Yet another dubious breast cancer cure testimonial

[NOTE: Please be sure to read the addendum!]

I hate cancer quackery.

I know, I know, regular readers probably figured that out by now, and even new readers rarely take more than a couple of weeks to figure it out. That’s because cancer quackery is a frequent topic on this blog. One of the most powerful tools of persuasion that cancer quacks employ in promoting their quackery is something I call the cancer cure testimonial. Basically, a cancer cure testimonial is a story of a patient using alternative medicine and “curing” himself of cancer. Such testimonials come from both practitioners and patients, the latter of which are often the most powerful testimonials of all, stories that get passed around the alt-med blogosphere and around alt-med discussion forums like a joint at a Grateful Dead concert, with about the same results on the critical thinking skills of those inhaling their essence. There’s a good reason why one of the very earliest substantive posts that I wrote (and wrote nearly eight years ago, I might add) deconstructed a typical breast cancer cure testimonial. Since then, there has been a long and depressing litany of similar stories, from names that have become part of the history of this blog, many of which long time readers will remember. I’m referring to people like Suzanne Somers, Kim Tinkham, Hollie Quinn, Abraham Cherrix, a man named Chris, and several others, in particular a number of patients who succumbed to the blandishments of Dr. Stanislaw Burzynski.

The reason that I take such an interest in these cases is three-fold. First, I’m a cancer surgeon. As I said before, I hate cancer quackery. As a result, these stories deeply disturb me, particularly when the end result is a potentially preventable death, as it was in Kim Tinkham’s case. Second, they all share a number of common elements that are worth examining. Examples commonly include confusing adjuvant chemotherapy, which decreases the chance of the tumor’s return, with primary therapy for the cancer, which can cure the cancer on its own. Adjuvant therapy can’t cure the cancer alone but it can decrease the risk of tumor recurrence after curative treatment. Not surprisingly, one major strain of alt-med testimonial consists of patients who undergo curative therapy but forego adjuvant chemotherapy in favor of quackery and conclude that the quackery saved their lives. Another major strain of such testimonials consists of stories in which it is impossible for a health care professional hearing the story to tell if there was even a diagnosis of cancer or in which the seriousness of the prognosis was probably not as bad as represented. Finally, these testimonials are almost invariably suffused with misinformation about real cancer therapy, and that misinformation is worth refuting with science. It’s also worth explaining how

All of which brings us to the latest alt-med testimonial of which I’ve become aware through, of course, one of the most prominently wretched hives of scum and quackery in the known universe, Mike Adam’s NaturalNews.com:

The story of former model Jessica Richards’ battle with cancer is a remarkable one, especially because it has defected from the use of conventional treatments like chemotherapy, radiation, or surgery. In her book The Topic of Cancer, Richards explains how following a strict metabolic diet and receiving high-dose intravenous injections of vitamin C has helped successfully reverse the progression of her breast cancer, to the shock of many conventional doctors.

In case you’re not familiar with cancer quackery lingo, a “strict metabolic diet” is basically synonymous with the Gerson therapy or one of its variants, such as the Gonzalez protocol, which, it must be emphasized, are useless against cancer. High dose vitamin C is at best really, really wimpy against cancer and is more likely completely useless against it. Much of the story recounted by Adams drone Ethan Huff comes from this story in The Sun entitled I refused drugs and chemo to battle my breast cancer with fresh veg, which features a picture of a smiling, healthy-appearing Jessica Richards posing next to a big bowl of fruit and tells the following tale:

FOR thousands of women diagnosed with breast cancer, chemotherapy is an unavoidable part of the course.

But Jessica Richards shocked loved ones when she turned down all the drugs normally prescribed to fight the disease.

She refused not only chemo, but also a mastectomy and radiotherapy advised by doctors.
Instead, the 55-year-old former model decided that what she needed was a complete diet overhaul.

Jessica, from Bedfordshire, England, who now works as a leadership mentor, cut out dairy, upped her vegetable intake and took high doses of vitamin C.

Within three weeks of starting her intensive regime, a scan showed her tumour had gone to sleep and her latest blood tests came back normal.

I knew this story was utter nonsense when I read this last sentence. Her tumor “went to sleep”? What does that even mean? Nothing, that’s what it means. For one thing, even the most effective chemotherapy won’t result in the “tumor going to sleep” within three weeks. Cancer biology is such that the only way to get rid of a solid tumor that fast is to cut it out. In fact, I’d be very curious to know what test, exactly, was used to tell that the tumor “had one to sleep.” Was it a PET scan? An MRI? Another important aspect of these sorts of testimonials is the frequent claim that “all my blood tests were normal.” Here’s some news: That is utterly meaningless when it comes to breast cancer. Tumor markers in breast cancer are notoriously unreliable, which is why oncologists often don’t even bother with them. Another consideration is that frequently these “negative blood tests” touted in testimonials as “proof” that the cancer is gone are blood tests administered by quacks that have no scientific validity.

Be that as it may, the most critical take-away message from the story above is that Richards’ tumor is not gone. It’s still there. Just like Kim Tinkham’s tumor. You might remember Kim Tinkham saying that her tumor was dormant, too. As it turned out, it wasn’t. It continued growing and ultimately killed her. It is quite possible, likely even, that Richards is deluding herself in just the same way.

Another aspect of these stories, which Richardson’s story has in spades, is the emphasis by the person telling the story trying to represent herself as completely rational, as having done research, as having come to a rational decision, as having based her decision on science. This narrative seems to be very important to the people telling these stories; the people telling them want to present themselves as not being loons. Of course, most of them aren’t. It’s possible (common, even) to be rational but to have cognitive blind spots that lead them do make disastrously wrong decisions that take them down disastrous roads. To boost her appearance of hyperrationality, Richards points out that she undertook this metabolic therapy under careful medical supervision, even naming her doctors. One of her doctors is Dr. Andre Young Snell, who is represented as having “had 15 years’ experience specialising in hospital medicine, where he gained a great deal of experience treating cancer patients as well as working in the breast care unit at St George’s Hospital in London.” What the reporter neglects to mention is that Dr. Snell now runs The Vision of Hope Clinic, which offers metabolic therapy quackery (complete with “natural nutritional therapy,” liposomal vitamin C, ozone and hyperthermia sauna sessions (including infrared sauna).

It’s true that Mark Kissin is a legitimate breast surgeon, but Dr. Carolin Hoffman appears to be heavily into “integrative medicine,” having published studies on topics such as mindfulness in breast cancer and works for a center touting “integrative medicine” and offering acupuncture and a wide range of quackery including Bach Flower remedies, craniosacral therapy, Emotional Freedom Technique, homeopathy, reiki, reflexology, and more. It would appear that there’s no woo that this clinic doesn’t offer.

So let’s get back to the testimonial. Richards was, according to her account, diagnosed five years ago, in 2007. According to this report, it was diagnosed with mammography:

Having just turned 50, I’d been for a routine mammogram a week earlier which I’d known hadn’t gone well. Around five years before that I’d gone to my GP with a lump in my breast and after extensive tests I was given the all-clear.

This is very interesting and very relevant. Richards had noted a lump in her breast five years before being diagnosed, and it hadn’t changed. It was diagnosed five years ago, which means that she’s had the lump for at least ten years, likely longer given that it was probably there for at least a couple of years before she noticed it. Right away this tells me that, assuming she has cancer, Richardson probably has a pretty indolent, slow-growing cancer. Indeed, it might well be the sort of cancer that either doesn’t progress or progresses so slowly that it takes a long time to change appreciably. As I’ve discussed before, breast cancer can have a highly variable clinical course, and historical data show a small but not insignificant proportion of women (3.6%) surviving longer than ten years. When faced with a testimonial like Richards’ the most parsimonious explanation is not that some incredible, biologically incredibly implausible bit of woo cured her cancer, particularly given that, reading between the lines, I see her basically admitting that her tumor is still there. Rather, it’s that she’s either an incredibly lucky woman to have a very indolent cancer, one that isn’t progressing appreciably over a five year period, or that she might not have had cancer at all, given that the appears to have had this mass for at least ten years.

Of course, we don’t know anything about the tumor, at least not from this media account or from Richards’ website (and I’m sure not going to buy her book to see if she reveals more). As is often the case with such testimonials, it’s very hard to find any information at all about her case from sources that aren’t promoting alternative medicine or aren’t completely credulous, as the reporter who wrote the Sun story clearly was. At least with Suzanne Somers, it’s possible to find out quite a bit about her and her tumor just by doing some Googling. Not so with Jessica Richardson, which always makes me wonder about the story. I’d very much like to know whether the tumor was estrogen receptor-positive, HER2-positive, whether she was clinically node positive (had palpably suspicious lymph nodes under her arm), and the like. If I knew that information, I could comment a bit more knowledgeably about what might be going on here.

Testimonials like that of Jessica Richards represent the perfect storm of nonsense, laden with claims that the survival of a single cancer patient can tell us much of anything about the clinical effectiveness of a treatment. This is particularly true of a cancer like breast cancer, whose clinical course can be so variable and biological aggressiveness can be so different from woman to woman. Her story would be a lot more convincing, for instance, if she had been unequivocally diagnosed with stage IV pancreatic cancer, widely metastatic, undertook treatment with her “metabolic therapy,” and survived five years. Somehow, I’ve never seen that story in a form convincing enough that it makes me scratch my head and think that there might actually be something going on there. Jessica Richards’ case, as superficially convincing as it sounds, is far more likely the result of indolent cancer biology than it is because a Gerson therapy-like protocol cured her of an aggressive cancer.

ADDENDUM added after publication:

Commenter lilady supplied me this story featuring Jessica Richards in the Daily Mail, which describes her clinical course thusly:

The 54-year-old from Bedfordshire was diagnosed in 2007 with a 2.5cm Grade 2 ductal cancer after she noticed a change in a long-standing lump in her left breast.

‘Five years before I had a scan of the same breast and I was told the lump was benign,’ she says. ‘This time the mammogram said it was abnormal.

‘After a biopsy, the cancer was graded as invasive and there were cancer cells in one lymph node, a micro amount in another and my blood tests came back as normal. I was advised to have a mastectomy, followed by chemotherapy and a five-year programme of drug therapy as soon as possible.’

Jessica adds: ‘Rather than rush into anything, I took a step back. I spoke to doctors and radiologists, alternative therapists, went online and read a lot.

‘I knew I didn’t tolerate medicines well and felt chemotherapy would be disastrous. My blood tests kept coming back normal and I decided I would not go it alone with conventional treatment, but would have regular ultrasound scans and tests.’

A fan of alternative therapy, Jessica also took large amounts of vitamin C intravenously and altered her diet. Within a few weeks the lump had softened and began to break down.
Five years on, the lump is a tiny hard pip, she is fit and well, and has written a book, The Tropic Of Cancer, to share her experiences and knowledge.

The information in this story tells me as a breast surgeon that Richards almost certainly underwent a lumpectomy and sentinel lymph node biopsy, the latter of which is a procedure in which dye is injected into the breast, gets taken up by the lymphatics, and identifies the lymph node(s) where the tumor would be most likely to go first. The lymph node(s) is/are then biopsied. SLN biopsy is the main method that breast surgeons use now to determine whether the cancer has traveled to the lymph nodes, and it’s unlikely that any surgeon would do an SLN in a patient diagnosed with breast cancer without also removing the primary tumor. In any event, the language she used to describe her lymph node status in the interview quoted above tells me right off the bat that it almost certainly was a sentinel lymph node biopsy and that she probably had isolated tumor cells in one lymph node (“cancer cells in one lymph node”) and micrometastases in the other (“Micro amount in another”). You usually can’t tell from just a needle biopsy of a lymph node that there are “cancer cells” in it or micrometastases; it takes an examination of the entire lymph node to be able to say that because the needle biopsy only samples a small part of the node and finding a micrometastasis or small cluster of tumor cells on a needle biopsy doesn’t rule out more tumor in the lymph node. In that case, we would simply say that lymph node metastases were found. Finally, it’s true that SLN biopsy is still sometimes performed in patients who are to undergo neoadjuvant chemotherapy in order to shrink their tumors before undergoing lumpectomy, but that appears not to be Richards, given that she reports that the recommendation was that she have a mastectomy followed by chemotherapy.

Reading between the lines, I think that what happened is probably that Richards underwent an attempt at a lumpectomy, along with an SLN biopsy (which would be standard-of-care for a tumor that the surgeon deems amenable to complete removal as part of a lumpectomy), but that she had close or positive surgical margins (close margins mean that tumor cells are too close to the cut edge of the specimen removed; positive margin mean that there are tumor cells right at the cut edge of the specimen removed). Given that the tumor was fairly large, at that point the surgeon probably recommended mastectomy, rather than an attempt at a reexcising the lumpectomy area in order to try to clear the margins. At least, that’s how I put the story together now that I know the information in the article to which lilady pointed me.

Now that I know this, to me it’s looking more and more as though Jessica Richards is yet another case of a woo-prone woman with breast cancer confusing adjuvant chemotherapy with curative therapy. Indeed, now I’m pretty sure that she falls into the category of women who eschew adjuvant chemotherapy and lose the extra survival benefit it gives, but who are lucky enough to be cured by surgery. Moreover, also reading between the lines, note how Richards says that it was recommended that she undergo a “five year programme of drug therapy.” There’s only one kind of drug given for five years to treat breast cancer in the adjuvant setting, and that’s antiestrogen drugs, such as Tamoxifen or aromatase inhibitors. Clearly, Richards’ tumor was estrogen-receptor positive, which is often consistent with a less aggressive, more indolent tumor.

If my take on this story is true, Richards is much more like Suzanne Somers and Hollie Quinn than she is like Kim Tinkham, which is good for her. The one wrinkle is that, if her margins were indeed positive (rather than just close), she has a very high chance of having a local recurrence in that breast in the area of her “biopsy” cum lumpectomy.