Dr. Devra Davis in her 'Secret History of the War on Cancer' was critical in blowing away the nonsense about cancer testing and treatments that for decades has caused endless grief. Especially loss of quality of life – say after a P.S.A. test or even a mammogram. With regard to the first, we now know- thanks to rigorous recent research and data - that most prostate tumors are deemed “indolent,” meaning that they don’t spread or cause bothersome symptoms. Davis argued, however, that too many men panicked if the P.S.A. even hit 'threshold' level - say of 4.0 or above, followed by a biopsy showing Gleason score 6.0. (An elevated P.S.A. reading can prompt a cascade of subsequent tests and treatments, because “‘cancer’ is an emotionally charged term that send brains off the rails.)
In the relevant chapter, she examined the extreme consequences of responding to higher P.S.A. levels, which included trans rectal prostate biopsy - carrying the risk of sepsis, urinary blockage or other trauma.
See e.g.: Side Effects of a TRUS Biopsy (news-medical.net)
And:
Then also rushing to any invasive treatment, whether surgery (prostatectomy) or high dose radiation such as I had in 2012, e.g.
- The Longest Day...And Then Some...
- Only later did I realize (after reading a book by oncologist John P. Mulhall) the extent of damage done, e.g.
Radiation attacks the DNA in our cells. It causes breakages in the DNA, and when this occurs, the cells commit suicide, a process known as apoptosis. Normal cells have better repair machinery to fix some radiation damage while cancer cells do not. As well as killing off the actual prostate cancer cells, radiation causes injury to the blood vessels that supply the cancer."
Despite all these issues about half of men over 70 continue P.S.A. screening, according to a new study in JAMA Network Open. Though testing declined with age, “they really shouldn’t be getting screened at this rate,” said the lead author Sandhya Kalavacherla. Devra Davis in her book would definitely agree and regard the choice to get tested - given the advanced age - an absurd risk to quality of life.
True, doing mothing can carry risks (doing watchful waiting or active surveillance) but treatment involves significant side effects, which often ease after the first year or two but may persist or even intensify. This is what I have found but also why I have refused further "invasive" treatments - like more radiation - because of the risk to quality of life. British data showed, for instance, that six months after treatment, urinary leakage requiring pads affected roughly half of the men who’d had a prostatectomy, compared to 5 percent of those who underwent radiation and 4 percent of those under active surveillance.
After six years, 17 percent of the prostatectomy group still needed pads; among those under active surveillance, it was 8 percent, and 4 percent in the radiation group. By contrast, men under active surveillance were more likely to retain the ability to have erections, though all three groups reported decreased sexual function with age. After 12 years, men in the radiation group were twice as likely, at 12 percent, to report fecal leakage as men in the other groups.
The financial costs of unnecessary testing and treatment also run high, as an analysis of claims from a large Medicare Advantage program demonstrate. The study, recently published in JAMA Network Open, looked at payments for regular P.S.A. screening and related services for men over 70 with no pre-existing prostate problems. According to David Kim, a health economist at the University of Chicago and lead author of the study.
“The initial screening, which is unnecessary, triggers these follow-up services, a series of events catalyzed by anxiety. The further it progresses, the harder it is to stop.”
This is one reason I have delayed any further (e.g. chemical. hormone therapy) interventions, despite a rising P.S.A. e.g.
To fix ideas, from 2016 to 2018, each dollar spent on a P.S.A. test on men over 70 generated another $6 spent for additional P.S.A. tests, imaging, radiation and surgery. Extrapolated to traditional Medicare beneficiaries, Medicare could have spent $46 million on P.S.A. tests alone for men over 70 and $275 million in follow-up care.
One way out of this morass of cascading cost is to change how providers get paid. Kim has suggested that refusing to reimburse them for procedures that receive low recommendations from the U.S. Preventive Services Task Force could mean fewer inappropriate P.S.A. tests and less aggressive treatment in their wake. Some urologists and oncologists have called for a different kind of shift — in nomenclature. “Why are we even calling it ‘cancer’ in the first place?” asked one oncologist - Dr. Sartor, who has argued against using the word for small, low-risk tumors in the prostate.
Well this gets back to Devra Davis' arguments that given the current highly refined level of scans -observations (like with PET scans or PSMA scans) something - "anyplasms"- are now likely to be detected, necessitating treatments. And we know the first mandate of the Medical industrial complex is to treat first, ask questions later.
What about the renaming option? A less frightening label — indolent lesions of epithelial origin, or I.D.L.E., was one suggestion — could leave patients less inclined to see test results as lethal portents and more willing to carefully track a common condition that might never lead to an operating room or a radiation center. But then one can just hear the screaming of the urological community that patients are risking their lives. But what good is living to 80 or 85 if your cognition is cratered, your body has turned into a blob of 'man-boobs' and your risk of myocardial infarction now exceeds that for death by cancer? Good questions more men need to ask before they commence a prostate cancer treatment journey.
PART 1 OF 3:
ReplyDeleteRe "the war on cancer"
Most people would be much smarter and better informed if they had awareness of what the "war on cancer" movement (and the "Breast Cancer Awareness" movement, etc) does NOT raise awareness about.
The official mainstream "war on cancer" has been an unofficial "war" on the unsuspecting public: to keep them misinformed and misguided about the real truth of this "war." The latest program/"promise" is an extension or reincarnation of the enduring deep racket.
This PHONY official "war" was never meant to be won but to be CONTINUED (preferably endlessly, at least for decades) so that the criminal BIG allopathic medical business (the medical mafia) built around them makes insane profits and defraud the general naive/foolish public, which they've been doing successfully ... so "THEY ARE winning THEIR war against the general forever-naive/forever-foolish public"..
The orthodox cancer establishment has been saying a cure for cancer "is just around the corner" and "we're winning the war on cancer" for decades. It's almost all hype and lies (read Dr. Guy Faguet's 'War on cancer," Dr. Sam Epstein's work, or Clifton Leaf's book, or Dr. Siefried's work on this bogus 'war', etc). The criminal medical establishment deliberate and falsely self-servingly claims and distorts a 'win' in the bogus 'war on cancer' when the only truly notably win is a reduction in lung cancer mortality due to a huge reduction in smoking (eg ca. 40% reduction of the overall cancer death rate in men between 1990-2006 was because of a large reduction in cigarette smoking [https://tinyurl.com/ypk4ccyj]), which has NOTHING to do with their cancer treatments. Lying is their mode of operation.
PART 2 OF 3:
ReplyDeleteSince the war on cancer began orthodox medicine hasn't progressed in their basic highly profitable therapies: it still uses primarily and almost exclusively highly toxic, deadly things like radiation, chemo, surgery, and drugs that have killed millions of people instead of the disease.
As long as the official "war on cancer" is a HUGE BUSINESS based on expensive TREATMENTS (INTERVENTIONS) of a disease instead of its PREVENTION, logically, they will never find a cure for cancer. The moonshot-war on cancer inventions, too, includes industry-profitable gene therapies of cancer treatment that are right in line with the erroneous working model of mechanistic reductionism of allopathic medicine.
The lucrative game of the medical business is to endlessly "look for" a cure but not "find" a cure. Practically all resources in the phony 'war on cancer' are poured into TREATMENT of cancer but almost none in the PREVENTION of the disease. Eg, Heidi Williams, the director of science policy at the Institute for Progress, explained that from the time the "War on Cancer" was announced, in 1971, until 2015, only six drugs were approved to prevent any cancer. From 1973 to 2011, nearly 30,000 trials were run for drugs that treated recurrent or metastatic cancer, compared with fewer than 600 for cancer prevention.
It's IRREFUTABLE PROOF POSITIVE that BIG MONEY and a TOTAL LACK OF ETHICS rule the official medical establishment.
It's just like with any bogus official "war" ('war on drugs', 'war on terrorism', 'war on covid' etc) --- it's not about winning these wars but to primarily prolong them because behind any of these fraudulent "war" rackets of the criminal establishment is a Big Business, such as the massive cancer industry. The very profitable TREATMENT focus of conventional medicine, instead of a PREVENTION focus which these official medical quacks (or rather crooks) can hardly make any money off, is a major reason why today 1 of 2 men and 1 in 3 women can expect a cancer diagnosis at some point in their lifetimes (https://tinyurl.com/ypk4ccyj) yet that rate was multiple times lower 5 decades ago when the phony 'war on cancer' began (1 in about 16) and the current much higher rate cannot at all be attributed solely to an aging population. And 5 decades ago when this bogus war began cancer was the second leading cause of death and 50 years later it is STILL the second leading cause of death in the country this "war" was declared in (https://tinyurl.com/ypk4ccyj). These facts alone prove we are NOT winning the war on cancer.