Rethinking Cancer

All cancers are dangerous and should be cut out - or should they? Dr Joe Kosterich muses whether a lot of effort is being spent for nothing.

 The front cover of Time Magazine remains a significant place for a news story. Late last year there was a confronting cover story - “What if I decide to just do nothing? Breast Cancer’s new frontier”.

 If we accept the traditional notion of cancer as something which starts small but grows relentlessly, spreads through the body and ultimately results in death, this is crazy! We know that early detection and aggressive treatment being the best approach.

 But what if our understanding of cancer is incomplete?

 Today we find that not all cancers follow the path of relentless growth. Some never grow at all. Some reach a level and do not change after that.

 An analogy might be seeds planted in the soil. Not all “take” and grow to reach the surface.

 A thyroid cancer study found that from 2003 to 2007, up to 80% of women in Australia, France, Italy and the US had their thyroids removed for tumours that should have been left alone.

 Modern screening programs are leading to significant over-diagnosis, exposing people to needless treatments and associated harm at considerable cost to an overstretched health budget.

 Dr Ray Moynihan from Bond University discussed this issue in an excellent presentation in the Challenging Conventional Thinking seminar at the Brisbane GPCE.

But what if our understanding of cancer is incomplete?

 Modern screening programs are leading to significant over-diagnosis. This in turn exposes people to treatments they do not need and associated harm. And this is at considerable cost to an already overstretched health budget.

 US experts have suggested that we need a new way of describing the growths that do not grow. Calling them cancer carries all the connotations of the “standard” type of cancer. The term IDLE (indolent lesion of epithelial origin) has been considered.

 Many breast “cancers” are actually IDLEs.

 The notion of “doing nothing” with these breast IDLEs is a bit of a misnomer. Monitoring a growth which is causing no harm with a view to acting if it changes, is doing something.

 Over the last 30 years, there has been a near-doubling in the number of early breast cancers detected but a minimal decrease in the number of late stage breast cancers. Actual mortality figures have been largely unchanged as the survival rate has gone up in parallel with the total number of cancer cases.

 The small decrease in late stage cancers with a doubling in early stage cancers (which get treated) means we are finding mainly non-fatal tumours. Survival rates increase because it is easy to cure a condition that would not have been a problem.

 Why are we finding so many cancers that are not a problem? Screening mammography. Up to 40% of growths found on screening are ducal carcinomas in situ that can be watched rather than treated.

 But when found they are all treated. This approach is being reconsidered, drawing on the more watchful approach adopted successfully in prostate cancer.

 Women are also voting with their feet. Figures show a reduction in screening mammograms with no change in breast cancer incidence and a slight decline in mortality (due to improved treatment).

 Our knowledge evolves in medicine. Unfortunately there is much vested interest and dollars dependent on the current approach so change happens slowly.

Jow KosterichDr Joe Kosterich MBBS
Doctor, speaker, author of three books, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.

He is a regular on Channel 9 and radio, writes for various medical and mainstream publications, as well as maintaining a website and blog providing health information. He is the health ambassador for locally grown fresh potatoes. Dr Joe also gives practical motivational health talks for the general public and organizations.