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Nov 26, 2009

Early Detection is Not Prevention

The controversy surrounding the new recommendations on the use of mammography casts a dubious light on America’s attempts to reform healthcare. Though everyone agrees that we must reduce costs, we seem unable to address the fact that the high-tech, chemo-industrial practices that define American medicine are unsustainably expensive and unavoidably harmful.

The panel basically said that for women below the age of fifty, regular mammographies do not provide enough benefit to outweigh the risks involved. They made clear that they were not talking about women who were deemed to be at high-risk for the disease, and they strongly advised that such women continue with regular screening, along with all women over the age of fifty.

But for those who are not high-risk and are now asymptomatic — most women — they found that screening detected one aggressive cancer for every 1,900 women tested, while some 190 (10%) would receive false positives. Those women would undergo biopsies and some undetermined number would go on to receive cancer treatment that they never really needed.

As Breast Cancer Action explains:

But the complex biology of breast cancer means that women diagnosed with “early” breast cancer fall into one of three groups.

• One group has very aggressive disease that, no matter how small it is when it is found, cannot be effectively treated with the therapies that are currently available. These women will die of breast cancer eventually, no matter what treatment they are given, unless they die of something else first.
• Another group of women diagnosed with breast cancer has a type of either non-aggressive invasive disease or some presentations of DCIS (ductal carcinoma in situ) that will never be life-threatening.
• The third group has a type of breast cancer that responds to currently available treatments. Finding breast cancer earlier does increase the likelihood that treatment will work for women in this group.

We do not know how many women historically have fallen into each of these three groups. And, while these divisions and the treatments currently available mean that “early detection” only matters for women in the third group, we cannot determine at the time of diagnosis the type of tumor a woman has. The result is that we mistreat or over-treat many women diagnosed with breast cancer.

Since treatment involves some combination of surgery, radiation, and chemotherapy, mistreatment and over-treatment amounts to serious harm. Some women are sickened by the chemo and radiation, some receive unnecessary mastectomies, some ultimately die from the would-be cure.

First, Do No Harm

On one side of this debate are the medical researchers who make clear that they are not anti-testing and that their recommendations were not based on costs. They are simply calling for an evidence-based adjustment of the screening protocols.

On the other side are the medical professionals who play an active role in the testing, along with the strong voices of breast cancer survivors who benefited from early detection. The latter make an especially compelling case: if these recommendations had been in effect some years ago, they say, they’d probably be dead.

However, we don’t know how many of those women actually had non-aggressive growths; such women were more harmed than helped by the screening and resulting mistreatment.

Moreover, absent from the debate are any women who were harmed. Some have died, while others have had their health seriously degraded by toxic and invasive treatments. But it is impossible to document any of these cases because once a woman has received a false positive and enters a treatment regimen there is no way to know what is occurring on its own and what is being caused by the chemo and radiation.

So we have a debate about risks versus benefits that fails to investigate  or even acknowledge the risks.

Fighting Symptoms or Preventing Causes

Some insist that early detection is the only thing preventing them from getting cancer. But of course even when early detection works (finds an aggressive but treatable cancer), it is not prevention. What we really need to do is prevent breast cancer from ever occurring, or at least greatly reduce the at-risk population.

To do that we will need to know what causes cancer in the first place. Yet little of our mega-bucks, 50-year War on Cancer has been devoted to finding and resolving causes. Instead, we’ve spent billions and billions on variations of the breast cancer strategy: high-tech screening to find existing cancers and then more high-tech treatments/weapons to kill it.

Even if such weapons worked — they eliminated cancer without causing any collateral damage — they would still inflict great stress on patients and they would still be extremely expensive.

Instead of teaching women to passively show up for their regular screenings and then, when the news is bad, to passively undergo the latest treatments, we should be teaching women (and men) to actively practice cancer-preventing lifestyles.

The fundamentals are known and well-documented: a whole food, chemical-free diet; avoidance of environmental toxins; and, learning to deal with stress.

If everyone simply practiced the fundamentals, and if as a nation we mandated clean air, water, and soil and required strict industry compliance, including comprehensive testing of all industrial chemicals, we would do better than win the war on cancer: we would discover our innate abilities of self-regulation and self-healing. And we’d save a lot of money.

Michael Sky | CommonHealth

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