Overdiagnosis and Pseudodisease

What is overdiagnosis?

Overdiagnosis is the diagnosis of “disease” that will never cause symptoms or death during a patient’s lifetime. It’s a side effect of our relentless desire to find disease early through annual checkups and screening. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted.

What’s the problem with wanting to know if there’s a cancer or disease lurking in our bodies?

The problem is, we all harbor abnormalities. Today with our technology we have all sorts of tests that are increasingly able to find our potential health problems, yet most of these abnormalities will not go on to cause disease.

Jennifer Durgin wrote: “Due to the sophisticated scanning technology, like computed tomography (CT) and magnetic resonance imaging (MRI), we’re able see ourselves at a level of detail that has never before been possible. Dartmouth radiologist William Black, M.D, said.”Because we’re now able to see every millimeter of the body, we of course find a lot more abnormalities in the body than we ever knew existed. Oh, there is this ton of tumors out there and other diseases, so disease must really be increasing in frequency.'” But is it?”

But because doctors don’t know which abnormality will and which will not develop into full blown disease, they tend to treat everybody. That means doctors are treating those who cannot benefit because there’s nothing to fix, and these people can be harmed.

What’s the harm?

Overdiagnosed patients cannot benefit from the detection and treatment of their “cancer”, because the nature of the cancer was never destined to cause symptoms or death in the first place. So patients can only be harmed instead due to the following.

Overdiagnosis triggers overtreatment or unnecessary treatments. All medical interventions have side effects. This is particularly true of cancer treatments. Surgery, radiation and chemotherapy all pose varying morbidity and mortality risks.
Psychological effects – just being told that you have “cancer” makes your world turns upside down. Unknown to both doctors and patients, this so-called “cancer” may not be harmful after all.
Unnecessary expenditure due to the cost of treatment from which the patient cannot benefit, because the disease posed no threat.

Who benefits from overdiagnosis?

A lot of people: drug companies, device manufacturers, imaging centers, hospitals and of course the doctors. The easiest way to make money is not to make a better drug or build a better device—it’s to expand the market for existing drugs and devices by expanding the indication to include more patients. Similarly, for hospitals, the easiest way to make money isn’t to deliver better care; it’s to recruit new patients—and to make patients to come for regular checkups.

Early detection of cancer – the cause of overdiagnosis

Overdiagnosis is the side effect of the systematic evaluation of asymptomatic patients to detect early forms of cancer, as in the widely promoted “Early Detection” or “Screening” for cancers (in breast, prostate, etc.). This procedure may detect abnormalities that meet the pathologic definition of cancer as seen under the microscope and interpreted by the pathologists. But these abnormalities will not progress to cause symptoms or death during a patient’s lifetime.

A patient once said this to me, A cancer is a cancer. And like it or not it must be taken out. There is this long-standing assumption that all cancers when found early will inevitably progress to become full blown cancer. This assumption does not hold true all the times. Some pre-clinical cancers will not progress to cause problems for patients.

It has long been known that some people have cancers with short pre-clinical phases (fast growing, aggressive cancers), while others have cancers with long pre-clinical phases (slow growing cancers). Pre-clinical phase is defined as the time period that begins with the onset of an abnormal cell and ends when the patient notices symptoms from the cancer.

The figure below depicts the heterogeneity of cancer progression using 4 arrows to represent 4 categories of cancer progression.

Source: Gilbert Welch, Should I Be Tested for Cancer? pg.55

The arrow labeled “Fast” represents a fast growing cancer, one that quickly leads to symptoms and to death. These are the worst forms of cancer.
The arrow labeled “Slow” represents a slow growing cancer, one that leads to symptoms and death but only after many years.
The arrow labeled “Very Slow” represents a cancer that never causes problems because it is growing very slowly. If a cancer grows slowly enough, then patients will die of some other cause before the cancer gets big enough to produce symptoms.
The arrow labeled “Non-progressive” represents a cancer that never causes problems because it is not growing at all. In other words, they are cellular abnormalities. They meet the pathologic definition of cancer but never grow to cause problem simply because it stops growing or perhaps even shrinks. You may have thought that all cancers progress. That is not the case.

Some cancers outgrow their blood supply and are starved, others are recognized by the host’s immune system and are successfully contained, and some are not that aggressive in the first place. They don’t need to be treated and are harmless.

From the above it is clear that all cancers are not created equal. Some grow rapidly and invade other tissue, others grow slowly and remain noninvasive, and some don’t grow at all or may even recede. So many of the cancers that doctors are finding and treating today are what’s called “pseudodisease”—tumors that will never cause harm, let alone kill you.

Pseudodisease

Nonprogressive cancers and very slow growing cancers are collectively referred as pseudodisease (meaning “false disease’). Pseudodisease is, therefore, a type of cancer that need not be treated. Steven H Woolf, MD, MPH, writing in the British Medical Journal, 18 November 2003, said, “Pseudodisease is the portion of the iceberg below the waterline. Modern medicine is too ignorant to know for sure which of the submerged parts are worth detecting. Doctors of the future will know better. Until then, caution is warranted as we probe beneath the water. (http://www.bmj.com/content/327/7418/E206.full)

Dr. William Black said, “It should be pointed out that pseudodisease is almost impossible to document in a living individual. When pseudodisease is treated, as it almost always is, long-term survival is attributed to the treatment and is labeled a cure. In the rare instances when it is not treated because of old age or other contraindication, pseudodisease cannot be confirmed as such while the patient is still alive because, by definition, it must remain asymptomatic until the patient dies of other causes. These problems with documentation probably explain why pseudodisease has received relatively little attention.”

The medical community doesn’t know enough about some cancers to predict how they will behave over time. So it’s safer, they reason, to label a questionable abnormality as “cancer” and to treat it, than it is to risk its growing out of control. Only after an untreated person dies from other causes can a cancer be declared pseudodisease. Only then is it clear that treatment of the cancer would have provided no benefit, only potential harm.

Examples of cancers that don’t progress

1. Neuroblastma: This is a rare form of cancer that typically affects young children. This cancer generally starts near the kidney. It can grow to as large as a grapefruit, can invade major blood vessels and can metastatasize to major organs like the liver. They can kill children. In Japan, parents of 11 six-month-old infants declined surgery or chemotherapy for their infants. Instead they opted for watchful waiting. This decision turned out to be a blessing. The cancers in these 11 children began to grow smaller and eventually regress.

2. Kidney cancer: Radiologists at New York University Medical Center reported the growth of 40 small kidney tumours (less than 3.5 cm in diameter). The three fastest-growing tumours increased in diameter by about 1 cm per year. The remaining 37 grew considerably slower – less than 0.6 cm per year. Some did not grow at all. Twenty-six of the tumours grew large enough that they were ultimately removed, but fourteen never grew large enough for the doctors to recommend surgery. More important , no one developed metastases or any symptoms from their cancer and no one died of renal cell carcinoma.

3. Breast cancer: The incidence of ductal carcinoma in situ (DCIS) rose dramatically in the US after mammography screening became widespread. DCIS now accounts for 1 out of 5 newly diagnosed breast cancers.

More than one half million women have been diagnosed with DCIS in the past 20 years in the US. Virtually all of them were treated with surgery, radiation and chemotherapy as if they had invasive breast cancer. DCIS is actually quite prevalent in the population and is present in 40% of the findings of autopsies conducted in middle-age women who die of other causes.

Most DCIS is psedodisease. Although rarely done, watchful waiting may be a reasonable strategy for many women with DCIS.

4. Prostate cancer: Autopsy studies had shown that elderly men who died of other causes often had histologic evidence of prostate cancer, latent disease that was clinically silent while these men were alive. Introduction of a screening test (prostate-specific antigen – PSA) in the late 1980s brought an “epidemic” of prostate cancer to the United States in the early 1990s.

“The most compelling evidence that pseudodisease is a real problem comes from the experience with prostate cancer. Prostate cancer is the second-leading cause of cancer-related death in American men, and over the last 30 years, more and more of it has been found. In 1975, about 100,000 new cases were diagnosed; in 2003, about 220,000. At first glance, one might conclude that prostate cancer is on the rise. However, if a cancer is “really increasing,” you’d expect death rates to rise. And that hasn’t happened with prostate cancer. The death rate has remained more or less constant, hovering around 30,000 deaths per year in the U.S.

5. Lung cancer: Swensen describes the pseudodisease that emerges when computed tomography (CT scan) is used to screen for lung cancer. It detected 56 lung cancers over 4 years at the Mayo Clinic, but also a much larger number of uncalcified chest nodules, 98% of which were benign. He notes that wedge resection carries a 4% mortality rate, raising the prospect of patients’ dying on the operating table in the pursuit of pseudodisease.

Twenty years ago, Yale researchers examined the autopsy reports of patients (generally over age 60) who died at Yale-New Haven Hospital and who were not known to have lung cancer during life. The rate of surprise cases of lung cancer in these autopsies was 10 times the rate of lung cancer diagnosed in the general population. What does this mean?

If pathologists found very few kung cancers in patients not known to have cancer in life, doctors could expect that most small lung cancers they do find will progress to be the type of lung cancer we all fear.

However, if pathologists find a high incidence of lung cancers in patients not known to have cancer in life, doctors need to recognize that many small lung cancers detected by CT scan may be pseudodisease.

6. Thyroid cancer: Pathologists in Finland examined the thyroid gland in 101 autopsies. Over a third of the autopsied patients had thyroid cancers! But thyroid cancer is rare in Finland as well as in the United States. However, many of the cancers they found were small, some as small as 0.2 mm in diameter. The researchers concluded that virtually everybody would have some evidence of thyroid cancer if examined carefully enough. Put another way, we might say that the smallest forms of thyroid cancer are so common that they should be regarded as normal.

Summary

Let me end this discussion with the following statements by Dr. Gilbert Welch:

Not all cancers should be treated. Some small cellular abnormalities that are called “cancer” will not progress to cause symptoms or death. Others will progress so slowly that people will die of something else before they ever have symptoms of cancer.
It is practically impossible to know for sure whether an individual cancer is, in fact, pseudodisease.
There is a bottomless reservoir of cancer in the general population – the harder you look for it, the more you find but this pseudodisease will never harm the individual anyway.
As diagnostic methods and equipments become more sophisticated doctors are beginning to find smaller and smaller tumours in such organs as the thyroid gland, kidney, lung and breast.
The fact that pseudodisease exists suggests that the correct approach to cancer is not always treatment. Instead, watchful waiting may be a reasonable strategy.

Points for You to Ponder On

Given that there is such a thing as pseudodisease, do you really need to go “hunting” for cancer every year in the forms of mammogram, PSA test, colonoscopy, etc, etc?
The person who determines whether you have cancer or not is really not your doctor but the pathologist. He studies a bit of your tissues under a microscope and decides if you have cancer or not. Do you think he is 100 percent right all the time? Can he be 100 percent sure that the abnormal cells that he observe under the microscope would grow in you and become a full blown, dangerous cancer?
Given that all cancers are not created equal, is the standard “all-size-fits-all” recipe of surgery, chemotherapy, radiotherapy (and taking hormones in breast cancer) the only correct solution for every cancer?

Read more:

Gilbert Welch, M.D., M.P.H. Should I Be Tested for Cancer? Maybe not and here’s why, University of California Press.
Lisa Chedekel, http://www.bu.edu/today/2011/medical-overdiagnosis-bad-for-you-good-for-business/
http://en.wikipedia.org/wiki/Overdiagnosis
William Balck, http://jnci.oxfordjournals.org/content/92/16/1280.full.pdf
Jennifer Durgin, http://dartmed.dartmouth.edu/summer05/print/hunting.php

The Cold Hard Facts About the US Cancer Program, Part 2: Misguided and Ineffective

Have you read our earlier write-up: The Cold Hard Facts About the US Cancer Program, Part 1: Misguided and Ineffective?

Townsend Letter, the Examiner of Alternative Medicine, is a magazine published in Washington, USA. It is written by researchers, health practitioners and patients. Its editorial staff is headed by Jonathan Collin, a medical doctor. The aim of this magazine is to provide a forum for discussion on the pros and cons of alternative medicine.

The October 2011 issue of The Townsend Letter has another (continuing) article, The US Cancer Program and Specific Types of Cancer, 1975–2007: A Failure – Part 2. This article is written by Anthony D. Apostolides, PhD, and Ipatia K. Apostolides, BA. (Part 1 and 3 of their papers were published earlier). You can access their papers by clicking this link: http://www.townsendletter.com/Oct2011/cancer1011.html#.TsDAmpB2S7A.email

Dr. Anthony D. Apostolides is a researcher and teacher of health-care economics. He received a doctoral degree in economics from the University of Oxford, UK, and a master’s degree from the University of Pittsburgh. Ipatia K. Apostolides has more than 15 years of experience in the field of cancer (Cleveland Clinic Foundation, and Children’s Hospital, Cincinnati). She has a bachelor’s degree in biology from Case Western Reserve University.

The authors assessed the US cancer program by analyzing the overall incidence and mortality rates of 24 specific types of cancers. The assessment, based on a long time period (1975–2007), provides results that are more comprehensive and thus more reliable than those based on shorter time periods.

The criteria used for assessing the effectiveness of the National Cancer Institute (NCI) program were:

The incidence rate and the numbers of Americans afflicted by a cancer. A constant or increasing incidence rate over time, along with increased numbers of those afflicted, indicates a failure of the program.
If the incidence rate declines, but the number of people afflicted increases, the program is deemed to be a failure.
A declining incidence rate, along with a declining number of those diagnosed with the cancer, indicates success in the prevention of that cancer.
A constant or increasing mortality rate of a cancer over time, along with increased number of deaths, indicates a failure of the NCI in the treatment of that cancer.
If the mortality rate declines over time but the number of deaths increases, then the program for the treatment side is shown to be a failure.
If the mortality rate declines over time and the number of deaths decline, this indicates success in the treatment of a cancer.

Definition: A cancer incidence or mortality rate is the number of newly diagnosed cancers or number of reported cancer deaths of a specific type occurring in a specified population during a year (or group of years), usually expressed as the number of cancers per 100,000 population at risk.

Here are some of the facts that the authors presented regarding some of the common cancers that we hear of in Malaysia (read the authors’ three papers to know more on other types of cancer).

Brain Cancer (Invasive)

The overall incidence rate of brain cancer increased from 5.9 (per 100,000) in 1975 to 6.6 (per 100,000) in 2007. That rate is 12% higher than in 1975.
The number of people afflicted by brain cancer surged from 12,634 in 1975 to 20,004 in 2007. From 1975 to 2007, the number of Americans afflicted with this cancer was a marked 558,716.
The number of Americans who lost their lives to brain cancer was 8,876 in 1975, and this number rose significantly to 12,732 in 2007.
On average 60% of the people who get brain cancer will die from it – a dismal outcome.

Cancer of the Female Breast

The overall incidence rate of in situ breast cancer in 1975 was 5.8, and this rate climbed sharply, that in 2007 it had reached 34.8. The rate of this cancer soared 500% over the analysis period, a phenomenal rate of increase.
In 1975, the number of women diagnosed with in situ breast cancer was 12,591, while in 2007 an immensely higher number of women, 105,057, received the unpleasant diagnosis. During this period, the total number of women getting this cancer reached a stunning 1.7 million.
With regard to invasive breast cancer, the overall incidence rate of that cancer rose substantially from 105 in 1975 to 126 in 2007.
The number of women afflicted by invasive breast cancer also grew significantly. In 1975, the number of women diagnosed with that cancer was 226,923. This number climbed steadily over time and reached 381,125 in 2007. The total number of women diagnosed with the cancer between 1975 and 2007 was an astounding 10.6 million.
With regard to mortality of invasive breast cancer, the overall mortality rate increased from 31.5 in 1975 to 33.2 in 1990. Subsequently, the rate decreased to 22.8 in 2007.
In 1975, there were 67,924 deaths from this cancer, and by 2007 the number had reached 68,911 deaths. This means that the decline in the mortality rate was not large enough to offset increases in the population. The total number of women who died from this disease from 1975 to 2007 was a shocking 2.5 million.

Cancer of the Colon and Rectum (Invasive)

The overall incidence rate of colon cancer declined by 33% over the period of analysis.
The number of people diagnosed with colon cancer in 1975 was 128,547, and in 2007, the number reached 136,616, still higher than the number in 1975. During the analysis period, a total of 4.8 million Americans had contracted colon cancer. This is a stunning statistic.
The overall mortality rate of colon cancer decreased by 39% over the course of 1975–2007.
The annual number of deaths from colon cancer decreased from 60,667 in 1975 to 50,447 in 2007. However, the total number of deaths from this cancer during the period of analysis was 1.9 million. This indicates that of the Americans diagnosed with colon cancer 41% will die from it on the average.

Leukemia

The overall incidence rate of leukemia increased from 12.8 in 1975 to 14 in 2007.
Even if the incidence rate of leukemia had stayed the same over time, it would still indicate a failing program of prevention. Consequently, even a relatively small increase in the incidence rate is a definitive sign of failure in prevention.
The other negative development of this cancer is that the number of Americans afflicted with leukemia increased steadily and significantly over time. In 1975, the number of people diagnosed with leukemia was 27,601 and this climbed markedly to 42,270 in 2007. The total number of people diagnosed with leukemia during the analysis period totaled a significant 1.1 million.

Cancer of the Liver and Intrahepatic Bile Duct (Invasive)

Data on liver cancer clearly show a dismally failing program. The overall incidence rate of liver cancer rose significantly from 2.6 in 1975 to 7.2 in 2007.
The number of Americans stricken with liver cancer rose rapidly from 5,702 in 1975 to 21,844 in 2007. This represents an amazing 283% increase and proves that the cancer program failed in preventing liver cancer.
The total number of Americans afflicted with liver cancer during 1975-2007 was 378,311.
The mortality rate grew by 1.3% annually. But the situation worsened in 1988 to 2007, the mortality rate increased by 3.2% annually.
The rising mortality rate of liver cancer increased from 6,069 in 1975 to 16,202 in 2007. This represents a 167% increase.
On average, 88% of Americans afflicted with liver cancer die from the disease; that is indeed a horrendous statistic, showing the abysmal failure of the NCI program in treating this cancer.

Cancer of the Lung and Bronchus (Invasive)

The overall incidence rate of lung cancer rose from 52 in 1975 to 61 in 2007. This indicates an increase of 17% over the analysis period.
In 1975, the number of Americans diagnosed with lung cancer was 112,867. That high number increased rapidly over the years that followed, reaching 183,895 by 2007. As a result of these increases, the number of Americans diagnosed with lung cancer during the period of analysis totaled a shocking 5.4 million.
The number of Americans who died annually from lung cancer increased tremendously. In 1975, the number of Americans who died from this cancer was 91,918, and by 2007 that number jumped 66% to reach 152,539. The total number of deaths from this cancer during the period of analysis was a shocking 4.6 million.
On average, 85% of Americans diagnosed with the disease, will die from it – a horrible statistic.

Non-Hodgkin’s Lymphoma (NHL)

In 1975, the overall incidence rate was 11, and by 2007, it had climbed 91% to 21.
The rapidly increasing incidence rate resulted in ever-rising numbers of Americans being afflicted by NHL over the analysis period. The number afflicted with this cancer was 23,887 in 1975 and climbed significantly to 63,028 by 2007. The number of Americans afflicted with NHL during the period of analysis totaled a significant 1.5 million.
Data on the mortality rate of NHL also indicate a failing US cancer program in treating this cancer. The overall mortality rate increased from 5.6 in 1975 to 6.5 in 2007.
The number of Americans who lost their lives to NHL increased significantly over time. In 1975, 12,000 Americans died from the disease and this number grew by over 100% to reach 24,235 in 1997; it then decreased to 19,672 in 2007. The total number of Americans who lost their lives to NHL during the period of analysis totaled 622,451. This indicates that on average, 42% of Americans diagnosed with NHL will die from it.

Cancer of the Ovary (Invasive)

The overall incidence rate of ovarian cancer declined over the analysis period from 16.3 in 1975 to 13 in 2007. However, the decline in the overall incidence rate of ovarian cancer over time was not large enough to offset the effect of the country’s population increase; consequently, the number of women afflicted by ovarian cancer increased over the period of analysis.
In 1975, the number of women afflicted with ovarian cancer was 35,247 and by 2001 the number had reached 41,649. After 2001, the number of diagnoses declined slightly to reach 39,132 in 2007. That number was still markedly higher than in 1975. During the 1975–2007 period, a total of 1.3 million women were diagnosed with ovarian cancer.
The overall mortality rate of ovarian cancer declined over the analysis period. In 1975, that rate was 9.8, and it hovered around 9 for over two decades before declining in the last few years of the analysis period to reach 8.2 in 2007.
The number of women who lost their lives to ovarian cancer increased over the period of analysis. This is similar to what was observed for the overall mortality rate. The number of women who died from this cancer was 21,252 in 1975, and by 2007, that number had risen to 24,801. The number of women who died from that cancer during the 1975–2007 totaled 770,398. This indicates that on average, 61% of the women diagnosed with ovarian cancer die from their cancer – a dismal statistic. Based on the mortality rates, the majority of these women are from the “65 plus” age group.

Cancer of the Pancreas (Invasive)

The overall incidence rate of pancreatic cancer increased over 1975–2007, from 11.8 to 12.4. The number of Americans afflicted by pancreatic cancer also increased significantly over time. In 1975, the number of people diagnosed with pancreatic cancer was 25,571 and by 2007 that number jumped to 37,292. The number of Americans afflicted with this cancer during the period of analysis totaled 984,698.
The overall mortality rate of pancreatic cancer essentially stayed the same over the period of analysis, at 10.7 in 1975 and 10.8 in 2007.
The constant overall mortality rate of pancreatic cancer contributed to increases over time in the number of Americans who lost their lives to that cancer; that number rose from 23,023 in 1975 to 32,525 in 2007.
The number of Americans who died from pancreatic cancer during the analysis period totaled 899,943; this was very close to the number of people diagnosed with the disease at 984,698. On average, 91% of the pancreatic cancer patients die from their cancer. This is indeed a most dismal statistic, showing the failing NCI program in treating this cancer.

Cancer of the Prostate (Invasive)

The incidence rate of prostate cancer show a big failure in the US cancer program in preventing this cancer. The overall incidence rate rose rapidly from 94 in 1975 to a high of 237 in 1992; subsequently, it declined to 171 in 2007, still much higher than in 1975.
The number of men diagnosed with prostate cancer in 1975 was quite large, at 203,058. That number increased rapidly over time, reaching a stunning 610,000 in 1992. This was followed by a decline to 515,569 in 2007, which was still much higher than in 1975. The number of those afflicted by prostate cancer over 1975–2007 grew by a remarkable 154%.
- The total number of men diagnosed with prostate cancer during the period of analysis was the highest number observed of all the cancers – an unprecedented 13 million.
- The overall mortality rate of prostate cancer increased from 31 in 1975 to 39 in 1993. Thus, during the first 19 years of the analysis period, the US cancer program in treating this cancer was a failure. After 1993, the mortality rate began to decline; and by 2007, the rate had dropped to 23.5. Thus, after 1993, there was some success in the treatment side of this cancer.
- In 1975, 66,887 men died from prostate cancer, and that number rose to 102,384 in 1993. After 1993, the number of deaths declined, reaching 70,903 in 2007; that number, however, was still higher than in 1975. The number of men who died from prostate cancer during the analysis period totaled 2.8 million. This indicates that on average, 21% men diagnosed with prostate cancer will die from it.

Cancer of the Stomach (Invasive)

The overall incidence rate of stomach cancer decreased over the analysis period, from 11.7 in 1975 to 7.1 in 2007. This indicates that the US cancer program was successful in the prevention side of that cancer.
The decline in the incidence rate of stomach cancer also resulted in a decrease in the numbers of Americans afflicted by that cancer over the analysis period. In 1975, the number of people diagnosed with stomach cancer was 25,226 and by 2007, that number had declined to 21,512. The total number of Americans afflicted with this cancer during the analysis period was 794,935.
The overall mortality rate of stomach cancer declined, from 8.5 in 1975 to 3.6 in 2007. The declining mortality rate of stomach cancer resulted in a decrease in the number of Americans who lost their lives to that cancer over time. In 1975, that number was 18,379 and by 2007, it had dropped to 10,892. The total number of people who died from that cancer during the analysis period was 481,716. This indicates that on average, 61% of people diagnosed with stomach cancer will die from it – a dismal statistic.

Comments

On 23 December 1971, President Nixon declared War on Cancer. He promised the American people and the world that victory against cancer would be achieved within five years. Forty years have passed. That declaration still remains an empty promise, typical of statements made by politicians everywhere. Billions and billions of dollars have been poured into this War with no victory in sight.

In 1975, Nobel Laureate James Watson said, It produced no promising leads. It‘s a bunch of shit. Linus Pauling, a two-times Nobel Prize winner said, Everyone should know that the War on Cancer is largely a fraud. An article in the New England Journal of Medicine came to a similar conclusion, Cancer remains undefeated … and the war on cancer is a qualified failure.

Dr. Richard F. Taflinger wrote, “Statistics are a prime source of proof that what you say is true. Statistics are based on studies. There are, of course, problems with using statistics as evidence. Let me remind you of a famous saying: “There are three ways to not tell the truth: lies, damned lies, and statistics.” http://public.wsu.edu/~taflinge/evistats.html

In this case, can we ever lie with such hard facts? Actual numbers tell better truth than the manipulated and massaged statistics put out by drug companies and their cohorts. Ask this question – Is the US War on Cancer a roaring success or a great dismal failure?

Show me the hard facts and numbers please!

From Hepatitis to Liver Cancer: Nexavar for Free – No Thanks

Sonny (not real name) is a 59-year-old male. He was diagnosed with Hepatitis B about five years. He opted for herbal treatment from Taiwan. After six months, his alpha-fetoprotein increased further indicating it was not effective. Nevertheless he continued to take the Taiwanese herbs up to this day. About three years ago he went to see a doctor and was prescribed Lamivudine and ever since he has been taking both Lamivudine and the Taiwanese herbs.

In September 2011 Sonny had bloated stomach and lost his strength. An ultrasound of his abdomen indicated liver cancer. On 30 July 2011, his alkaline phosphatase was at 224, AST = 79 and GGT = 354 (all these values are beyond normal range). He was told by the doctor that he had an incurable, terminal stage liver cancer. He probably has two months to live or at most six to eight months. Before he dies he would vomit blood.

Sonny went to Singapore for a second opinion. A CT scan on 4 October 2011 showed a 14 x 12 x 12 cm tumour in the caudate lobe. There was also a 3.8 x 3.4 x 2.4 cm nodule in Segment 2 of his liver. There was tumour thromhus demonstated in the right portal branch and the main portal view. Thrombus was also seen in the proximal left portal branch. In addition he had liver cirrhosis with mild splenomegaly and moderate ascites.

Blood test on 4 October 2011 showed elevated alkaline phosphate = 315, AST = 164, ALT = 73 and GGT = 614.

His tumour markers, however, were within normal range – AFP 14.7, CEA 0.8 and CA 19.9 27.2.

There was nothing the doctor in Singapore could do for him. He was offered oral chemo drug, Nexavar which cost S$10,000 per month. He was told this would not cure him but could prolong his life for two months. However, the Malaysian doctor who first saw him did not recommend Nexavar because of its severe side effects.

Sonny then went to the University hospital in Singapore for another opinion. There was nothing more that could be done. Since the University is currently carrying out a clinical trial on Nexavar, Sonny was offered to take this drug for free. He said no thanks to this offer of free Nevaxar – listen to what he has got to say in the video below.

Lung Cancer: Surgery, No Chemo But On Herbs – CEA Elevated After Bad Diet

Jan (M471) is a 55-year-old male from Indonesia. He is an ex-smoker of 40 plus years. Sometime in mid-2008 he had coughs. There was no blood in his sputum. He went to Melaka for a checkup. A CT scan indicated cancer of the lung. Not satisfied he came to Penang for a second opinion.

A colonoscopy, done on 20 September 2008, indicated haemorrhoids and presence of polyps in the colon and rectum. Biopsy of the colonic polyp indicated tubular adenoma associated with moderate dysplasia, while the polyp from rectum was hyperplastic.

CT scan of the thorax indicated a small irregular 1.7 x 1.7 x 1.6 cm nodule. The paratracheal, carinal and right hilar lymph nodes were enlarged ranging from 1 to 3 cm. Impression: Features are suspicious of underlying early carcinoma of lung.

Jan underwent an operation to remove the tumour in his lung. He was told he had a 85 to 90 percent of cure if he had surgery. Histopathology report confirmed a moderately differentiated squamous cell carcinoma, pT1N1Mx, Stage 2A. Surgical margins were free of malignancy. The total cost of his medical treatment came to about RM 35,000.

Jan was asked to undergo chemotherapy. He refused and came to seek our help on 8 October 2008. He was prescribed Capsule A, C-tea, Lung 1 and Lung 2 tea and GI 1 tea.

About a month later, 14 November 2008, Jan came back to see us again. He said he felt healthier and his sleep was better. He was asked to undergo chemotherapy. The doctor said chemotherapy can cure him. He declined.

Jan is from a small town in Sumatera. It is a long travel to come to Penang from his home. From home he has to take a 3-hour-bus-ride to a town where he would have to take another 24-hour-bus-ride to Medan. From Medan he has to fly to Penang. In spite of this long journey, Jan come to see us regularly. On most visits to us, Jan said he was well and healthy with no complaints. His CEA decreased from the initial 133.66 (before surgery) to 27.6 (after two years on herbs). However, on 21 October 2010, Jan was jolted by the sudden rise of his CEA from 27.6 to 83.12 (See table). We were disappointed too. What had gone wrong? From experience we could roughly guess the answer. We asked him, “What did you eat wrong these past month?”

Date	CEA	Remark
19 Sept 2008	133.66
15 July 2009	51.2
22 Oct 2009	43.0
14 May 2010	27.6
21 Oct 2010	83.12	Bad diet – ate meat, fried food and tau sar paw
4 Dec 2010	75.58
31 Mar 2011	93.97
25 Aug 2011	57.9

Jan admitted that since he was doing fine, he did not keep to his diet very well. He ate the food that we asked him to avoid such as meat, fried food and “tau sar pow” (bun made form sweet beans boiled in pork lard). He used corn oil for his cooking instead of coconut oil. We explained to Jan we did not know the cause of the rise in his CEA – it could be due to the problem of his colon since he had polyps or it could be due to his lungs. Anyway, the only option is to go back to his good diet again. Jan promised to do just that. About a month later, the CEA dropped to 75.58 only to increase again to 93.97 in March 2011. However, in August 2011 his CEA was down to 57.9. With this decrease Jan seemed to believe that diet is important for his wellbeing.

Overall, Jan’s health was alright. It has been three years since his lung surgery. And he declined chemotherapy and opted for herbs instead. Up to this day, he is able to eat, sleep and do his routine activities without any problem. It did not matter if the CEA was at 93.97 or 57.9 – these numbers did not make any difference in terms of his wellbeing. In short, his quality of life has been maintained through his cancer journey, minus the chemo of course.

Acugraph Study

The AcuGraph taken on 26 August 2011 showed improvements – a more balanced meridian reading compared to the one take on 22 October 2010 (below).

Some questions for you to reflect on:

After surgery Jan refused to undergo chemotherapy in spite of being asked to do so by his doctor. What happened to him now? What could have happened if he was to undergo chemotherapy? Will he be as well as he is today?
After the surgery, his CEA dropped from 133 to 51 and then to 27 – and he was only on herbs and “good” diet. Do you believe that herbs and diet are effective in keeping his cancer at bay? Or do you prefer toxic drugs to do the job?
Jan started to take “bad” food after two years of being in good health. His CEA shot up to 83. He realized his mistake and started to go on his “good” diet again. After six months his CEA went down to 58. Do you still insist that cancer patients can eat anything they like and that food has nothing to do with cancer progression and/or recurrence?
From October 2010 to March 2011, Jan’s CEA hovered around 76 to 94. In spite of that he felt well. His wellbeing was not affected by either a high or low CEA. What does this tell you? Learn to live with your cancer! Don’t let the lab test numbers make you sick!

Pancreatic Cancer: Severe Itch Disappeared and Health Improved After Herbs and the e-Therapy

Bak (M952) is a 56-year-old male from Indonesia. Sometime in November 2010, he complained of itchiness but he did nothing about it. In April 2011, he went for a checkup in a hospital in Aceh, North Sumatera. He was told there was a tumour in his bile duct. On 8 April 2011, he came to Penang for further checkup. CT scan of his abdomen and pelvis indicated the following:

A rounded hypodense lesion seen in mid-transverse colon measuring 10.5 x 21.3 mm. The doctor was unsure of what it was polyp ?
Pancreatic head and uncinate process carcinoma with distal CBD (common biliary duct) obstruction.
Left inguinoscrotal hernia.

His liver function results on 8 April 2011 are as follows:

Parameters	8 April 2011	5 October 2011
Total protein	79 H	76
Albumin	26 L	34
Globulin	53 H	42
A/G ratio	0.5 L	0.8 L
Total bilirubin	284.4 H	62
Direct bilirubin	212.2 H
Indirect bilirubin	72.2 H
Alanine transaminase	90 H	44
Alkaline phosphatase	222 H	62
GGT	67 H	68 H
AST	110 H	46 H
Alpha-fetoprotein	4.62
CEA	3.5
CA 19.9	1569.55	7.9

Bak was asked to undergo an operation for his pancreatic cancer. He declined, but he opted for ERCP (Endoscopic Retrograde Cholangiopancreatography). This is a specialized technique to clear off the bile duct obstruction. Three plastic stents (tube) were installed to help with the flow of the bile. The total cost of hospitalization came to RM 4300.

After this procedure, Bak was asked to undergo chemotherapy. He refused. Instead, on 10 April 2011, he came to seek our help. He presented with the following:

Severe itch throughout the whole body
No appetite
Fevers, unable to sleep
Diarrhoea
Yellow urine

We had no choice but to put Bak on the e-Therapy hoping to help him with the itchiness. After one session of the e-Therapy, the itchiness was reduced. After two sessions, his itch was reduced by 50 percent. After four sessions of the e-Therapy his itch was totally gone. Bak had fevers. We prescribed him with Appetite & Fever tea. After taking a glass of this tea, his fevers were resolved. Then he went home to Aceh.

On 7 July 2011, Bak came back to see us again. He said for the past two weeks, he started to itch again. It came on and off and affected the palms, elbows and feet. We were not able to put him of the e-Therapy because he had to go home the next day.

On 5 October 2011, Bak showed up at our centre again. This time he came specifically for the e-Therapy. Bak said that since taking the herbs in April 2011, his health had improved. He felt more comfortable, his sleep was better and he felt more energetic. Previously he had to wake up 4 to 5 times a night to urinate. After taking the A-Kid-6 tea his urination frequency has reduced to only once a night. He started to itch again but this was not as serious as before the e-Therapy. Before the e-Therapy the whole body was itchy and he had to scratch until the skin bled. Now the itch was confined to his elbows and feet only.

A blood test was done on 5 October 2011. The results showed improvements in his GGT, AST and CA 19.9 (Table, Column 3). Bak underwent the e-Therapy again from 5 October to 11 October 2011. After two sessions, the itch reduced by about 50 percent. By 10 October 2011, six days on the e-Therapy, the itch was almost totally gone. What remained were the itches on his finger tips.

Over the past six months since taking the herbs, his health had improved, his sleep was good and so was his appetite. The e-Therapy had helped tremendously with his itchiness.

The video clip below documented his progress with the e-Therapy.

Dissecting Chemotherapy 11: No Chemo for Dad’s Liver Cancer – Wisdom of a Daughter

Daughter: My father was diagnosed with liver cancer in August 2011.

The doctor wanted him to do chemotherapy. We did not allow him to do so. I argued with the doctor.

The doctor did not get angry with you? Yes, he was but I did not bother. Since we did not want to go for chemo (injection) he was asked to take an oral drug for his liver. This cost RM 20,000 per month.

Wait, wait. Let’s start from the very beginning. Actually what happened and when? D: My father had winds in his stomach. This was in August 2011. He consulted a doctor who told him that he had a gallstone. His liver had some shadows. The doctor then suggested that my father do a CT scan. He went to do a CT scan and the result showed a Stage 2 liver cancer. The doctor suggested chemotherapy. We told the doctor we wanted to go home first and consult with all the members of the family. After that we went to seek a second opinion from a liver specialist.

The Second Opinion – the Liver Specialist

D: The liver specialist studied the CT scan. He also suggested chemotherapy. This time I accompanied my father to consult with this specialist because I did not want him to undergo the chemotherapy. I told the doctor, “We do not want chemotherapy.” When the doctor saw my father, he encouraged him to get admitted into the hospital. He said, “Uncle get admitted immediately and tomorrow we shall start with the chemo.”

I was not happy. The first doctor we consulted with told us that my father had to stop all his heart medications before undergoing chemotherapy. My father had a heart by-pass before. But this liver specialist did not even consider this. He was pushing my father to do chemo quickly. But I refused.

Okay, you refused chemo. What did the doctor say? D: I argued with him. Then I requested that he do another CT scan for my father. So, a second scan was done.

Did you ask the live specialist if chemo can cure your father of his liver cancer? D: Cannot. I asked him, “Doctor, you want to give chemo to my father – can you cure him?” The doctor could not give me an answer. He just kept quiet – no answer. Then he said. “It all depends on the patient himself.”

What ? It now depends on the patient? D: I asked the doctor further – “ You give my father the chemo, what can happen to him after that?” He answered, “The liver may become hard, the patient becomes yellow (jaundice). And his eyes may become yellow.” I countered the doctor, “Okay doctor, my father currently has no pains, can eat, can sleep, can walk and move his bowels – after the chemo, his health is jeopardised and he may not be able to do all these – what’s the whole idea?

What did he say to that? D: The liver specialist said, “I have found the best oncologist to do the chemo for your father, do you know that? I have already made the necessary arrangements for your father to do the chemo tomorrow. Now you tell me you don’t want to do it.” But I said, “In the first place, we never ever agreed to undergo chemo.”

But he told you, There is no cure and the patient becomes yellow – why do the chemo then? D: I eventually told the doctor very bluntly, “My father doesn’t want to do chemo.” My mother also said, “The patient refused chemotherapy.”

How did he respond to that? D: Okay, if the patient did not want chemo, there is nothing we can do.

Did you ask him how much the chemo is going to cost you? D: No, we never get into that. He did not tell us about the cost and also how many cycles of chemo he was going to give.

Assistant to the Liver Specialist: Patients come in healthy, they go out yellow! Why not try the RM 20,000-per-month oral drug for liver cancer?

D: The second CT scan report was ready after two weeks. I requested to have a copy of the report so that I can bring it to you (CA Care). I went to the hospital and met the assistant of the liver specialist. He is also a medical doctor – a nice person. I asked him, “From your experience giving chemo to so many patients, how many really do well? This nice and friendly doctor answered, “To tell you the truth, patients come in looking healthy, but they go out looking yellow after the chemo.” This is what the assistant told me. Then the assistant said, “If you don’t want to do chemo, why don’t you take the oral drug instead. “ This drug cost RM 20,000 per month. But I told the doctor, “But doc., this drug has so many severe side effects” (Read this post: Benefit and side effects of Nexavar).

My Friend’s Husband Took the Oral Drug for Liver Cancer, He Vomited Blood and Died Within Two Weeks

D: The doctor replied, “ No, no serious side effects – you only feel itchy and have reddish palms.” I told the doctor, “My friend ‘s husband had liver cancer. He took the oral drug that cost RM 200,000 per month. He vomited blood and within two weeks was dead.” The doctor went silent. He kept his cool and smiled. The he asked, “If you don’t want to do chemo for your father, what do you want to do then?” I replied, “I am going to bring my father to take herbs.”

What was his response? D: He said, “Go ahead and try it.”

He did not get angry with you? D: No, he was not angry.

Did you know what is the name of that oral drug? Nexavar? D: I did not take note of that. I only know that it can damage the liver and kidney. I read this on the packaging of the medication.

They Just Want You To Do Chemo – That is the way it is

D: Unfortunately, that is the way it is with doctors today. They just want patients to do chemo. After injecting the chemo into you, the poison is already in the body – if you die, you die. That is your business.

Wife: The doctor told us, my husband is still strong. He will be able to withstand the chemo – he can withstand the chemo. D: No, no, I think he will die.

This is the way our world is now. You need to take care of yourself. You have to be responsible for your own health and wellbeing. If not, it may be like “just jumping into the sea.”

Dissecting Chemotherapy 10: No Chemo for Mom’s Breast Cancer – Wisdom of a Son

Patient is a 55-year-old female. She had a lump in her right breast and underwent a lumpectomy in June 2011. Unfortunately the job was not done well. The resected margins were not clean. Patient had to undergo another surgery and this time the whole breast had to be removed. The histopathology report confirmed an infiltrating ductal carcinoma, grade 2 with high grade DCIS (more than 25%) with 1/9 lymph nodes shows metastasis. The tumour is ER +, PR + and C-erb-B2: 2+.

After the surgery, the patient was asked to undergo chemotherapy and radiotherapy. The son persuaded the mother not to go for further medical treatments. Patient came to us and was prescribed Capsule A, Breast M and C-Tea.

On 18 October 2011, I had the opportunity to talk with the patient and her son.

You were asked to do chemo? Patient: Yes, but I didn’t want to do it.

Why? P: (Looking towards her son) He did not want me to do it.

Ha, ha, he did not want to do it, not you didn’t want to do it.

How old are you now? P: Fifty-five years old.

Son: I did not have much confidence (in what they did on her). She went for an operation and after that the doctor asked her to do chemo. Before the surgery, I asked the doctor, “What is the reason my mother has breast cancer?” The doctor replied, “No reason. If it happens, it happens.” I don’t think this was a logical enough answer because any illness must have a cause. This doctor is an expert – so famous yet that was the answer he gave me – if the cancer is going to strike you, it strikes you.

Anyway, after my mother had the mastectomy, we were referred to an oncologist. She was told to undergo six cycles of chemo and fifteen sessions of radiotherapy. The doctor said, “You go ahead and do these treatments first. Later I shall inform you what else to do.” I asked the doctor, “She had just undergone an operation, can you confirm if there are still cancer cells in her?” The reply was, “No need to ask. You must go ahead and do these treatments.” I asked him back, “If there are no more cancer cells in her, why must my mother do chemo?” The doctor replied, “Patients overseas do the treatments. We must follow what they do. So your mother has to do the same treatments.” (Son shaking his head) I don’t think we have to follow what others do. It is illogical. As doctors I don’t think they should say such thing – other people do, so we must also follow. After all, all of us are different.

I again asked the doctor, “ If she were to do three cycles only and she is cured – do we still have to continue to do another three?” The answer was, “No, no, you must complete the entire six cycles. We must follow the protocol.”

According to my mind, this is not the right thing to do. I again asked the doctor, “After the chemo and radiation, do we still have to do other treatments.” The doctor answered, “Yes, yes, but let us not discuss that step yet.” I countered the doctor, “Does she need to go on receiving the treatment, one after another until she nearly reach the point when she is about to get into the coffin before the treatment ends?”

With such answers, I told my mother the way she is going does not seem right.

My Friend Died After Chemo for His Liver Cancer

I had a friend – my business partner. He had abdominal pains. A checkup showed liver tumour. The doctor asked him to go for an operation to remove it. He went for a second opinion. Another doctor told him surgery would be very risky. He might not survive. He should not operate. My friend went to seek the opinion of a third doctor. This one said he should undergo chemotherapy. My friend asked the doctor, “But doctor you only see the scan. You did not do a biopsy.” The doctor replied, ”If I do the biopsy, I might break the liver capsule.”

The family finally decided to undergo chemotherapy but they did not have any clue as to what chemo is. After the chemo, my friend’s abdomen bloated up. He could not eat or drink. He died within a few months. I saw with my own eyes what had happened to my friend. So I told my mother, “You don’t know what chemo is and you don’t know about the side effects that the doctor told us. Let us find another path. “

Chemotherapy and Radiation May Not Cure

They asked you to go for chemo and radiation – did you ask if these will cure your mother? Son: No cure. They said the cancer can come back again. They cannot guarantee anything.

Yes, right – no one can give you any guarantee. But I am a bit baffled. Just because others (Westerners) do these, we also must follow – we must do the same thing.

Parents Value Doctor’s Opinion More Than Their Son’s

My father and mother are not well educated. They only depend on the doctors to tell them what to do. As their son, they would not listen to my opinion. They believe the doctors more. There are things I can understand, but old folks do not understand even if you tell them. Sometimes relatives come – they give their opinions too. That complicates things even more. Uncle, auntie, neighbours come and put pressure on us. Until now, some people still come to me and asked me to send my mother for chemo. They said that so and so had chemo and was cured. But everyone of us is not the same.

I have read – there were people who died after chemo and there were people who were cure with chemo. I have read all these and told my parents about these. They responded, “Why go and read all these.” They do not have confidence in themselves.

Oh, they don’t want to learn for themselves? They only want to hear “good things” and only think that they can win? Son: Because they only believe in what the doctors tell them. Actually most old folks behave like this.

It is All About Money First

I checked all the information I got to see if they are true or false. It all boils down to money first. Like in my friend’s case, it is all about money when they discussed his case.

CA Care Website

You visited our website and watched the videos of patients telling their stories in Youtube. Can I ask you one question – do you believe what they said? Son: At least there is something in there – the information in there are better than what the doctor provided. These are real stories of people. I also want to find out if the information is true or false.

I put it to you – how sure are you that the videos are not fakes – made up stories with actors posed as patients? Someone wrote me an e-mail asking how much I paid each patient to talk or act like that? Son: That had never crossed my mind at all. No, no, I don’t have that kind of feeling at all. After all, doctors are also telling the same thing – there is no guarantee about anything. You want to do chemo or anything – there is no guarantee but money must come first. But for the side effects – that not their responsibility.

Advice to Patient

(Turning to the patient) What does your heart say Auntie? P: I never think about this at all.

Your friends or relatives may ask you to go for chemo – are you confused? P: No (shaking her head).

No one can help you except you yourself. So please take care of yourself. This is your illness. We can only guide you as what to do but you must be responsible for yourself. What I tell you may be different from what your doctors tell you. It is up to you to believe me or not. I advise you to take care of your diet. They tell you, you can eat anything you like. In addition I advise you to exercise, take the herbs and be happy – don’t think so much.