Cancer Treatment is a Self-Serving Industry

[Tekward]

Tough topic. My first wife had less than 2 years from cancer diagnosis to passing. I often wonder if we could have enjoyed our limited time together better than the hell of chemotherapy, heart damage and pain of sudden loss.

https://blogs.scientificamerican.com/cross-check/the-cancer-industry-hype-vs-reality/



"A 2015 meta-analysis by epidemiologist John Ioannidis (renowned for bringing the scientific replication crisis to light) and others found no reductions in all-cause mortality from tests for cancer of the breast, prostate, colon, lung, cervix, mouth or ovaries for asymptomatic patients."

 

[molly312]

It is a crapshoot. I experienced all the symptoms you listed. It was a rough ride. I am 5 years out and doing well. I am grateful to have the time. It changed our lives and retirement plan. I am afraid to venture too far from home for an extended period. We live close to our family and have treasured being able to watch the grandkids grow up. No easy answer there. There were "days" but, it was worth the struggle.

 

[blueskyk]

I’m so sorry for your loss - it’s so hard and sad to watch someone we love suffer.

Quote from the link posted above: “But as a 2015 analysis points out, in general people do not live longer as a result of early detection. They simply live longer with a diagnosis of cancer, with all its harmful emotional, economic and physiological consequences.”

Barbara Ehrenreich makes a similar point in her book (which is an excellent read, btw):

Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer.

Caveat emptor as always, I suppose.

ETA: I should point out the book questions the efficacy of screening for early detection when one is “old enough to die”. At 72, she put herself in that category and no longer does any cancer screening tests.

 

[Aerides]

I don't know that the industry is so much to blame, as we as patients are far too likely to do anything, try anything, to eek out extra time.

I'm not talking about "survivable" cancers, I'm thinking those aggressive clearly terminal things, like stage 4 pancreatic.


Long piece I read years ago on this topic still good:

"Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left."

https://www.newyorker.com/magazine/2010/08/02/letting-go-2

 

[Midpack]

Very disturbing, thank you for posting this, I hope it gets a lot of reads.

For selfish reasons, I identified with the quote below, I’ve posted about the over diagnosis shortcomings of PSA in 2013 and again this years.

IME the patient MUST become a well informed advocate for themselves when confronted with any early diagnosis. Some doctors will act in your best interest, some won’t. We can’t become medical experts, but we can gather all the available information on the cancer or other illness we’re confronted with - the good news is it’s much easier today than generations ago.

I know a lot about prostate cancer only because I had a high PSA reading, and my doctors would have happily over treated me, my unnecessary pain and suffering, and wasting health care dollars (spending $6,000 instead of a $49 retest). Multiply that by all the patients and all the illnesses in the US and you have some small piece of why healthcare in the US costs twice as much as all other developed nations with poorer outcomes than many.

My sister learned everything she could about lymphoma to navigate intelligently through it. She did require treatment, but she did so with eyes wide open avoiding mistreatment, and luckily she’s been clear for over 25 years.

Neither of us are doctors, neither of us know near as much about any other cancer or illness.

Mammograms and prostate-specific antigen (PSA) tests have led to especially high rates of overdiagnosis and overtreatment for breast and prostate cancer. A 2013 meta-analysis by the Cochrane Collaboration, an international association of experts that assesses medical procedures, estimated that if 2,000 women have mammograms over a period of 10 years, one woman’s life will be saved by a positive diagnosis. Meanwhile 10 healthy women will be treated unnecessarily, and more than 200 “will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.”

Another nonprofit medical group, theNNT.com, has spelled out a disturbing implication of these data. (NNT stands for “number needed to treat,” which refers to the number of people who must receive a treatment for one person to receive any benefit. Ideally, the number is 1.) The NNT notes that some overdiagnosed women might “die due to aggressive therapies such as chemotherapy and major surgery.” Thus any benefit from screening “is balanced out by mortal harms from overdiagnosis and false-positives.” Breast-cancer specialist Michael Baum, who helped found the United Kingdom’s breast-screening program, has advocated abandoning such programs, which he believes might cut short more lives than they extend.

As for PSA tests, a federal task force of medical experts estimates that 1.3 deaths may be averted for every 1,000 men between the ages of 55 and 69 tested for 13 years. But for every man whose life is extended, many more will experience “false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.” A 2017 analysis by the task force estimated the ratio of beneficial PSA tests to false positives and overdiagnosis to be as high as 1/240.

A 2013 meta-analysis by Cochrane Group found “no significant reduction” in mortality resulting from PSA tests. “The strategy of routinely screening all men with PSA tests leads to interventions that are not saving lives and may be causing harm,” the NNT stated. The discoverer of the prostate-specific antigen, pathologist Richard Ablin, has called the PSA test a “profit-driven public health disaster.”

 

[LRDave]

Diagnosis and treatment are two different things. For me, life would be hellish to start showing symptoms and to then steadfastly refuse any diagnosis.

I in no way disagree with Midpack on the whole PSA thing, as I hardly consider it a diagnostic tool at all.

 

[mystang52]

OP: Sorry for your loss, including watching a loved one suffer.

The issue of cancer screening, when or if to treat, etc is a somewhat common topic. And a cancer diagnosis brings considerable emotional issues as well.

I think, as this thread grows, we'll see lots of anecdotes. My anecdotes and comment: First, I'm tired of reading about PSA tests and false positives. False positives from PSA tests are well known, but I'm pretty darned certain treatment doesn't begin based solely on PSA result.
Anecdotes: My PSA was steadily rising and ultimately had a big spike. During this time frame of a few years biopsies were negative. Finally came up positive AND a need to treat. I'm glad I treated and got that cancer out of me.
I'm also a leukemia survivor of 13 years. I am "treated" conservatively, as in nothing more than monitoring. There is no rush to treatment for my type. Leukemia keeps me immuno compromised, so I take precautions. Who knows, if I was ignorant about my type of leukemia I might be dead already. At least in my case, diagnostic testing was worthwhile.

 

[Midpack]

OP: Sorry for your loss, including watching a loved one suffer.

The issue of cancer screening, when or if to treat, etc is a somewhat common topic. And a cancer diagnosis brings considerable emotional issues as well.

I think, as this thread grows, we'll see lots of anecdotes. My anecdotes and comment: First, I'm tired of reading about PSA tests and false positives. False positives from PSA tests are well known, but I'm pretty darned certain treatment doesn't begin based solely on PSA result.
Anecdotes: My PSA was steadily rising and ultimately had a big spike. During this time frame of a few years biopsies were negative. Finally came up positive AND a need to treat. I'm glad I treated and got that cancer out of me.
I'm also a leukemia survivor of 13 years. I am "treated" conservatively, as in nothing more than monitoring. There is no rush to treatment for my type. Leukemia keeps me immuno compromised, so I take precautions. Who knows, if I was ignorant about my type of leukemia I might be dead already. At least in my case, diagnostic testing was worthwhile.

Happened to me twice, in two states, two unnecessary biopsies if I hadn’t educated myself. And I think “a 2017 analysis by the task force estimated the ratio of beneficial PSA tests to false positives and overdiagnosis to be as high as 1/240” is reason enough for discussion.

Sorry you’re tired of hearing about PSA, but I never imagined and expected anyone would bother reading about it unless confronted with a high result personally or a friend/family member. And I’m done posting re: PSA on this thread, I’m against thread hijacking.

But the OP’s link gives many examples of other cancers and illnesses. No one is saying all diagnosis and treatment is suspect. But over diagnosis and over treatment is substantial, that was the OP’s point. Our individual experiences are real but anecdotal in the big picture.

 

[NW-Bound]

I don't know that the industry is so much to blame, as we as patients are far too likely to do anything, try anything, to eek out extra time.

I'm not talking about "survivable" cancers, I'm thinking those aggressive clearly terminal things, like stage 4 pancreatic.

+1000

Terminal cancers are, well, terminal, particularly among the elderly.

On the other hand, don't forget younger patients who undergo surgeries and treatments and survive.

Don't we all know breast cancer patients who survive, for example?

 

[Midpack]

+1000

Terminal cancers are, well, terminal, particularly among the elderly.

On the other hand, don't forget younger patients who undergo surgeries and treatments and survive.

Don't we all know breast cancer patients who survive, for example?

I’ve personally known 3 women with breast cancer. All were “successfully” treated, and it seemed to extend their lives, but all three died of breast cancer within 10 years from initial diagnosis. Maybe you know long term breast cancer survivors? OP link stats below suggest what the odds may be.

A 2013 meta-analysis by the Cochrane Collaboration, an international association of experts that assesses medical procedures, estimated that if 2,000 women have mammograms over a period of 10 years, one woman’s life will be saved by a positive diagnosis. Meanwhile 10 healthy women will be treated unnecessarily, and more than 200 “will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.”

 

[NW-Bound]

I’ve personally known 3 women with breast cancer. All were “successfully” treated, and it seemed to extend their lives, but all three died of breast cancer within 10 years from initial diagnosis. Maybe you know long term breast cancer survivors? OP link stats below suggest what the odds may be.

Would these 3 women's life be shorter if they forgo all treatments? Perhaps the extra years are not worth the money?

I totally agree that there are many ineffective cancer drugs now on the market, and doctors have spoken out against this for years. But it's the desperate dying patients who want it so bad. I posted about this several times in the past.

We cannot lump all cancers together. Do we not bother with treating skin lesion, and just let nature run its course? Are all cancers non-treatable?

 

[audreyh1]

I know women who were treated for breast cancer almost 20 years ago and are still alive with no recurrence.

 

[Midpack]

I’ve personally known 3 women with breast cancer. All were “successfully” treated, and it seemed to extend their lives, but all three died of breast cancer within 10 years from initial diagnosis. Maybe you know long term breast cancer survivors? OP link stats below suggest what the odds may be.

Would these 3 women's life be shorter if they forgo all treatments? Perhaps the extra years are not worth the money?

I totally agree that there are many ineffective cancer drugs now on the market, and doctors have spoken out against this for years. But it's the desperate dying patients who want it so bad. I posted about this several times in the past.

We cannot lump all cancers together. Do we not bother with treating skin lesion, and just let nature run its course? Are all cancers non-treatable?

Your comments and questions, not mine...

 

[ERD50]

I’ve personally known 3 women with breast cancer. All were “successfully” treated, and it seemed to extend their lives, but all three died of breast cancer within 10 years from initial diagnosis. Maybe you know long term breast cancer survivors? OP link stats below suggest what the odds may be.

A 2013 meta-analysis by the Cochrane Collaboration, an international association of experts that assesses medical procedures, estimated that if 2,000 women have mammograms over a period of 10 years, one woman’s life will be saved by a positive diagnosis. Meanwhile 10 healthy women will be treated unnecessarily, and more than 200 “will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.”

You've kinda jumped from anecdote and asking for anecdotes, to data. And your data is really on another subject (though worthwhile) than survival rates. I prefer to stick with the data on survival rates:

https://www.cancer.net/cancer-types/breast-cancer/statistics

The average 5-year survival rate for women with invasive breast cancer is 91%. The average 10-year survival rate for women with invasive breast cancer is 84%.

If the cancer is located only in the breast, the 5-year survival rate of women with breast cancer is 99%. ....

They didn't provide a 10 year survival number here though.

... If the cancer has spread to the regional lymph nodes, the 5-year survival rate is 86%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 27%. ...

About 6% of women have metastatic cancer when they are first diagnosed with breast cancer. Even if the cancer is found at a more advanced stage, new treatments help many people with breast cancer maintain a good quality of life for some time.

... However, the number of women who have died of breast cancer has decreased by 40% from 1989 to 2007 thanks to early detection and treatment improvements.

It sure seems that last part must be due to better detection/treatment? Are you suggesting, that based on your 3 observations, that there is no value to detection/treatment for breast cancer?

BTW, I appreciate your posts on PSA (PSA on PSA?), the things that can affect the test, and the risks of false positives. As far as I'm concerned, it's worth hijacking every thread on mortgage pay-off, SS "break-even", and "safe WR" with that info!

-ERD50

 

[NW-Bound]

Your comments and questions, not mine...

Yes, the questions are mine.

I ask them, because the answers will help us decide whether society should stop paying for cancer treatment.

Perhaps some cancers are cheaply treatable, and some are not. If we lump them all together, we do not make effective use of resources.

 

[Tiger8693]

Do we not bother with treating skin lesion, and just let nature run its course? Are all cancers non-treatable?

I don't think anyone is saying that, but each situation needs to be reviewed individually. Age, type of cancer/aggressiveness, etc.

My Mom died from cancer when I was a Freshman in college, 18 years old. She was 40. She had a seriously aggressive cancer (I think now called MBC) and was diagnosed in July just before I left for college, went through horrendous treatments (both chemo and radiation), and died in November before my 1st semester was even completed. Due to the treatment(s), she lived those last months of her life in pain, and a large part of it in the hospital. I often wonder if she would have lived at least a little longer not going through the poison of treatments (especially at that time - 1981).

 

[NW-Bound]

I don't think anyone is saying that, but each situation needs to be reviewed individually. Age, type of cancer/aggressiveness, etc...

Thank you. That's my point.

The problem I see with the thread title is that it leads one to think that society would be better served by stopping all cancer diagnosis and treatments altogether.

How else does one think when seeing "Cancer Treatment is a Self-Serving Industry"?

Just pull the plug to stop all the shenanigans, and save the money.

 

[Midpack]

Thank you. That's my point.

The problem I see with the thread title is that it leads one to think that society would be better served by stopping all cancer diagnosis and treatments altogether.

How else does one think when seeing "Cancer Treatment is a Self-Serving Industry"?

Just pull the plug to stop all the shenanigans, and save the money.

Being honest, I sure didn’t get that from the thread title, or the link. Did you read the linked article?

This is a topic almost NO ONE can be completely objective about.

 

[NW-Bound]

I will read it later, but will say that the thread title turned me off.

Now, as I already mentioned, I have posted numerous times in the past about doctors sounding the alarm about expensive cancer drugs that simply extended the life of terminal patients for a few months, at great costs and pitiful quality of life.

One such article I quoted was written a few years ago, about oncologists at Sloan-Kettering Hospital refusing to administer some expensive ineffective drugs to their patients. I have found the story again here: https://www.early-retirement.org/fo...self-serving-industry-102195.html#post2370973.

But don't blame it all on the doctors. It's the patients who often clamor to have the latest drugs, whether they work or not. Money be damned. How else do you think we have a policy of "no lifetime limits" on medical costs?

It is very hard for sick people to accept that they are going to die, and that nothing can help them. I have posted plenty about books that talk about this.

 

[Tekward]

Due to the treatment(s), she lived those last months of her life in pain, and a large part of it in the hospital. I often wonder if she would have lived at least a little longer not going through the poison of treatments (especially at that time - 1981).

I have the special pain of knowing that I convinced her to continue Chemo when she was going through hell.

I don't know if I'd do anything different, but I was young and wish I had learned and challenged more.

 

[NW-Bound]

I know of a few cancer patients who stopped treatments and accepted death. They were in their 70s though.

And I have a cousin who even refused dialysis after diagnosis of renal failure. He said the quality of life would be poor, and he accepted death. His health steadily declined, and he eventually died. He was in his mid 70s.

 

[Teacher Terry]

Tek, the problem is you don’t know who will be the lucky survivor. A friend of mine had stage four ovarian cancer after extensive surgery to remove it. She was given 6 months to live but decided she wasn’t dying and had chemo. She was 52 and it took 2 years of her life but she survived. Over 20 years it came back 7 times and each time she cheerfully fought it. Finally all the chemo gave her early dementia and since her husband was dead I chose not to treat it because she was miserable in a home. I had another friend that had a very aggressive breast cancer at the same age. She had surgery and chemo and after 4 years it was in her liver. She was given 4 months to live and didn’t do treatment. She went on a diet that was easy on her liver and lived well until a month before she died 30 months later.

 

[Amethyst]

More than 20 years ago, a fellow gym-goer was complaining that no matter how much she worked out and how little she ate, her stomach stuck out.

I said, "You are so thin and in shape - you need to see your doctor about that tummy. It just doesn't fit with the rest of you."

She turned out to have Stage 3 ovarian cancer. She underwent a radical treatment that involved removing all the blood from her body, heating it to kill cancer cells, and re-infusing it. That's the treatment I remember, anyway; there were probably others. She definitely suffered - but she survived, went on to retire and start her own business!

Sorry to say, we lost touch. But I just Googled her name (it's distinctive) and she seems to be alive, well, and active in charitable causes.

 

[LRDave]

I have the special pain of knowing that I convinced her to continue Chemo when she was going through hell.

I don't know if I'd do anything different, but I was young and wish I had learned and challenged more.

It would be 1000% harder for me to be rational about the situation if it was DW as opposed to me. You can't kick yourself around for that. Sorry for your loss.

 

[daylatedollarshort]

This is a popular Tedtalk (the speaker also has a book on Amazon) on eating to beat cancer (and other chronic diseases) by William Li. I found it pretty interesting. Summary here - https://drwilliamli.com/how-we-can-starve-cancer-with-food/

"...you may be surprised to learn that we are all forming these microscopic cancers in our body all the time. Autopsy studies from people who died in car accidents have shown that about 40 percent of women between the ages of 40 and 50 actually have microscopic cancers in their breasts. About 50 percent of men in their 50s and 60s have microscopic prostate cancers, and virtually 100 percent of us, by the time we reach our 70s, will have microscopic cancers growing in our thyroid....The body’s ability to balance angiogenesis prevents blood vessels from feeding cancers, and this turns out to be one of our most important defense mechanisms against cancer. In fact, if you block angiogenesis and prevent blood vessels from ever reaching cancer cells, tumors simply can’t grow up. So, if angiogenesis is a tipping point between a harmless cancer and a harmful one, then a revolutionary approach to preventing cancer is by cutting off its blood supply by consuming anti-angiogenic foods."

Most of the foods he suggests loading up on are generally deemed healthy anyway, and not too different than what people tend to eat who live the longest in longevity studies, so for us there doesn't seem to be much downside in following his recommendations and possibly a lot to gain.