Another unnecessary death in the making, thanks to cancer quackery

I hate stories like this, but what I hate even more is the way stories like this are all too commonly reported. Readers have been sending me links to stories about a woman named Alex Wynn that have been published over the last few days, in particular this story about her in the Daily Mail (better known as the Daily Fail when it comes to medical stories). As is the Fail’s wont, the headline blares Newlywed shuns chemotherapy for CARROTS as she vows to beat cancer with alternative therapies while trying for a baby – even though doctors warn there’s ‘no evidence’ they work, with a picture of an attractive young woman proudly smiling next to a juicer sitting on a kitchen counter loaded with broccoli, cauliflower, carrots, bananas, cucumbers, oranges, apples, limes, and…you get the idea, with the caption “Alex Wynn has shunned traditional cancer cures of surgery, chemotherapy and radiotherapy in favour of a strict diet, Vitamin C drip and sessions of pure oxygen.”

Yes, a young woman is throwing away her one best shot at survival.

As is usually the case when I come across stories of women with breast cancer who eschew chemotherapy, I wondered if she had at least undergone surgery. As I’ve described on this blog more times than I can remember over the last decade, a very common alternative cancer cure testimonial involves a woman with breast cancer who undergoes lumpectomy but decides not to undergo chemotherapy and/or radiation and/or hormonal therapy. Then, inevitably, the woman attributes her survival to whatever quackery she’s decided to pursue when in reality it was almost certainly the surgery that took care of the cancer. Such stories exist and sound plausible because most people don’t understand the difference between using chemotherapy as a primary curative treatment for cancer and using it in the adjuvant setting. In the former case, chemotherapy is the primary treatment and potentially curative by itself. In the latter case (also the case for all but a couple of solid tumors), surgery is the primary treatment and chemotherapy is used as an adjuvant, as extra treatment that decreases the risk of cancer recurrence. In the case of breast cancer, radiation therapy is also often used, mostly after lumpectomy but sometimes after mastectomy, to reduce the risk that the tumor will recur in the breast or on the chest wall. Basically, chemotherapy is systemic and decreases the risk of recurrences in the whole body, while radiation is like surgery: A local therapy that doesn’t have an effect on the tumor outside of the area that the radiation beam hits.

So I asked, before I even started reading the body of the article: Did Wynn undergo surgery? Sadly, no:

A new bride diagnosed with breast cancer has refused conventional treatment in favour of alternative therapies in a desperate bid to have a baby.

Alex Wynn, 33, from Thame, Oxfordshire, was diagnosed with breast cancer in April last year, three weeks before her wedding.

Despite being told she needed her left breast removed, chemotherapy and radiotherapy to save her life, she refused treatment.

Instead, Ms Wynn is hoping to beat the deadly disease with a diet which includes 2kgs of juiced carrots a day as well as taking Vitamin C and regularly wearing an oxygen mask.

Whenever I see stories like this, the breast cancer surgeon in me tries to figure out from the information given what stage the cancer is, what its hormone receptor status might be, and the usual clinical information that informs what I do every clinic day when I’m seeing patients and trying to decide upon the appropriate course of treatment for women recently diagnosed with breast cancer. First off, given Wynn’s age, we can be very sure that her tumor must have been palpable and discovered because she or her doctor felt a lump because she is far too young to have started mammography screening yet. Consequently, it is highly unlikely that her cancer is overdiagnosed.

We can infer other likely characteristics as well. For example, from the statement that doctors recommended that her left breast be removed, we can conclude one of two things. Either her cancer is fairly large, such that trying to save the breast would lead to a poor cosmetic outcome, or Wynn has disease in more than one quadrant of the breast (multicentric disease), which makes breast conserving surgery (lumpectomy) no longer possible. Putting this together, I can tell right away that the tumor is at least stage II. From a strictly clinical viewpoint, given the size of Wynn’s breasts, if a breast surgeon didn’t think she could save the breast it means that the tumor is probably pretty big. Certainly it’s more than 2 cm (which, if true, automatically bumps it up to stage II) and might even be larger than 5 cm (which, if true, would automatically bump Wynn up to stage III). Next, we can infer some things about Wynn’s lymph node status.
With positive lymph nodes, particularly very young ones like Wynn, almost always undergo chemotherapy. However, we don’t know whether she has positive lymph nodes or not because she hasn’t undergone surgery. Putting two and two together, I’d bet she is probably hormone receptor negative or HER2-positive, both of which mandate chemotherapy regardless of lymph node status, particularly in a young woman.

Whatever the case, Wynn hasn’t undergone surgery since she was diagnosed in April. Instead, she’s doing this:

Now Ms Wynn lives on a strict diet and has cut out all meat, sugar, dairy, gluten and foods that are high in starch, like potatoes.

Each day she juices almost two large bags of carrots, a cucumber, a courgette, kale, ginger and a whole head of celery.

Alongside this, she is having high doses of Vitamin C through an IV drip.
She is currently on her first course of it, which lasts for three weeks. Within that time she will need 15 IV drips in total.

She said: ‘Because cancer doesn’t like oxygen and prefers an acidic environment, I sit an hyperbaric oxygen chamber twice a week with a mask on breathing pure oxygen.

‘I have a test kit called a Navarro Test which I do at home and send off, which measures the levels of HCG the same chemical produced by cancer cells.

‘I’ve tested myself four times so far and theoretically the level of cancer has dropped.

‘I always feel so nervous each time about what it’s going to say.

‘I just hope that with all of this will cure this cancer and then Matt and I can begin trying for children.’

Unfortunately, this is wishful thinking at its worst. There are the requisite doctors quoted saying that diet like this can’t cure cancer and that Wynn should receive conventional therapy, but the overall tone of the article makes Wynn seem like an appealing, brave woman, rather than a woman making a tragically misguided choice that could well result in her death if she doesn’t change course soon enough.

Much of what Wynn is doing is cancer quackery I’ve discussed before, such as high dose vitamin C, various “food as medicine” cancer “cures,” alkaline diet quackery, and the like. For instance, my first introduction to cancer quackery occurred when I was a general surgery resident. Twenty years ago at the beginning of my chief resident year when I was rotating on the chairman’s service, one of the senior surgeons admitted a patient for an abdominoperineal resection (APR). This is a nasty operation that, with the advent of chemoradiation regimens that shrink tumors effectively before surgery is thankfully rarely done any more. Basically, an APR involves removing the rectum and anus, sewing the hole shut, and leaving the patient with a permanent colostomy. The reason was because he had a large rectal cancer that could not be removed without removing his anal sphincter.

The patient’s rectal cancer had gotten so large because he had refused conventional treatment when his tumor had been diagnosed at a much smaller size. Instead, for more than a year he had pursued a carrot-heavy juicing regimen of some sort, very likely similar to the one that Wynn has started, plus coffee enemas. I had never heard of such things at the time, but now I know in retrospect that he was probably doing some version of the Gerson protocol. Whatever the specific regimen he had pursued, besides his needing an APR, another result had been that the man’s skin was the most amazing shade of orange, which inspired me when I wrote about his case ten years ago to call my post The Orange Man. As I put it that post, early on in my blogging “career,” the Orange Man was the first to teach me that alternative medicine that is ineffective is not harmless. That was 20 years ago, and I’ve never forgotten the lesson.

No matter how long I do this, however, I I had never heard of the Navarro test before; so I looked it up. It turns out that there is a place called the Navarro Clinic. Perusing the website, I conclude that the clinic appears to exist for only one purpose: To sell a bogus diagnostic test for cancer:

Developed in the late 1950s, by the renowned oncologist, the late Dr. Manuel D. Navarro, the test detects the presence of cancer cells even before signs or symptoms develop. Dr. Navarro found HCG to be present in all types of cancers. The test is based on a theory proposed by Howard Beard and other researchers who contend that cancer is related to a misplaced trophoblastic cell that become malignant in a manner similar to pregnancy in that they both secrete HCG. As a consequence, a measure of the amount of HCG found in the blood or urine is also a measure of the degree of malignancy. The higher the number, the greater is the severity of cancer.

Howard Beard and the trophoblastic theory of cancer? Does that sound familiar? If it doesn’t, I’ll reiterate, since I haven’t discussed it in a while. Basically, it’s a concept of how cancer develops that is at the core of quackery promoted by William Donald Kelly and the late Nicholas Gonzalez. Although at one time (100 years ago), this concept of how cancer forms seemed plausible, but was long ago discarded. Basically, according to Beard’s trophoblastic theory of cancer, the cause of cancer is the changing of an ectopic germ cell into an ectopic trophoblast cell, a change brought about by an excess of female hormones. This “upsetting” of the male-female sex hormone balance, according to Beard, led to the growth of normal tissue, namely germ cells, in the wrong place. Cancer then supposedly would progress because of a lack of cancer-digesting enzymes in the body; so the idea behind Gonzalez’s cancer quackery was to ingest large quantities of pancreatic enzymes.

The trophoblastic “theory” was discarded many decades ago because it explained nothing, predicted nothing, and conflicted with the emerging understanding of cancer biology new scientific studies were producing. Indeed, whenever I read about the “trophoblastic theory of cancer,” to this day I still have a hard time figuring out how this “theory” leads to the use of digestive enzymes to treat cancer, particularly given that only very tiny amounts of proteins like digestive enzymes can find their way into the bloodstream after passing through the GI tract. The vast majority of such proteins are completely broken down to amino acids and very small peptides.

In any case, the Navarro test, based on this long-discredited “theory,” is nothing more than a urine HCG test. In essence, it is a more sensitive version of a pregnancy test, and these are the levels that the Navarro clinic uses to determine whether there is cancer. Of course, one wonders how the Navarro clinic interprets its HCG levels in pregnant women. Actually, no I don’t. It is true that there are cancers that do produce HCG, such as ovarian cancer, tumors of placental and germ cell origin, testicular cancer, and the like. It is also true that some common cancers, such as breast, pancreatic, cervical, and gastric cancers can produce HCG. However, the secretion of HCG by these tumors is relatively uncommon and usually at low levels. For example, elevated serum levels are only observed in 45-60% of patients with biliary and pancreatic cancer and in 10-30% of most other cancers. In other words, HCG is not a reliable test for most cancers or for monitoring cancer treatment. Clinically, it’s really only used as a tumor marker for germ cell tumors and testicular cancer. For everything else, it’s pretty much useless.

So why is Wynn doing this? The reason is simple. She desperately wants to have a child and fears chemotherapy-induced infertility. While this is understandable, Wynn is young, and it is young women who have the best chances of fertility after chemotherapy. Indeed, Living Beyond Breast Cancer points out that if a woman is under 30 her chances of regaining fertility after chemotherapy are excellent; between 30-35 (as Wynn is), chances for fertility are good; 35-50, chances for fertility are less than 50-50; 40 or older, chances for fertility are slim. More information can be found at MyOncofertility.org, which also lists strategies for fertility preservation.

I always wonder in cases like this why women refuse all treatment. For instance, although I would strongly counsel a woman against such a decision to forego chemotherapy, if I were Wynn’s surgeon I would try to urge her to undergo surgery at least. Her chances of cure would be lower than if she accepted the full multidisciplinary treatment of breast cancer, but there would be a decent chance, at least as far as I can tell from what was presented. She could also have her child after surgery. Again, it’s not an ideal plan (far from it), but it’s better than what she is doing now, which is the equivalent of no treatment at all.

I fear that Wynn is heading down the same road as The Orange Man. Her tumor will grow relentlessly until it breaks through the skin and start to leave little tumor deposits all over her chest wall. It will ulcerate, bleed, and, as the tumor outgrows its blood supply and dies in the center, start to reek. If she is lucky, it will metastasize and kill her quickly. If she is not, she will face unrelenting pain as the tumor erodes into her chest wall, a fate like that of Michaela Jakubczyk-Eckert, who trusted cancer quack Ryke Hamer and paid the ultimate price. What could be even worse is that she might become pregnant and have a child in the interim and leave her husband a widower and her baby motherless.

That is the price of cancer quackery. What I really want to know are the identities of the clinics and doctors that are selling this treatment to her. The light of science needs to be shined on these quacks.