Elle Macpherson’s breast cancer: Another example of how antivax and quackery are inseparable

I rarely mention supermodels or vacuous pop culture figures on this blog, not so much because I am unaware of them—although the older I get the less aware of many of them I become—but rather because they are so uninteresting to me. As a result, I tend only to mention such celebrities when they become involved in topics relevant to this blog. So it has been with supermodel Elle Macpherson. The one and only time, until now, that I’ve ever written a post about her was in 2018, when it was widely reported that she was dating Andrew Wakefield, the granddaddy of the 21st century antivax movement, in particular the flavor of the movement that has demonized the MMR vaccine as causing autism. I also noted at the time that she ran a business called Welleco, which, as the name implies, sells a lot of beauty products, but also “wellness” products, including supplements, and, more interesting to me, “alkaline” quackery that very much resembles that of Robert O. Young, a frequent topic of this blog years ago for his cancer quackery. Basically, I likened Welleco to Goop, but more of a one trick pony version in that it didn’t sell the wide variety of nonsense and quackery that Goop sells.

At the time, I pointed out how the brief romance between Andrew Wakefield and Elle Macpherson was a good example of who antivax and quackery go together, how they are nearly always inseparable. However, until yesterday, I had no idea how far Macpherson’s dedication to quackery went; that is, until I started seeing a number of news reports relating how she had been diagnosed with breast cancer in 2017 and had refused chemotherapy, mastectomy, and radiation. Given how long I’ve been dissecting alternative cancer cure testimonials, a story like this virtually mandates that I discuss it on this blog or my not-so-super-secret other blog. A typical story appeared in The Telegraph, Elle McPherson refused chemotherapy to treat breast cancer despite advice from 32 doctors, because it’s so much more dramatic if you don’t listen to this many doctors:

Elle Macpherson has revealed that she refused to undergo chemotherapy for breast cancer despite the advice of 32 doctors.

The supermodel and mother of two, 60, is now in “clinical remission” after being diagnosed seven years ago.

In her upcoming memoir, Life, Lessons, and Learning to Trust Yourself, Macpherson revealed how she decided to take a holistic approach to the disease and refused to use conventional medicine – going against the wishes of her family.

How many times have we heard this one before? The narrative is always the same. The person giving the testimonial was diagnosed with cancer, but decides to forego conventional treatments such as chemotherapy, and is fine, implying the quackery saved her life. I’ve lost track of how many such “testimonials” I’ve discussed, particularly about women with breast cancer. They include Suzanne Somers, Dr. Lorraine Day, Hollie Quinn, and many others. One characteristic that nearly all such testimonials share is that the woman giving the testimonial nearly always undergoes surgery (at least) to excise the primary tumor, a characteristic shared with testimonials for “alternative cancer cures” for other surgically treated cancer, such as Chris Wark’s testimonial for his colon cancer. Unsurprisingly, as I read about Macpherson’s breast cancer, I saw that it it did indeed share many of those characteristics, although there are some puzzling inconsistencies. You’ll see what I mean. I’m not sure if they’re due to misreporting or something else.

What I will say is that the primary source of the interview with Macpherson, who is portrayed as oh-so-brave for her decision to eschew that nasty conventional treatment in favor of her quackery—and, make no mistake, Macpherson used many forms of quackery. The interview is in The Australian Woman’s Weekly and entitled EXCLUSIVE: Elle Macpherson on what she has learnt about motherhood, business and wellness. She’s promoting her book, and the magazine goes all out helping her:

And then there’s Cancer. Subtitled “Don’t Sweat the Small Stuff”, this chapter is the most stark, not just for its revelation of her diagnosis – which she’s kept secret for the past seven years – but for its raw honesty about how she underwent treatment.

Elle, who turned 60 earlier this year, is known for not sticking to convention, and has very much lived life on her terms. She describes it as “a life of authenticity”. So when it came to cancer, she stuck with her beliefs. And like most things Elle does, she didn’t choose an ordinary path for her cancer treatment. Eschewing traditional medicine, she instead chose a holistic approach.

But she did have surgery—just to emphasize. Of course, “holistic” is nothing of the sort. It’s just a hodge-podge of quackery that I’ll describe later, but let’s find out what clinical details we can:

On that fateful Friday 13th, she was called by her doctor and informed that the diagnosis of the lumpectomy she’d had was HER2 positive oestrogen receptive intraductal carcinoma. Her doctor suggested a mastectomy with radiation, chemotherapy, hormone therapy, plus reconstruction of her breast.

Elle was, understandably, thrown into fear and anxiety about the diagnosis of this life-threatening disease that affects one in seven Australian women.

“It was a shock, it was unexpected, it was confusing, it was daunting in 
so many ways,” she tells The Weekly. “And it really gave me an opportunity to dig deep in my inner sense to find a solution that worked for me…I realised I was going to need my own truth, my belief system to support me through it. And that’s what I did. So, it was a wonderful exercise in being true to myself, trusting myself and trusting the nature of my body and the course of action that I had chosen.”

Sadly, cancer doesn’t care about your own “truth” or “belief system” or whether you are “true to yourself.” It just doesn’t.

First, however, let’s discuss what little clinical information is provided. First, what is meant by a “HER2 positive estrogen receptive intraductal carcinoma”? Here’s where I wonder about possible misreporting. In general, “intraductal carcinoma” means ductal carcinoma in situ (DCIS), which is not breast cancer but rather premalignant, basically cancer cells in the milk ducts that have not yet invaded into the surrounding tissue. It is generally treated with surgical excision, therapy that blocks the action of estrogen, and radiation therapy if breast-conserving surgery is used to treat it, rather than total mastectomy. It is not treated with chemotherapy. Moreover, we don’t routinely test DCIS for amplification of the HER2 oncogene—at least not here in the US. Any Australian doctors can tell me if the situation is different in Australia, but I doubt it. The main reason to test for HER2 amplification is because, when HER2 is amplified, then the patient can be treated with monoclonal antibodies that target HER2, such as Herceptin and Perjeta. Again, we do not treat DCIS with these agents.

This is why I suspect that, rather than “intraductal carcinoma,” likely Macpherson had invasive ductal carcinoma, or full-blown breast cancer. If that were the case, then the recommendation for much more aggressive therapy, including chemotherapy, would make sense, because most HER2-positive breast cancers are indeed treated with chemotherapy, unless they are very small. Even so, there are still…inconsistencies…in the story. For one thing, these days most HER2-positive breast cancers are treated with neoadjuvant chemotherapy plus HER2-targeting agents (neoadjuvant = treatment before surgery), not adjuvant chemotherapy (after surgery). Such tumors are generally quite responsive to neoadjuvant combined therapy, which is highly successful at downsizing them to the point where breast-conserving surgery is often possible.

I then remembered that this was 2017. I just so happen to have many of the copies of the National Comprehensive Cancer Network (NCCN) guidelines for treating breast cancer, including the February 2017 update. (Don’t ask me why I keep the old PDFs, but I do. Every time a new update comes out, I move the old one into an “Old Guidelines” folder.) Sure enough, in 2017 neoadjuvant chemotherapy + Herceptin (trastuzumab) was not the general recommendation, but adjuvant chemotherapy plus trastuzumab was:

You’ll note that adjuvant chemotherapy with trastuzumab was recommended for most of these tumors. Neoadjuvant chemotherapy was usually reserved in 2017 mainly for either inoperable tumors that one wishes to try to shrink to the point that they become operable or for large tumors that one wishes to try to shrink to the point where breast-conserving surgery becomes possible. In 2024, based on new evidence and clinical trials, most women with HER2-positive breast cancer will receive neoadjuvant chemotherapy with trastuzumab and pertuzumab, the latter being a newer HER2-targeted agent. It thus sounds to me as though Macpherson received recommendations for treatment of a HER2-positive breast cancer consistent with the evidence-based standards of 2017.

Reading between the lines—and I admit that I’m engaging in speculation, although I hope you appreciate that it is educated speculation—I suspect that Macpherson underwent excision of the breast mass and had positive margins (tumor at the cut edge of the specimen). Positive margins nearly always mandate further surgery, because of a much higher risk of local recurrence at the surgical site. Additional surgery would then consist of either a reexcision of the positive margin or a completion mastectomy. Again, what I suspect, but can’t know from this account, is that she probably had one or more positive margins and her tumor was large enough relative to the size of her breast that in the surgeon’s judgment reexcision would have resulted in a poor cosmetic result, hence the recommendation for completion mastectomy with reconstruction.

One last thing before I discuss what Macpherson did instead of science-based treatment of her breast cancer, as a breast surgeon I have to admit that I was puzzled by the lack of mention of what was done with her axillary lymph nodes. Generally, the diagnosis of invasive cancer also requires evaluation of the axillary lymph nodes (the lymph nodes under the arm) through an operation called a sentinel lymph node (SLN) biopsy. This procedure is usually done at the time of the removal of the primary tumor (either by lumpectomy or mastectomy) and involves using dye to map the lymphatics and identify the axillary lymph nodes to which the tumor drains. These lymph nodes (usually between 1-3 or so) are examined for the presence of metastatic cancer, to determine if the cancer has spread to the regional lymph nodes. This knowledge determines stage of the cancer, which also guides treatment.

One reason why a surgeon would not do an SLN biopsy while excising a primary breast cancer is in the setting of lumpectomy for DCIS, a case when it is usually not necessary to evaluate SLNs. This leads me to speculate—again, I hope it’s educated speculation!—that perhaps Macpherson underwent a lumpectomy for DCIS (“intraductal carcinoma”) but that the final pathology showed that there was invasive cancer mixed in with the DCIS, a common situation. Such a finding, if the cancer was HER2-positive and larger with positive margins, could easily lead to a recommendation for mastectomy and chemotherapy.

But what about the radiation? (Yes, it gets more complex.) Radiation is almost always indicated after a lumpectomy, mainly because local recurrence rates are unacceptably high (30-40%) without adjuvant radiation therapy (although I can’t help but recommend that there are now cases where radiation can be skipped after breast-conserving surgery). In contrast, after a mastectomy, adjuvant radiation therapy is generally only indicated for cancers that are very large and/or have positive lymph nodes. Can you see why the sparse information provided in this article leads to confusion in a breast surgeon, an expert in breast cancer treatment? It’s particularly annoying to me because I can’t figure out a good estimate of what Macpherson’s odds of recurrence-free survival would be without and with proper adjuvant systemic therapy (chemotherapy and HER2-targeted agents) and adjuvant locoregional therapy (radiation). Also, because Macpherson’s tumor was estrogen receptor-positive, normally her oncologists would have recommended at least five years of endocrine therapy with drugs that block the action of estrogen, usually tamoxifen for premenopausal women or a member of a class of drugs called aromatase inhibitors for postmenopausal women. I saw no mention of any endocrine therapy anywhere; so I have to assume that Macpherson refused that as well.

To sum it up, it’s not clear exactly what stage of cancer that Macpherson had. It is, however, very clear to me that her testimonial is just like so many previous testimonials that I’ve examined. She had surgery to remove her tumor and then refused all the other adjuvant treatments designed to reduce the risk of recurrence. Unlike some celebrity breast cancer testimonials (e.g., Suzanne Somers), I have a hard time estimating the magnitude of benefit that Macpherson, by refusing adjuvant treatment after having undergone surgery, threw away. However, in the case of a HER2-positive cancer, the benefits were likely not insubstantial, because HER2-positive cancers are bad actors, generally more aggressive than those without amplified HER2. (Oncologists, I know, I know. That’s a simplification, perhaps an oversimplification. I know that, for example, triple negative breast cancer is nasty too, although its being more nasty than HER2-positive cancers is, these days, more likely due to the existence of HER2-targeted therapy, which is highly effective against HER2-positive breast cancer.) The bottom line for Macpherson is, like every other case I’ve discussed, that she got lucky. Surgery cured her, and she was one of the lucky ones who would not have recurred even without adjuvant therapy. The problem, of course, is that a woman has no idea and no way of knowing at the time of treatment whether she will be one of the lucky ones, which is why eschewing adjuvant therapy is generally such a bad idea, particularly for a HER2-positive cancer.

Also, as is the case for so many celebrity alternative medicine cancer cure testimonials, instead of her case being represented as someone with horrifically bad judgment who made bad choices treating her cancer but got lucky, Macpherson is portrayed as brave, “spiritual,” and thoughtful:

Choosing her own path to treatment sent Elle, who in recent decades has embraced a holistic approach to health and wellness, into a tailspin. She deliberated for several weeks, seeking advice from 32 doctors and experts. In the end she went to a beach in Miami, prayed and meditated, and made one of the biggest decisions of her life: Not to undergo chemotherapy. Instead, Elle opted for “an intuitive, heart-led, holistic approach” to treating her cancer under the guidance of her primary doctor who specialises in integrative medicine, which uses a combination of therapies and lifestyle changes to treat and 
heal the whole person.

Note the mention of the “32 doctors and experts.” Reading between the lines, I wonder how many of these “32 doctors and experts” were actually breast cancer oncologists, surgeons, and radiation oncologists? How many were quacks? (I suspect I know the approximate answer.) The headline and article from The Telegraph make it sound as though Macpherson consulted with 32 breast cancer doctors and experts (“Elle Macpherson has revealed that she refused to undergo chemotherapy for breast cancer despite the advice of 32 doctors”), but nowhere is it explicitly stated that all of those 32 doctors and experts were breast cancer doctors and experts.

Macpherson portrays her decision as spiritual, “authentic,” and requiring courage:

Taking a non-pharmaceutical path is not for everyone. She admits in her book: “I came to the understanding that there was no sure thing and absolutely no guarantees. There was no ‘right’ way, just the right way for me.

“I chose an holistic approach. Saying no to standard medical solutions was the hardest thing I’ve ever done in my life. But saying no to my own inner sense would have been even harder,” she writes.

“Sometimes an authentic choice from the heart makes no sense to others … but it doesn’t have to. People thought
I was crazy but I knew I had to make 
a choice that truly resonated with
 me. To me, that meant addressing emotional as well as physical factors associated with breast cancer. It 
was time for deep, inner reflection. And that took courage.”

Note the false dichotomy. Addressing emotional and physical factors associated with breast cancer does not require embracing pseudoscience and quackery, but cancer quacks and those who pursue treatment with them often assume that addressing emotional and physical factors requires whatever quackery they champion. Also, courage and wisdom are not necessarily the same thing.

So what, exactly, did Macpherson decide to do? I think you can guess:

Elle was under the care of several specialists, including her primary doctor, a doctor of naturopathy, holistic dentist, osteopath, chiropractor and two therapists. For her treatment, Elle took herself to Phoenix, Arizona, rented a house and for eight months she stayed 
there alone under her doctor’s care, “focusing and devoting every single minute to healing myself”.

So what is her health status now?

“In traditional terms, they’d say I’m in clinical remission, but I would say I’m in utter wellness. And I am!” she says. “Truly, from every perspective, every blood test, every scan, every imaging test … but also emotionally, spiritually and mentally – not only physically. It’s not only what your blood tests say, it’s how and why you are living your life on all levels.”

You know, if Macpherson had spent that same eight months undergoing additional surgery, chemotherapy, and radiation (plus four more, given that adjuvant trastuzumab is usually administered for a full year), she would have optimized her chances of not having a recurrence. Don’t get me wrong. I’m happy that she’s doing well. Really, I am. However, being happy at a breast cancer patient’s good outcome after suboptimal treatment doesn’t mean that I won’t point out yet again—even a bit bluntly—the obvious: She got lucky, and the unlucky ones who embrace quackery for their adjuvant therapy don’t give glowing testimonials like hers, write books, or have interviews lionizing them for their choices in major women’s magazines. It’s called survivorship bias.

Moreover:

Her holistic approach reminded me of Olivia Newton-John, who complimented her clinical treatment for cancer with holistic practices. Did Elle ever seek advice from Olivia?

“Yes, we spoke a few times when I was diagnosed and also through
both of our healing journeys,” she says. “We did things differently, but we did share experiences with each other and how we feel and how we approach things.”

One notes that Olivia Newton-John underwent what sounds like mostly standard-of-care treatment in 1992—including partial mastectomy and chemotherapy, although I was not clear whether she initially underwent radiation—when her cancer was first diagnosed. Yes, she did quackery, including “herbal formulas,” in addition to mostly standard-of-care treatment. Yes, she founded a center dedicated to “integrating” quackery into standard-of-care treatment:

As part of her cancer journey, Newton-John helped to found the Olivia Newton-John Cancer Wellness & Research Centre in Australia, where she advocated for a holistic approach to treating the disease that involves traditional medical treatment as well as herbal therapy, meditation, and lifestyle and diet changes. Christian says she often encourages patients to add those elements to their standard medical care. 

However, she did do standard-of-care treatment. It’s also unclear whether she needed radiation, as the article cited above states that she underwent “partial mastectomy, followed by chemotherapy and breast reconstruction.” On the Komen Foundation website, however, there is an interview with Newton-John in which she states that she underwent a modified radical mastectomy (mastectomy plus axillary dissection, or removal of the lymph nodes under the arm, the surgical standard-of-care for larger breast cancers in the early 1990s), with immediate reconstruction. Back then, unless you had a lot of positive lymph nodes, you wouldn’t undergo post-mastectomy radiation. (In 2024, one positive axillary lymph node is an indication for postmastectomy radiation; in 1992 it required four or more positive nodes for radiation to be indicated.) So, again, unlike Macpherson, who clearly underwent incomplete and therefore suboptimal treatment, Newton-John underwent what was then standard-of-care treatment for her breast cancer, adding to it woo like homeopathy.

Of course, it’s not surprising that Macpherson would embrace woo after her breast cancer diagnosis, because:

In 2014 she found a lump in her breast and while that one, thankfully, turned out to be a benign cyst, 
it fortuitously led her to meet
 Dr. Simoné Laubscher, a naturopath, nutritionist and wellness expert renowned for her work in hormone rebalancing, cancer, diabetes and wellbeing. Elle had been feeling depleted and was entering menopause, and Dr. Laubscher had prescribed 
a daily cocktail of vitamins. Elle, however, just wanted to take one, 
so the pair created a one-and-done complete vitamin and mineral complex – WelleCo The Super Elixr and super greens powder – ingestible wellness products that support enhancing energy levels, improving gut health and promoting
 clear skin.

As she recounted this story on stage, with bouncy hair and a magnetic smile that lit up the room, Elle charmed the audience in an instant. When you hear her talk about how embracing a life of wellness and daily doses of this product changed her life, you feel like you want in too. When she greets you, she cups your hands in hers and looks you in the eye with absolute authenticity, dazzling with that Elle superpower.

I mentioned Not-a-Doctor Simoné Laubscher before, when I discussed the news that Macpherson had started dating antivax icon Andrew Wakefield. Being a naturopathic quack, Laubscher was then promoting “alkaline diet” quackery as a cure-all, much as Robert O. Young has long done.

At this point, let me just say that I had difficulty finishing the interview in The Australian Women’s Weekly. It was so hagiographic, so cloying, and presented Macpherson as this brave, wise, funny, brilliant model and entrepreneur, and that’s a huge problem. As bad as the articles in The Telegraph and The Guardian were, at least both quote Cancer Research UK saying that there is no evidence that alternative medicine can cure cancer, with The Telegraph quoting David Robert Grimes and retired breast surgeon Liz Riordan and both mentioning her past dalliance with anti vaxxer Andrew Wakefield. Not a word of skepticism, not even token skepticism, is to be found in The Australian Women’s Weekly.

Remember, there’s a reason that I call these sorts of alternative breast cancer cure “testimonials.” They more resemble religion than anything having to do with medicine or science. I also always feel obligated to point out that these testimonials almost never provide evidence for efficacy against cancer for the quackeries chosen. Elle Macpherson’s testimonial is no different. Unfortunately, because she is famous, there is a good chance that her book—and for those who don’t read her book, the wildly irresponsible interview published by The Australian Women’s Weekly—will inspire women diagnosed with breast cancer to forego potentially life-saving treatment.