbert Welch

A major study on cancer survival examined data over a 45 year period and found that “changes in 5-year survival rate over time bear little relationship to changes in cancer mortality.”

Proof that cancer patients’ increases in survival is not ‘because of better drugs’
A study published in 2018 in JAMA Oncology found that colorectal cancer patients who improve their diet and lifestyle survive longer with a 42 per cent reduced risk of death than those who do not make the changes. This is way beyond anything drugs have to offer…and with only positive side effects!

So, while putting a positive spin on survival rates certainly helps to bring in more donations for cancer charities, the harsh reality is that “more modern treatments in chemotherapy and radiotherapy” do nothing to reduce cancer deaths in any meaningful way.

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