One more example of the price of refusing science-based cancer therapy

Another year, another Breast Cancer Awareness Month.

While most people who have either been touched by breast cancer or who have a professional interest in it, the significance of Breast Cancer Awareness Month is that it is a time, well, to increase awareness and to promote breast cancer research. There is another side to Breast Cancer Awareness Month, however, and it’s not just the question of its excessive commercialization, which concerns some people. Rather, inevitably, just as the vaccine-autism quacks have come out of the woodwork for Autism Awareness Month each April, each October breast cancer quacks come out of the woodwork. For example, Mike Adams did it in 2007, then again in 2008, then yet again in 2010. (I’m sure he probably did it in 2009, 2011, and 2012, but for whatever reason I didn’t bother to blog about it those years.) Then, when someone like Mike Adams isn’t busy sliming Breast Cancer Awareness Month, then others do it, as when that wretched hive of scum and quackery (The Huffington Post) published an alternative medicine testimonial or when Suzanne Somers released her napalm-grade stupid book on cancer therapy. Another time, a clueless Chicago Tribune commentator fed the myth that abortion causes breast cancer.

We’re 1/3 of the way through October, and, for whatever reason, Mike Adams hasn’t produced anything about Breast Cancer Awareness Month that caught my interest, perhaps because he appears to be too busy producing anti-GMO nonsense fast and furious, as he promotes Proposition 37. I’m sure that he (or someone else) will get around to using Breast Cancer Awareness Month to promote some form of breast cancer quackery or another (or to launch specious, non-evidence-based attacks on “conventional” medicine), but in the meantime, I think it’s appropriate to point out once again the potential cost of such quackery. This time around, it comes in the form of a story out of Africa.

It is the story of a 66-year-old Kenyan woman referred to as Nancy Auma. It begins in August 2008 when Nancy noticed a painful breast lump that “just appeared one day.” She underwent a fine needle aspiration (FNA), which confirmed that the lump was breast cancer. This is what happened next:

Her doctor advised her that surgical removal of the breast was the best option, with Kisumu or Nairobi having the best facilities.

Nancy, however, was reluctant to lose her breast and said she would go home to think about it.

As can be imagined, Nancy went through all the usual stages after receiving shocking news. She was also very afraid as all the people she had known to have breast cancer had passed away.

She consulted several friends and relatives and opted for other healing options. She did not take any specific actions toward medical treatment.

In the U.S., one option that might have been offered to Nancy is neoadjuvant chemotherapy. This is chemotherapy given before surgery in order to shrink large tumors to the point where they can be removed without removing the whole breast. From the lack of details in the description, I have no way of knowing whether Nancy was a candidate for such an option, which also requires radiation therapy after surgery, but if her tumor was greater than 5 cm in diameter or if she had 4 or more lymph nodes under her arm with tumor in them she’d be recommended to have radiation after a mastectomy anyway. Be that as it may, if Nancy refused surgery, chances are good that she probably would have refused neoadjuvant chemotherapy as well. She seemed to be refusing the whole package of science-based medicine, eschewing it in favor of “other healing options.” Whether she did this because she was in denial, afraid, or didn’t trust science-based medicine, who knows? It was probably a combination of the three. Whatever the reason, her decision doomed her.

Fast forward nearly three years, to May 2011. By this time, Nancy was in unbearable pain and had a large open wound on her breast. This part of the story hits home for me because, as hard as it is to believe in the U.S., not so long ago I saw such a patient. It was a woman whose breast was nearly completely replaced with tumor, the lower half of which was an open wound, complete with the very strong smell of rotting flesh. I hadn’t seen (much less smelled) anything like since at least the 1990s. In fact, I don’t recall ever having seen a case of neglected breast cancer that bad. The entire lower 2/3 of her breast was an open, gaping wound with dark rotting flesh visible. After having been in practice for 13 years and having seen a lot of breast cancer patients during my residency and fellowship for ten years before that, it’s sobering to realize that even I can still be shocked by something like this. I probably have around 15 or 20 years left in my career, and I hope I never see anything like this again before I retire.

So I can picture in my mind what Nancy’s tumor looked like, and, just as intense, I can smell it. What people who haven’t seen it don’t realize is that neglected tumors like this often bleed or rot—or both. It’s truly horrible to behold, and at this point there is nothing a surgeon can do except to recommend local wound care and hope that the chemotherapy works. As I showed in the case of Michaela Jakubczyk-Eckert, chemotherapy can have a dramatic effect, even on tumors that are very locally advanced, often to the point that a mastectomy can be performed, something that can’t be done at initial presentation.

I also note that I don’t know for sure that this patient that I saw used alternative therapy. She didn’t explicitly say what she did during the years that this tumor was growing, but she apparently told other practitioners that she had tried some sort of regimens that included supplements and other things. Be that as it may, this is what all too often happens to patients who choose alternative therapy over science-based therapy:

The pain became unbearable for Nancy and her breast now had a large wound.

It was clear that what had earlier been suggested had been ignored and the alternative treatment she sought had failed. After a lot of debate and conflict, her last born daughter Alice insisted that Nancy starts treatment.

However, the outlook of the condition was bleak. The cancer had now spread beyond the breast to the lungs.

At this stage, the doctor advised that the treatment that would be given was to alleviate the pain, prevent the cancer from spreading further and heal the wound on the breast through surgery.

It sounds as though what the doctors recommended is what I alluded to earlier for cases like this: Chemotherapy to try to shrink the tumor and allow the open wound to heal enough to try to resect the tumor. In the case of Nancy, because she had lung metastases, she was not “curable.” That is not the same thing as saying that there is nothing doctors can do for her, which is all too often how it is misinterpreted when a patient faces the devastating news that she has incurable disease. In any case, Nancy did chemotherapy, but experienced side effects and only managed to get through five cycles before reverting to “traditional healing methods” that apparently included some form of herbal therapies. Her appetite and energy levels improved, most likely because she was no longer on chemotherapy, but:

Unfortunately, the wound on the breast was getting worse and this is when she accepted to start the second round of chemotherapy. But she was not able to get to the fourth session and she passed away five months later.

In retrospect, Alice wished that her mother had the initial surgery that was recommended in August 2008.

At that time, the chances of her mother’s survival were high. She also wished that they had listened to her doctor and followed the treatment guidelines.

It’s by no means clear that conventional therapy would have been successful in saving Nancy. I can’t really make a particularly accurate estimate of what her chances would have been, because I don’t have enough information regarding what her cancer looked like on initial presentation or whether she had tumor in the lymph nodes under her arm. However, if we assume that “large” meant at least 5 cm in diameter, then we know that treatment, even surgery alone, had a good chance of giving Nancy long term survival of five years or even ten years or more. While it would appear that Nancy was “lucky” enough (if you can call it that) to have had a slow-growing, indolent tumor that took four years to kill her, even though effective treatment wasn’t begun until it had ulcerated, we can definitely say that her chances would have been much better with conventional therapy begun when she was first diagnosed than it was with all the herbal woo and the intermittent therapy not begun until it had become painfully obvious that the woo wasn’t working. We can even estimate the price, in terms of years of life lost.

So I’m taking this opportunity to remind my readers one more time that, when people like Mike Adams and his ilk refer to “natural cancer cures,” what they are talking about is not what they think they are, namely saving patients’ lives without the toxicity of surgery, chemotherapy, and radiation therapy. Whether they know it or not, whether they can be forced by the evidence to admit it or not, what they’re really talking about producing more Nancys. Alas, the story is the same the world over.