How Valid Are The Oft-Cited Stats For Cancer "Survival" Rates?

Prostate image yielded as part of 3D staging biopsy with cancerous lesions in mud yellow, urethra in green. This is completed prior to focal cryotherapy treatment  - where a cryo-probe at -90C is inserted into the perineum to freeze cancer cells.  The procedure can last from an hour to an hour and forty five minutes. But no promises are made to rid the cancer entirely.


The recent press reports of lowered cancer survival rates, and a WSJ editorial on the subject, make it incumbent on critical- thinking citizens to examine such stats and whether they're really valid.  We read in the WSJ piece from January 9, for example, that: "the cancer death rate in the U.S.  fell 2.2. % from 2016 to 2017 "the largest single year drop ever recorded".   This according to the latest report in the American Cancer Society.   However, we also learn:

"The drop is largely driven by progress against lung cancer".

A result of great new terrific treatments? Actually not. More a case  that such lung cancer deaths were largely fueled by "fewer people smoking."

Meanwhile  we learn that (ibid.):

"Doctors made progress in breast, prostate and colorectal cancers."

But how much?  According to a WSJ editorial ('Where You Want To Get Cancer', January 10, p. A16):

"The five year survival rate is now 98 % for prostate cancer, 92% for melanoma and 90 % for breast cancer"

But what does that even mean and is it 'more pie in the sky'  or wishful thinking than anything else?   A recent issue of Skeptic magazine (vol. 24, No. 4, 2019) provides some clues in an article entitled 'How Much Longer Will Cancer Screening Myths Survive?'  The author, Felipe Noguiera, cites two problems with figuring survival rates associated with screenings:

1)The lead time bias. I.e. when statistical studies include already screened patients, and

2) A length of time bias which occurs when screening is done periodically and cancer- contrary to what most people think - is a heterogeneous disease with different progression rates.

A key problem in respect of (1) which I've discussed before in the case of prostate cancer (when I referred to radiation, and radical prostatectomy treatments) is that screening allows many cancers to now be detected in the asymptomatic phase.  That was how my prostate cancer was detected using a needle biopsy back in July, 2012 e.g.

Notes on a Prostate Biopsy: Don’t Fear and Don’t H...

In my case I was told non-action (e.g. watchful waiting) was not an option so I had to choose either the surgery (RP) or radiation. Well, I ended up choosing high dose brachytherapy in September that year.  But four years later the cancer (evidently diagnosed from MRI biopsy, fusion biopsy and 3D screening- staging biopsy results e.g.

3D Staging Prostate Biopsy Unlikely To Come Into...

Returned. Would I have still survived this long (e.g. nearly 6 1/2  years) without any treatments?  (I had another, focal cryotherapy treatment in June, 2017) The jury is still out according to the Skeptic author. As he writes (p. 34):

"Imagine that a group of patients without screening is diagnosed due to symptoms at an age of 63 years, but they die from the cancer at 65. Now, consider that screening (e.g. biopsy) detects the tumor at age 59 and the patients still die at 65.  Thus, without screening the 5 year survival rate was 0 % but with screening it is 100 %, even though screening did not make them live any longer. Both groups of patients died at the same time.  This is called the lead time bias."

In terms of (2), the effect arises because screening is done periodically( in my case, in July, 2012, in June 2016, September, 2016 and January, 2017.   As the author points out:

"Basically, aggressive and more lethal cancers tend not to be detected by screening because they grow fast and cause symptoms between screening rounds. Similarly, screening tends to detect slow, progressive cancers.  As a result a group of patients whose cancers were detected by screening will live longer than those diagnosed clinically imply because screening selected a group of patients with a better prognosis."

In other words, the success wasn't on account of the screening per se, but because that screening selected for the slower growing cancer.   As the author adds:

"That means that screening detects abnormalities that meet the pathological criteria of cancer, but would not have caused symptoms or death in the patient's lifetime. This is called overdiagnosis."

The problem of overdiagnosis is that at the time of diagnosis it is not possible to know which cases will progress and which will not. So almost everyone is treated leading to overtreatment. That leads to another complication, i.e. "to look only for cancer specific mortality could miss deaths caused by treatment."

He then cites (p. 36) Swedish trials of mammography to show the problem of bias associated with cancer-specific mortality in breast cancer. Thus:

"For every other woman screened every other year for 12 years - while one cancer death was avoided, the total number of deaths increased by six."

In other words, the increased radiation endured in mammography screenings led to other cancers not related to the one originally detected and which caused a death.   The conclusion?

We should publicly acknowledge that we cannot be sure whether early detection lengthens, shortens or has no effect on how long people live."


This comports with what I wrote in my November 9, 2018  blog post on the changed recommendations for prostate cancer screening, for example, e.g.


"Most experts agree that people with a life expectancy of 10 years or less don't need routine screening for cancer. One problem is that overscreening can lead to overdiagnosis and overtreatment. For instance, a screening might find a slow-growing cancer that wouldn't cause any harm within a person's lifetime if left undetected, a situation that's common with prostate cancer. If that's the case, it's not worth the burden and anxiety caused by testing and the potential for more—possibly invasive—follow-up procedures.

Yet, according to published studies, too many older adults continue to undergo unnecessary cancer screenings despite age- and health-related recommendations from professional groups.

Three groups that have weighed in on prostate cancer screening are the National Comprehensive Cancer Network (NCCN), the United States Preventive Services Task Force (USPSTF), and the American Urological Association (AUA). Following are their current recommendations for when to stop:

I'd also posted this on the Team Inspire prostate cancer forum and was met with a lot of pushback, some downright vitriolic, i.e.

"What are you a politician running for office? An insurance company agent? I am sick of you guys coming in here and trying to tell us to try to control costs and not to get these tests! I don't care how much they cost, even if I'm 78 I am gonna get them! Maybe I want to live to 95!"

 "I'm in no position to contradict medical science on this, but 70 seems a bit young. Yes, it leaves a "life expectancy" of 10 years (in 2018, living in the U.S., given today's technology), but healthy people with good genes and healthy  lifestyles routinely live well into their 90s. My G4+5 was discovered when I was 59. What if it had been 12 years later? Answer: a horrible death from PCa, diagnosed only after I became symptomatic, and far too late to treat it."

So there's no doubt that because of the feel good propaganda pushed by the likes of the WSJ editors (and other corporate media)  it will be a long time before people back off on the benefits of screening, and indeed adhere to the revised recommendations.

Yes, Truth Is A Casualty In The "War On Cancer"

Prostate image yielded as part of 3D staging biopsy with cancerous lesions in mud yellow, urethra in green. This is completed prior to focal cryotherapy treatment  - where a cryo-probe at -90C is inserted into the perineum to freeze cancer cells.  The procedure can last from an hour to an hour and forty five minutes. But no promises are made to rid the cancer entirely.

Steve Salerno, in his WSJ article ('In The War On Cancer Truth Becomes The Casualty',  p. A13, April 21-22) is adamant that cancer patients are being sold a bill of goods via phony TV ads where "the multimillion dollar industry appeals to emotion".  He wrote this after seeing an M.D. Anderson ad proclaiming:  "Come to us and you will beat  cancer "  i.e. rendered in red strike through to reinforce the point.

Salerno emphasized there were "no asterisks" and "no disclaimers" - viewing the ad as exaggeration to prey on false hopes.  After all, those with cancer are often desperate to get rid of it, get the proverbial "cure", so if a promise (by a reputable medical center)  is made to "beat cancer" that's interpreted as getting the job done. And why not, given "Cancer Inc's denizens will compete for an estimated $207 billion in 2020.."  So "it is less a war on cancer than a war on truth - and on vulnerable consumers."

Salerno continues:

"The most comprehensive study of such advertising, published in the Annals of Internal Medicine in 2014, notes that cancer treatment ads as a class rely on emotional appeals evoking hope or fear, while pointedly eliding useful information. Eighty -eight percent tout treatments and only 18 percent mention screening even though early diagnosis is more critical to survival than the interventions romanticized on TV"

Which is absolutely true.   For example, by the time my youngest brother Mike was diagnosed with stage IV liver cancer in early May he'd already run out of time for any useful treatments. The  most discriminating screening test - the liver biopsy -   was just too late.   His oncologist informed him-  soon after the grim  diagnosis -  that he could provide "palliative" treatment and  keep him alive an "extra few months" by use of radiation plus chemo, "but there would be side effects."  Mike wanted nothing of it, and said flatly 'No!'   He could not be moved to struggle for a further month or two,  expending a lot of money for useless treatments,  knowing his time was up anyway.

In my case, with prostate cancer, I also know the clock is ticking but I am not sure how fast. Having had high dose radiation in September, 2012 as a first treatment then focal cryotherapy as a salvage treatment last June, all I know is what the further screening tests have disclosed: that is a PSA of 2.7 at the end of April, and free PSA of 4.1 % - which indicates a more than 70 percent probability the cancer is still there - in other words it hasn't been "beaten" yet.

When I  asked the UCHealth NP, Kristen. : "Why has it seemed to come back?" She replied, "Well, it happens!"  Perhaps, but perhaps you guys never had it as much  under control - or treatable (especially with a focal therapy) -  as you assumed! After all, prostate cancer is a multifocal disease.

Even if we adhere to the most judicious diets and avoid all meats, alcohol, smokes etc. there is absolutely no assurance of continued wellness to the point of escaping all diseases such as cancer. Nor, I will add, is there any assurance that ANY prostate cancer treatment - even the "gold standard" radical prostatectomy - can ultimately beat it.  When one reads the litany of complaints on the Team Inspire prostate forum it is totally disheartening.  Forum members have referred to treatment after treatment:   RP, EBRT, HIFU, HDR brachytherapy, focal cryotherapy, proton beam - but none  working with finality. Well, let's amend that a bit:  maybe there is a 0.5% success rate, i.e. 0.5 % of guys who come away from said treatment and find no recurrence afterward.  That includes no more rising PSA, no more low free % PSA, no more need for invasive biopsies.

In other words, in the "war on cancer' there are very few ultimate victors, at least with prostate cancer and I suspect with many others.  One Team Inspire member actually insisted that "with so many different treatments it's obvious the oncologists and urologists know little or nothing."  An extreme take but it illustrates the level of frustration after getting a professed "excellent treatment" then having it come back.

Thus, all the ads bleating  about "beating it" are mostly fulsome rubbish fed to people desperate to be rid of it.  The ads then are more inundated with false hopes than realistic expectations, and cancer patients - at least those with prostate cancer - are starting to figure that out.

At the center of the hopelessness of fighting the disease is Barbara  Ehrenreich's research on immune cells as a Ph. D. student in the 1960s, specifically on  “macrophages".  Her research led her to drop the  rose tinted glasses of hope and finally grasp these cells originally viewed as friends – frontline defenders against microbial invaders-  had been exposed as traitors. They were "biological double agents" for their role in cancer and autoimmune diseases. Hence, one of her basic "wellness" beliefs was shattered early and with it all the associated hokum and delusionary twaddle. . If one's body can attack itself, then why bother trying to look after it? At least to any assiduous, extreme extent?
 
Much of this was exposed in her new book, Natural Causes: An Epidemic Of Wellness, The Certainty Of Dying, And Killing Ourselves to Live Longer')   Such discoveries led Ehrenreich to conclude once one reaches the mid-70s, then extraordinary life preserving measures as well as screenings ought to be off the table. Let it go already! 
 
As even Salerno puts it (ibid.):

"The war on cancer is not the place for pep talks and poetic license. We could do with more disclosure, less delusion. "


But the other side that needs less delusion has to do with the covert nexus of the "cancer industry" and its components, agenda.  What is the "cancer industry"? According to Breast Cancer Action, quoted by Lauretta Schwarz -Nobel in her book,  Poisoned Nation, St. Martin's Press, 2007:

"The Cancer industry consists of corporations, organizations, and agencies that diminish or mask the extent of the cancer problem, fail to protect our health or divert attention away from finding the causes of breast cancer...this includes drug companies that, in addition to profiting from cancer treatment drugs, also produce toxic chemicals that may be contributing to the high rates of cancer in this country and increasing rates throughout the world. It also includes the polluting industries that continue to release substances we know or suspect are dangerous to our health, and the public relations firms and public agencies who protect these polluters.

The Cancer industry includes organizations like the ACS that downplay the risk of cancer from pesticides and other environmental factors and which have historically refused to take a stand on environmental regulation".

This take on concealing the extent of the cancer problem, especially in terms of chemical toxins and their effects, was first broached by Devra Davis in her 'Secret History of the War on Cancer'.  She courageously exposed the PR underbelly of the American "Cancer wars" and their beneficiaries (see. e.g. Chapters 1-4), while also naming the American Cancer Society as having conflicts of interest and mixed motives (Chapter 5, 'Fear Sells').

Davis notes that people get told over and over (by the likes of the ACS and their physician apologists) that "too much fat" is causing their cancers - whether of lungs, bladders, prostate gland or breasts - and hence they bear greatest responsibility.  Never mind the evidence from more than 80 years of cumulative data which discloses it's chemicals in the environment that contribute more than fifty times as much.  

By contrast,  Ms. Schwarz -Nobel pulls no similar punches. She not only names environmental toxins and the chemical industry as the biggest culprits in the cancer explosion (she notes breast cancers have increased 300% since the 1960s) but shows in her (named) Chapter 6 that one of the biggest cancer drug producers (Astra Zeneca) ALSO produces one of the most toxic herbicides around, acetochlor. See also my earlier blog on Toxic America: http://brane-space.blogspot.com/2011/10/america-toxic-1.html

I point all this out because this is the major delusion in terms of the cancer wars, imho, not the TV ads blabbering false hope and bunkum.  If we don't know the extent of the agents that are connected to cancer then there is little chance of proactively avoiding them, and the necessity of getting so many screening tests (at the cost of tens of billions of dollars a year) in the first place.

Schwarz -Nobel asks, as every thinking American ought to, how it is that a multinational that manufactures one of the worst known carcinogens (p. 107) can also be manufacturing cancer treatment drugs. How can you basically be causing cancers and treating them at the same time?

Referring to AstraZeneca, the author points out:

"According to Sierra Magazine, 'Its Perry, Ohio chemical plant is the third largest source of potential cancer-causing pollution in the United States releasing 53,000 pounds of recognized carcinogens into the air in 1996". AstraZeneca is also the world's third largest drug concern, valued at $67 billion."

She then goes on to quote a Dr. Samuel Epstein from the same Sierra piece (ibid.):

"This is a conflict of interest unparalleled in the history of American medicine."
And further:

"You've got a company that's a spinoff of one of the world's biggest manufacturers of carcinogenic chemicals and they've got control of breast cancer treatment. They've got control of chemoprevention studies, and now they have control of cancer treatment in eleven centers - which are clearly going to provide the drugs they manufacture."

Clearly, the exposure of these hidden connections is the truth that needs to come out in the ongoing cancer battle, including the funding of treatments. At the end, we should not be funding companies if they are causing cancers at the same time as offering treatments. 

See also:

http://brane-space.blogspot.com/2018/07/guarding-against-cancers-in-pruitt.html

The New W.H.O. Meat & Cancer Study - Another Pile of Medical Malarkey

The new cancer warnings on Monday from the World Health Organization (W.H.O.)  about eating red meats and processed meats make me laugh. The latest medical pinheads want us to believe that eating a hot dog a day has the same risk as smoking a pack of cigarettes a day or being exposed to asbestos. They claim eating one hot dog a day can "increase the colon cancer risk". '

Know what the extent of increased  risk is? It goes from 5% over a lifetime (for non meat eater, e,g, Vegan) to 6 percent. BIG DEAL!  By the same token, the smokers increase their cancer risk by 17. 2 percent compared to 1.3 percent for non-smokers. So WHO is fooling WHO? DO these medical misfits really believe people will give up their hot dogs on that account? They must be smoking much more powerful stuff than available here in Colorado.

What exactly is the reasoning?

Well, processed meats like hot dogs and bologna have been salted, cured (with sodium nitrite) or smoked to enhance flavor and improve preservation. Medical health gurus have long worried that this processing leads to the formation of potentially carcinogenic chemicals like polycyclic aromatic hydrocarbons in these products. (Funny how they worry so much less about the abundance of toxic chemicals in our air, soil and water from fracking, such as benzene, xylene, toluene etc. as well as atrazine from weedicides.)

The concern with red meats — beef, pork and lamb — has more to do with the cooking, not the processing. Grilling, barbecuing and pan-frying meat creates potential carcinogens, including heterocyclic aromatic amines. But again, these pale beside the toxic chemicals already inundating our environment, such as perchlorate, glyphosate, atrazine and bisphenol-A and about which there is little concern shown at all

The report finds a link between consumption of processed meats and colorectal cancer (and perhaps other cancers). But here's the zinger:  it also acknowledged that the link between red meat and cancer has not been proved. According to the ancillary body, the International Agency for Research on Cancer, in a handout accompanying its report.:

“Eating red meat has not yet been established as a cause of cancer,”

In other words, it's just another medical alarm story like so many before, and which people had already become accustomed to tuning out.

Let's get into the numbers again, for perspective: W.H.O. estimated that 50 grams daily of processed meat or 100 grams daily of red meat might increase the risk of colorectal cancer by 18 percent and 17 percent, in that order, over the absolute risk — if indeed red meat were related to cancer at all, which the report also acknowledged is not known.

What does that mean? It means that as noted above, the lifetime risk goes from 5% to 6% so that the increased risk "over the absolute risk" is computed:

(6% - 5%)/ 6  = 1/6  - 16.667 %  ~  17%

Again, negligible! I prefer to think of it more realistically as the risk going from 5 in 100 for those who don't eat red or processed meats, to 6 in 100 to those who do. The use of the "17 percent" increase is merely a stat intended to alarm ordinary folk and throw them off. It reminds me of the old statin research done by PhrMA which purported to show the benefit of taking statins which allegedly reduced risk of heart attacks by 33 percent.

This  was first reported by FORBES in 2008 wherein outcomes from a control and statin-taking group were compared per capita for heart attacks. In the control (placebo) group there occurred 2 heart attacks per capita, and in the statin-takers there occurred 1 heart attack per 100. The results were then touted as "Statins reduce risk of heart attacks by 33%".

Thus:

(2 - 1)/3 x 100% = 1/3 x 100% = 33%

But anyone can play games with numbers like that, and misdirect people's attention. Indeed, in the case of the data reviewed by the W.H.O. we now know it was drawn from population studies, and many experts question whether these risk estimates can be applied to individuals who may have other risks for colorectal cancer. (Especially from toxic chemicals which can also find their way into the foods we consume).

My primary complaint, which is shared by author Devra Davis in her excellent monograph,  'Secret History of the War on Cancer' - is the medical industrial complex is trying to scare us off common foods that most people eat while turning a blind eye to the truly malignant carcinogenic risks of pesticides, weedicides etc. But as she notes there is a method to the madness; It foists the major responsibility for cancer to the ordinary person and away from the mammoth chemical industry. It protects their profits while holding US accountable for our cancers, say if we eat a hot dog or bologna sandwich or two each day instead of lentils and arugula.

In her book,  Davis accurately documents that people get told over and over (by the likes of the American Cancer Society and their physician enablers, apologists) that "too much fat" is causing their cancers - whether of lungs, bladders, prostate gland or breasts - and hence they bear greatest responsibility. ( Never mind the evidence from more than 80 years of cumulative data which discloses it's chemicals in the environment that contribute more than fifty times as much.)

But this sort of dishonest PR show is now common in the US of A.

The trouble is that most of us no longer buy into it. We have the evidence that there are far more pervasive risks to our health than eating a hot dog or bratwurst a day!

If the powers that be - whatever their source -  want to really protect citizens from carcinogens, they will first attend to the REAL culprits, e.g. everything from PFOA(perflurorooctanoic acid ) -based chemicals and additives, that causes monstrous birth or sexual defects in young kids to phthalates (pronounced THAL-ates), such as bisphenol A (now banned in Canada and most of Europe ) to atrazine and acetochlor in herbicides (for a rogue list of all of the most dastardly chemicals poisoning us, see: 'The Body Toxic', by Nina Baker, 2008)

Until these medical meatheads do that I will go on eating my brats, hot dogs and salami - knowing that their increased risk of cancer,  relative to what's already in the environment via toxic chemicals,  is roughly analogous to the risk of getting more drunk by adding a thimble full of beer to a keg already downed.