A horrifying breast cancer “testimonial” for “holistic” treatment, part 3

(NOTE ADDED 12/7/2010: Kim Tinkham has died of what was almost certainly metastatic breast cancer. Also note that, when it was publicized on the Internet and on the blogosphere that Tinkham’s cancer gave every indication of having recurred and she was dying, her “practitioner” Robert O. Young removed the videos embedded below from YouTube.)

Remember Kim Tinkham?

She’s the woman who was diagnosed with Stage III breast cancer about three years ago. At the time, she became infamous because she showed up on Oprah Winfrey’s show, back when Oprah was in her “Secret” phase and proceeded to alarm even the ever woo-friendly Oprah by announcing that she wasn’t going to undergo any conventional therapy. Although the show was about The Secret, that magical, mystical belief that states that you can have anything you want if you want it badly enough, fortunately Tinkham didn’t choose just The Secret as her treatment. Unfortunately, she did find an pseudoscience-slinging practitioner of acid-base woo named Robert O. Young, who believes that viruses are “molecular acids,” that sepsis is not caused by bacteria, and that cancer cells are cells that have been “poisoned” by excess acid and the tumor a reaction to these “spoiled” cells. He took Ms. Tinkham under his treatment, a saga that that I updated about a year ago.

Longtime readers may remember that the part of Tinkham’s testimonial that I found most puzzling was where she said in an interview:

She can still feel the tumor just underneath the surface of her skin, where it will probably remain for a while.

But she knows it’s harmless. Now, it’s simply her badge of honor – the reminder that she, Kim Tinkham, defeated cancer without any surgery, invasive procedures, radiation or chemotherapy.

It’s rare to find a better example of denial out there, given that Robert O. Young believes that all disease is due to excess acid and that alkalinization is the answer to cancer and pretty much every other disease. Still, every now and then I wonder what’s happened to Kim Tinkham. For some reason, last night was one of those nights, and it didn’t take me long to find videos on YouTube:

Now that Ms. Tinkham appears to have been around for three years now, I wondered if I could find out what’s going on. One thing that she keeps repeating again and again is that she was diagnosed with “stage III” breast cancer. In the video above, Young nad his wife keep harping on that again and again. The three of them also complain again and again that there “weren’t any options.” Unfortunately, assuming the diagnosis and staging were correct, there really aren’t a lot of options. If the tumor is Stage IIIA, then there is the option of mastectomy and lymph node dissection (modified radical mastectomy) or, in the case of a woman with–there’s no way to put this very delicately–very large breasts, it might be possible to do a lumpectomy with removal of the axillary lymph nodes. Either way, afterward, chemotherapy and radiation would be indicated. If the tumor is Stage IIIB or IIIC, then surgery is not performed first. Rather chemotherapy is administered first in order to shrink the tumor. If there is adequate response, then a lumpectomy can be done; otherwise a mastectomy is performed, both usually with a removal of the axillary lymph nodes (although this is changing). Radiation then comes last. In all cases, if the tumor makes the estrogen receptor, then treatment is followed up with five years of Tamoxifen or an aromatase inhibitor, and if the tumor makes the HER2/neu oncogene, Herceptin is administered for a year.

Those, for the most part, are the choices, outside of unusual cases.

One thing I found interesting is how Young actually asked some reasonable questions at about the 4:00 mark. He asked if the tumor was aggressive, if it was hormone receptor positive (estrogen receptor positive, in other words). I’d ask the same questions, particularly whether the tumor is ER(+), because that would tell me the most. Some ER(+) tumors, after all, can be very indolent, even when they present fairly advanced. If her tumor were ER(-), I’d be a lot more worried that it is a fast-growing tumor. Then Tinkham said:

I remember them saying something about its being in situ, but, other than that…

Mystery solved. If this is true, then Kim Tinkham by definition did not have stage III breast cancer. Ductal carcinoma in situ (DCIS) is by definition cancerous cells in the ducts that have not yet invaded into the breast tissue. By definition, DCIS is considered stage 0 cancer and has a close to 100% five year survival. If Tinkham really did have DCIS, then it’s not at all surprising that she’s still doing well three years later.

In all fairness, I rather suspect that Tinkham actually did have invasive cancer. For one thing, DCIS is very commonly associated with invasive cancer. The two are frequently mixed together. It’s rather unusual (although not unheard of) for DCIS to grow large enough to appear to be a stage III cancer. It also sounds as though her surgeons wanted to remove all the lymph nodes under the arm, an operation called axillary dissection, which is virtually never done for just DCIS, only for invasive cancer. It is possible that, given her lack of detail regarding what kind of cancer she had, Tinkham might well have been confusing the sentinel lymph node biopsy, in which one or a handful of lymph nodes were are removed for testing, with a complete axillary dissection, where all the lymph nodes under the arm are removed, but she did sound as though the surgeons wanted to remove all the nodes, which they would only have recommended if she had cancer in at least one of her lymph nodes diagnosed preoperatively. Most stage III cancers require an axillary dissection, while tumors with clinically negative lymph nodes (i.e., lymph nodes that appear normal on physical examination, mammography, and ultrasound) are usually tested with sentinel lymph node biopsy. Sometimes for large DCIS, we do sentinel lymph node biopsies even though DCIS does not in general metastasize to the lymph nodes, because large DCIS lesions often harbor small foci of invasive breast cancer. You don’t want to miss evaluating the lymph nodes at the time of the original surgery, because if the surgery is a mastectomy you can’t go back later and do a sentinel lymph node biopsy. You have to go back and take all the nodes.

I realize all of that is probably more discussion than most readers want to read, but I did it because I want to emphasize that, if Tinkham’s doctors thought that, as seems likely now, she had a large mass of DCIS that probably harbored a small foci or two (or three) of invasive cancer, then her prognosis is very different than if she truly had a stage III cancer. I don’t know where Tinkham got stage III as her stage from, but it makes me wonder if she confused stage III with grade 3 breast cancer. I’ve seen it before, and Tinkham wouldn’t be the first woman with breast cancer to confuse the two. Again, Ms. Tinkham doesn’t seem particularly facile with medical terminology, because she repeatedly calls the proposed surgery a “partial radical mastectomy” when the most likely means a “modified radical mastectomy.” There is no such thing as a partial radical mastectomy.

One thing about Tinkham’s testimonial that did resonate with me is that she felt rushed. Sometimes we surgeons do that, whether inadvertently or intentionally. Personally, I try very hard not to rush my patients. In most cases I tell them that they have time to decide, that there’s no huge rush, although I would hope they wouldn’t take more than a month to make up their minds. There are exceptions, of course. Nasty cancers that are ER(-)/PR(-)/HER2(-), so-called “triple negative” disease. These tumors tend to be aggressive and fast growing; so I don’t want to fart around. I want to get these women treated. But even for these women, except in uncommon cases, a week or two (or even three) probably won’t make a difference. If there’s one thing we physicians do that can drive cancer patients into the waiting arms of quacks, it’s to rush patients too much. True, there are tumors where time really does matter, but breast cancer is usually (but not always) a tumor for which the patient has the luxury of a fair amount of time to undergo treatment.

Not surprisingly, Tinkham did what Jenny McCarthy did, and attended the University of Google. As she says in her testimonial, she Googled everything having to do with breast cancer, and she repeats how personal choice is the big thing for her. Another thing that resonated with me is that Tinkham kept asking doctors what caused her breast cancer, her criterion apparently being that if someone could tell her what caused her breast cancer she would listen to that person. The problem with this question is not the question per se but not accepting the answer, namely that science, while it does know a lot about what causes cancer, can’t really say what caused any individual patient’s cancer. That’s the honest answer, and that’s what I tell patients every week when I’m in clinic: I don’t know what caused your cancer. I do know the sorts of things that cause or predispose to cancer, but I don’t know what caused yours. I also know how to treat your breast cancer, what the odds of success are, and what the potential complications are.

That’s honesty. It’s also humility in the face of biology that we only partially understand.

In constrast, it’s the quacks who “know” what causes cancer and lack the humility to admit the limits of their knowledge. Many of them focus on The One True Cause of Cancer, as Hulda Clark did when she declared a common liver fluke to be the cause of all cancer or when Robert O. Young declares that all cancer is caused by “excess acid,” which “spoils” cells and that the cancerous tumor is the body’s reaction to the cells “poisoned” by acid. In other words, quacks are all too often always in error, biologically speaking, but never in doubt. In their arrogance of ignorance, they exude the confidence that patients like Kim Tinkham seek and flock to answers that are simple, neat, and completely wrong.

Quacks like Robert O. Young.

In fact, Kim Tinkham made it explicit by saying that Young and his wife had told her what causes cancer by saying “there is no such thing as cancer.” Again, remember that Young thinks that cancer is the body’s reaction to cells “poisoned” by too much acid, and he really does say that there is no such thing as cancer. He even goes on and on about how acid being “deposited into the fatty tissues” and thereby causing cancer. From a scientific standpoint, it’s a laod of rubbish, pure pseudoscience without any good scientific evidence to back it up. But Young can assert his nonsense about tissue being due to acid “spoiling” tissues with utter sincerity. He looks completely convincing–if you don’t know anything about cancer biology, and most people don’t know much, if anything, about cancer biology. Give him a woman who is afraid, who wants concrete answers, and who has demonstrated that she is fairly clueless about breast cancer, and he can convince her that he has the answer and can cure her. The reason, it appears to me, is that Tinkham (and women like her) just want to believe that someone knows what’s wrong with them and how to fix it. Knowing how to fix it isn’t enough.

My guess is that Tinkham probably doesn’t have stage III cancer. There’s enough in her testimonial to cast doubt on whether she does, and, more importantly, her clinical course makes it unlikely that she does. True, it’s possible that she might have stage III breast cancer that happens to be very indolent. If that’s the case, she’s very lucky. She’s very lucky anyway even if she doesn’t have stage III cancer, because she clearly has disease that isn’t progressing or at least isn’t progressing very rapidly. The time she’s wasted “flushing herself out” with several liters a day and “alkalinizing” herself has probably not hurt her. I saw lots and lots of discussion of various dietary woo, but one thing I had a hard time finding was any objective evidence to support the contention that her tumor has actually shrunk or otherwise regressed. All she has is a live blood cell analysis, which is pure quackery and has no scientifically valid evidence whatsoever to support its use to diagnose or follow cancer. She also did some “conventional” cancer markers. Unfortunately, there are no good cancer markers for breast cancer that you can really rely on, particularly since we don’t know what Tinkham’s markers were. What I want to see is Ms. Tinkham’s mammogram. I want to see her ultrasound. I want to see her MRI. If the tumor’s still there, then all these other tests are meaningless.

And the tumor is still there. Tinkham says as much at the end of part 5 of the interview. She even says it’s hard like a rock. As a breast cancer surgeon, I can say that this doesn’t sound as though Young’s quackery did anything at all to it. Quelle surprise! Also not surprisingly, both Tinkham and Young claim that this remaining rock-hard tumor in her breast, which is still there three years later, is the “encapsulation” of the “spoiled cells.”

In the end, it’s hard to tell exactly what’s going on with Tinkham and her cancer. I have no objective evidence and no objective tests. All I have are secondhand reports, none of which give objective measurements of the tumor. We do know that Ms. Tinkham has undergone various useless tests. We do know that she is undergoing various other forms of quackery. We do know that her tumor is still there three years later, but we don’t know if it’s grown or regressed. We don’t even know if it’s something that can mimic breast cancer, like scarring or fat necrosis, although it probably was and is cancer. Most frustrating of all, we don’t know how much longer Tinkham has before her luck runs out and her tumor starts progressing. For all we know, it already has.