Posted by: themossreports | November 27, 2010

Is Radiation Therapy A Necessity?


Does radiation therapy add to survival?

A standard treatment for early-stage breast cancer is to remove the tumor via lumpectomy and then follow that with radiation therapy and the drug, tamoxifen. But a report presented at the 2010 annual meeting of the American Society of Clinical Oncology (ASCO) has called this approach into question. Researchers at Massachusetts General Hospital, Boston, studied women over the age of 70 who had estrogen receptor positive (ER+) tumors that were removed by lumpectomy. The subjects were randomly assigned to receive either tamoxifen alone or tamoxifen plus radiation therapy.

After more than 10 years, the women who received just the tamoxifen fared about the same as those who also received radiation. Although radiation resulted in fewer recurrences in the affected breast, the chance of being free from distant metastases was 95% with tamoxifen alone vs. 93% for tamoxifen plus radiation. The 10-year breast-cancer-specific survival was 98% with tamoxifen alone vs. 96% with radiation. The overall survival was 63% with tamoxifen alone vs. 61% with radiation added, i.e., it was slightly higher when women did not receive radiation.

The authors themselves concluded that “the addition of radiation does not impact survival, distant disease free survival, breast cancer specific survival or breast conservation” (Hughes 2010).

The Web site Breastcancer.org states that “these results shouldn’t be used to make treatment decisions for women younger than 70.” Fair enough. But many readers are bound to wonder whether radiation is worthwhile for women under the age of 70. That wasn’t addressed in this study. Radiation’s main purpose after breast surgery is to prevent recurrences, and it does a pretty good job at that. However, its impact on survival is not as great as some people suppose. Even the authoritative Perez and Brady textbook refers to “the lack of survival benefit associated with breast irradiation….” Needless to say, a lot of questions remain about the actual survival benefit of radiation therapy, including some indications for which it is now commonly used.

References

Hughes KS, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early breast cancer. 2010 ASCO Annual Meeting. Oral Abstract Session, Breast Cancer – Local-Regional and Adjuvant Therapy. J Clin Oncol 28:15s, 2010 (suppl; abstr 507)

Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N. Engl. J. Med. 2004;351(10):971-977.

Perez, Carlos and Brady, Luther, eds. Principles and Practice of Radiation Oncology, Philadelphia: LWW, 4th ed., 2004, p. 1371.

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Responses

  1. I received radiation after my lumpectomy, and because I did not do the chemotherapy, and the doctor did not agree with my decision, they gave me 3 additional weeks of radiation. Now, over 4 years later, my breast is still tender and sore, and it makes me very nervous that the treatment will cause some new cancer in the years to come.

    I’ve been very inspired by your work, and feel that the information that you have provided is the biggest reason I am surviving.

  2. Thanks for the article. I think that change of lifestyle, diet, and carefully selected supplements can be effective to protect against the recurrence of cancer, without weakening the body with side effects from drugs and radiation. The “side effect” of the natural approach is an increased feeling of autonomy and empowerment. (from my own experience)

  3. To explain further, I had surgery for early endometrial ca., and used a focused program of nutrition, supplements, chi gong, and energy healing after surgery, without the usual medical treatments. My doctor was supportive. I used supplements, like mushroom blends and a natural product called Cell Quest, that can be effective in protecting the body from cancer.

  4. As someone who had discussed the pros and cons of post breast cancer (and lumpectomy) irradiation with Dr. Moss, I had initially opted out altogether. I had done a lot of reading about traditional low dose external beam radiation. I learned that when radiation oncologists exclaim that they can reduce the recurrence of breast cancer by 50% (and that is misleading unless you know exactly how they are manipulating the statistics) there is a caveat. What they do not tell you is that many women’s heart muscles (and also blood vessels and lungs) can be damaged by the radiation. Many of those women died from heart attacks before a recurrence could occur. (It’s in the literature if anyone wishes to check.) After a lot of additional research, and discussions with my oncologist (Dr. Keith Block, the author of “Life Over Cancer), I opted instead for a relatively new form of brachytherapy (high dose short term irradiation). In this case, a device called a “Savi” is inserted into the tumor bed area, and high dose radiation is administered locally, through a very sophisticated system. A 9-10 minute application, two times a day for 5 days (with a 6 hour spread in between treatments each day) and you’re done! What I liked about this treatment was the elimination of the concerns of ancillary damage to my heart, lungs or blood vessels because there would be no “bounce” or scatter of the radiation because of the manner in which it was applied.
    I was 64 when I received this treatment, and I believe it was the right thing for me.
    Dr. Moss provides an invaluable service with this blog and his treatises, and I could not have made a truly educated decision without his help. In the end, it is up to us to be proactive in our own healthcare, and to educate ourselves to the best of our abilities before making any decision. Thanks, Dr. Moss, for all that you do!

  5. Wow. Reading first Dr. Moss’ latest newsletter and then Carole’s comments gave me an “aha!” moment. I was diagnosed with breast cancer 10 days before my 33rd birthday back in 1995. I opted for a combination of conventional treatment — lumpectomy and radiation, and alternative treatments — supplements, vitamin drips, shark cartilage, dietary changes (e.g., no meat, and reduced sugar, alcohol and dairy). I wholly credit the latter with how well I went through the five weeks of radiation, as I kept up my regular work schedule, never felt fatigued or had a loss of appetite, and had only a negligible and temporary skin reaction. However, ever since then I have felt like my heart pounds faster and harder than it should, especially when exercising, and in the back of my mind I have contended that the radiation damaged my heart — despite claims by my conventional doctors back then that “the highly sophisticated machines and calculations done by a physicist exclude any risk of scatter.” I have never been overweight, have always exercised, played sports, etc., and never smoked, so it’s not like I tried to go from an unhealthy lifestyle to a healthy one and therefore caused new stress on my heart. I had to get an EKG several years ago as part of a required physical, and I half expected that it would show something negative but it didn’t. So while I may never be able to prove that the radiation impacted my heart, I will forever believe that was the case, especially now that I have read Carole’s comments about the literature that she read on this topic (which I never looked into, so thank you).

    BUT NOW the clincher…today I am a 2x breast cancer survivor because I found another lump on the opposite side of the same breast just when I was getting ready to celebrate being free of cancer for 10 years. I did another lumpectomy, but after second, third and fourth opinions, lots of research, and endless soul searching, I ultimately decided to reject the conventional doctors’ recommendation for chemotherapy and tamoxifen post-surgery, and instead go solely with an alternative protocol (much of which I continue today). What put me over the edge was that I actually got the doctor who took over for the one who did my radiation therapy 10 years before to admit that it could very well have been the radiation the first time that caused the second breast cancer (it was deemed a second primary, not a recurrence). At that point, my faith in the conventional medical community — at least with respect to its protocol for early-stage breast cancer — was nearly gone. Now clearly there are many women who have received these treatments and go on to live long healthy lives, presumably the technology has improved and everyone has to make the choice that feels right for them, but I urge everyone I come in contact with regarding breast cancer to think long and hard about just accepting the views of conventional doctors — who can be intimidating as they speak from the top medical institutions — and to at least be open to looking into the myriad of alternative treatments that are out there. I fully believe that because of this I am now the proud mother of an 8-year-old who will be around to see her grow up…and beyond!

    • Marti,

      The potential heart issues you might encounter are not at all likely to be picked up with an EKG. The primary issue is a cardiovascular inflammatory process. I often recommend as part of a therapeutic regimen something like the product Meriva which I buy for myself from Swanson Vitamin Company off the web [product #SWU493] taking one capsule twice a day. It is a powerful version of curcumin. [Note: we have no connection to the supplier nor have any financial connections to any recommendations we make].

      If you wish our support Protocol, you are welcome to it [there are no fees charged by our non-profit Institute and we do not charge for consultations nor sell any products]. Dr Moss has kindly allowed me to note in these blog commentaries its availablity so you may just email me for it [sevans@gsm-usa.com] if you wish [which is not to say he or his blog vouches for its suitability in any way at all].

      I hope this helps.

      Steven Evans
      Senior Research Scientist
      Therapeutics Research Institute

  6. I opted out of radiation and chemo. None of my doctors were supportive of my decision and tried to pressure me into it. My primary care physician called me and asked me if I wanted to live to see my children graduate from high school. I am 10 years cancer free this month! I did a lot of research and feel I made an informed decision that was right for me.

  7. I have recently had a lumpectomy – diagnosed with the HER2 + , no ER,no PR.
    I have just started my Chemotherapy after 2 months of researching to try to NOT do Chemo.
    However I conceded and agreed to the therapy. There is supposed to be some radiation in there also…. Perhaps I could forego the radiation, but all the statistics I see posted are generally regarding ER not HER2. Do you have any information regarding the HER2 and radiation , or would these statistics apply to that also?

    Thanks
    Laurie

    • Laurie,

      it is my reading of the literature that radiation is suppose to be helpful to catch wayward cells — so it is not dependent on whether you are Her2/neu positive or not. It is also my reading of the literature that there is no net statisitcal gain from the radiation — see some of my earlier remarks. Finally it is also my reading of the literature that the notion of wayward cells in the vicinity is simply an incorrect model of the cancer process.

      I hope this helps.

  8. People like Carole — who I have found are relatively rare — do their own thinking, take a critical look at the literature themselves, and with Dr. Moss’ assistance, make an informed decision. I provide consultation to a very large number of patients, often indicating that they should spring for the modest fee Dr. Moss charges to provide some neutral, beneficial information. Unfortunately I can definitively report that the vast (overwhelming) majority simply fall in line and “do what the doctor ordered.”

    Let me note again some key points that Dr. Moss has provided in this report. Freedom from distant metastasis was improved by just 2% with radiation. This is an extremely modest benefit, but if it were “for free,” well go for it. However you are 2% more likely to die if you do the radiation. So which would the normal peroson choose: no metastasis [by a 2% margin] or no death [by a 2% margin]? Moreover overall survival is improved by 2% by electing not to do the radiation. Would not a rational person think that if there were not already the “standard practice” of radiation, we would never have been able to justify this intervention?

    The article goes on to state that radiation’s goal is to gain an edge in preventing recurrence — and this it does. However a Patient’s goal is not the same as feeding the radiologist — many if not all patient’s goal is to live — not die. Note the distinction.

    The experts comment that the impact on survival “is not as great as some people suppose.” Why no — “not as great” — why in fact it reduced survival! This leads us to the final commentary — women under 70 should not use this information to guide their therapy. Just why is this? Does your body at age 70 become more like an alien — so the trial has no implication? So finally, let me recall for Dr. Moss’ readers the fact that prior results also showed essentially the same result in that radiation after breast cancer reduced your life span, not extended it. My radiologist colleagues finally conceded this small problem — but claimed they fixed it with a narrow radiation beam focus. I have reported elsewhere on published results that show this did not actually solve the problem. So this outcome is not new — and radiation in my opinion continues to be as dubious now or more so than before. But that’s only if, I suppose, you rely on evidence-based medicine.

    Steven Evans
    Senior Research Scientist
    Therapeutics Research Institute

  9. It is good to see that some other medical reserachers are at last discovering what has been known for more than 20 years. Bernard Fisher found no survival benefits from adding radiatiotherapy to surgery for breast cancer in 1989 after 8 year follow-up and confirmed this in 2002 after 20 years follow-up. Similarly the Early Breast Cancer Trialists’ Collaborative Group in the UK found no survival benefits from adding Radiotherapy to Surgery in Early Breast Cancer in 1995. All of these studies were in the NEJM.

    Richard Evans on his website at least 15 years ago was aware of the lack of survival benefit from adding radiotherapy to surgery for breast cancer.

    I am surprised that anyone could conclude that the findings of this recent trial could not be extended to women younger than 70 years old. In fact all this trial confirms is that what has been known for at last 15 years for women aged below 70 years also applies to women older than 70.

    The fact that radiotherapy causes long-term harm when used for breast cancer has also been known since 1994 when Jack Cusick published his paper in J Clin Oncol.

    In 1993 Barry Brown writing in the JNCI found that treatments for breast cancer (including radiotherapy) increased the deaths from other causes by 9 percent.

  10. I had lumpectomy and radiation therapy when I had breast cancer at age 36. It was a difficult decision but I got very close excision margin (0.1 mm) and high grade cancer cells. I refused to have a second surgery or a mastectomy at that time. I also refused to take tamoxifen because my cancer cells are ER-ve. Actually, I knew even at that time that radiation therapy would not affect survival but it could reduce recurrence rate and this is very important. Whether radiation therapy is beneficial depends on several factors, age, excision margin, aggressiveness of the cancer cells. I won’t say it is necessary but it is beneficial in some cases. I did not regret having it as it’s been 9 years and I am still cancer free. I did suffer from some side effects in the first 2-3 years but not anymore.

  11. In my consultancy in England this is the most regular question I am asked. When one researches the long term side effects associated with receiving radiotherapy the information is very poor. This is because apart from some observational studies little quality research has been carried out. Younger women have longer to develop problems from radiation exposure and we urgently need good research into all the variables associated with this approach so people can make informed decisions.

    • I think that in fact there has been some informative quality research — women have been followed for about 10 years and radiation on balance does not extend survival. The notion that we will see case controlled 25 and 30 year studies is utterly impractical and unrealistic. What’s more, controlling for “all the variables” is research that is never going to happen in the life time of anyone reading this blog (or their children or grandchildren). Any studies will always have some variable un-controlled and so be “flawed” — and we will be told not to base therapy on these incomplete returns.

      I add these observations to my other replies above [so will not repeat them].

      Women must make informed decisions on imperfect data — just that simple, at least for the next 20 years, let’s say. The data do not currently support this therapy from a survival benefit point of view and the notion that we must do it until it is definitively proven unhelpful is not the philosophical perspective I would advance. In short, I do not think evidence-based medical care would have initiated radiation therapy if we knew then what we know now. It is now a train we cannot get off.

      This is just one point of view

  12. My first thought, anymore, when it comes to traditional American medical treatment, is where’s the money? And how many actual people are involved in these clinical trials, that major decisions are being made on.

    That being said, my mother who was in her 70s, had breast cancer, had the lump removed and was one of the first women to be put on Tamoxifen. No radiation was given because of a previous heart attack. She lived another 20 years with no recurrence of cancer anywhere in her body. The only other first hand experience I have with breast cancer (and I am in my 60s) is a dear friend who had breast cancer 10 years ago, had radiation given in addition to the lumpectomy, and now deals with leukemia that the doctors related to the radiation. She takes expensive medication that she will need to take for the rest of her life. She is grateful to be alive, but her quality of life has diminished, because of the leukemia and meds.

    Wasn’t there something in the ‘Hippocratic Oath’ about ‘first do no harm’?

    I have learned to question everything in the medical community, and am grateful for sites like this, that explore medical issues, and pose questions.

  13. I want to add some information here. The radiation oncologist told me that if I didn’t have the radiotherapy, the recurrence rate was 25% which could be reduced to 10% with radiotherapy. I had also consulted a TCM practitioner and he told me that the recurrence rate was over 50% without radiotherapy. Since I had early stage cancer, I cared more about recurrence rate than survival rate (never thought I would die of breast cancer).

    We really need some scientific and up-to-date studies to prove or disprove the long term damaging effect of radiotherapy. Some people don’t have radiotherapy and they have a recurrence, they may regret not taking it in the first place. Some people have radiotherapy and they have a new cancer and they may blame it on radiotherapy.

    I am a strong believer of alternative treatments. I see Chinese herbalist, take mushroom supplements. I think everyone who has cancer treatment needs the support of alternative treatments.

    • Well, doglover, your radiologist told you wrong. So did your TCM practitioner. I won’t be able to take the time to explain it all, but let me give you an example. Suppose out of 100 million women, 2 have a recurrence in 10 years. Now suppose that with radiation, only 1 women has a recurrence. So since 1 is half of 2, radiation can be said to have cut the recurrence rate in half — it reduces recurrence by 50%. This is arithmetically true. However it is also true in this example that there will be exactly one less women per 100 million women who has a recurrence –although your radiologist would radiate them all to “cut recurrence by 50%.” That, my dear, would be a fool’s bet [in my opinion] under the hypothetical example I just gave.

      In the meantime, let us suppose that if for every 5 women who get radiation, 4 die from heart disease while only 2 do if they do NOT have radiation. Then their risk of dying is cut in half by having no radiation. So survival is increased by precisely 50%.

      Now tell me, since the positive is 50% [prevention of recurrence] while the risk is 50% [death by heart disease], is the trade-off equal? Would you do radiation in this case? So do you see what can happen when the numbers are converted to percents? And percent of what population? As we all may recall the quote, there are lies, damn lies, and statistics.

      One last point before I conclude. You say we need some scientific and up-to-date studies to prove or disprove the long term damaging effect of radiotherapy. May I suggest you re-read all the above blogs — that data is already being reported or discussed. That data is in hand if you wish to embrace it [or if not, you can just call for yet more studies]. And it is all by probabilities — there is no data that says definitively blogger “doglover” will have this specific outcome.

      So what to do? I shall repeat myself — spend some money and get Dr. Moss’ consultation that tries to cut through all the bull and phoney baloney. [No, I’m not his shill]. Sorry, your radiologist is not the one to ask — nor in fact was your TCM provider. I have no stake in Dr. Moss’ service — although I have personally bought his reports on chemotherapy and radiation. I’m jut saying you need some neutral assessment and readers out there are not usually going to get it from the suppliers of the services they are asking about. And in fact, even the professional consultants may not be willing to go against their professionals’ current “standards of care.” I have even taken issue with some of Dr. Moss’ cautious statements [see above commentary in the blogs], but overall, I would send people [and in fact do] to his site for one of those consultations. Good neutral balanced consultation’ is very hard to come by.

      I too am a strong believer in alternative treatments. This is not a matter of faith — it is a matter of analyzing the published peer-reviewed medical literature. And just like the challenge of getting good standard of care medical advice, getting good well-grounded alternative treatment advice is not as hard — but in fact harder. I spend at least 6 and half hours a day, about 6 days a week working on it [for the past several decades]. This is not the task for the faint-hearted.

      Be assured I wish you well. We have many points of common agreement, and you raise important questions that should be addressed. We all are indebted to the many bloggers who take time to add their insights.

      • 1 out of 100 million has a recurrence? and 4 out of 5 die of heart disease after radiation? These are all arbitrary figures. Experience written in a blog is not scientific evidence. I have a Ph.D. degree so please don’t tell me what scientific studies mean. I did read a lot of peer-reviewed papers at that time. 10% recurrence rate means 10 out of 100 patients may have a recurrence after lumpectomy and radiotherapy and 25% means 25 out of 100 patients may have a recurrence without radiotherapy. If it is really 1 out of 1 million, no one cares about radiotherapy anymore.

        To debate if radiotherapy improves survival of early stage breast cancer patients has little meaning. These people have high survival rate (>90%) anyway, what really matters is the recurrence rate.

        For a cancer patient, what s/he cares is not just survival, recurrence and side-effects (long term vs short term) are also important factors. If radiotherapy does not improve survival of early stage cancer, how does it affect recurrence rate? What are the long term side effects? Give honest and unbiased information to the patients and let them decide themselves. I hate to see people just make up some figures to scare people to do something or not to do something.

        If you do have peer-reviewed papers showing that 4 out of 5 die of heart disease or suffer from heart disease after radiotherapy, please provide the links.

        p.s. I don’t know why the TCM practitioner said 50% recurrence rate though and I did not take this seriously (maybe he was referring to the questionable negative margin).

  14. This is an interesting discussion, drawing both from people’s experiences and research. For some resources I’ve discovered about natural ways to strengthen the immune system and heal from cancer, feel free to contact Aiyana at healingspirit101@yahoo.com. Thanks. I’ve been reading Dr. Moss’s newsletter from the time I was diagnosed.

  15. Radiation is just one of the therapies used to destroy malignant cells. It does nothing to improve the environment in which the tumour was allowed to grow namely the person surrounding it who can remain in a cancer-promoting mode unless the underlying causes are identified and changed. Unfortunately, it has been my experience as with others over the past decades, that despite making nutritional and other health changes, some patients still eventually have another cancer manifest. I have frequently identified covert dental issues with numerous metals and devitalised (root-filled) teeth, and have found that dental revision improves outcome. Notably, John Ionescu and associates (NEL 27 Suppl 1 (2006)) confirmed significantly elevated levels of free-radical promoting nickel, chromium, zinc, iron, cadmium and mercury in breast cancers compared to those in benign tumours. This endorsed what Issels, the most renown 20th cent. German oncologist had maintained, namely that in 98% of the 12,000 patients he treated there were major causal factors in teeth jaw and tonsils. This warrants serious consideration as Issels’ successes in so-called terminal patients were unrivalled.

  16. doglover’s dilemma about whether recurrence or survival is more important misses the main point:
    If reducing recurrence has no impact on survival, then breast cancer is a systemic disease. Tumours are then only symptoms or elements of the disease. So removing them with surgery or destroying them with radiotherapy does not affect the course of the disease. It might appear strange, but the presence or absence of the tumour years later, is not a reliable sign of cancer. So absence of recurrence is not a reliable sign of anything.

    James Devitt summed this up as keynote speaker at the Lancet Conference on Breast Cancer in 1994. His brilliant insights are in The Lancet in 1994.(Devitt JE. Breast cancer: have we missed the forest because of the tree? Lancet 1994; 344: 734-35.
    His idea is that breast cancer is so-called because this type of cancer is first seen in breast-like tissue. It appears later in the next susceptible tissue. It does not have to spread for it to appear elsewhere because it didn’t start in the breast. (I deduce from this that radiotherapy damages tissue such that it is no longer susceptible to tumour growth. Metastases are simply the same process at a later stage where other tissues have become susceptible. They look like breast cancer because it is the same cancer, not because they have spread from the breast)

    So if recurrence is meaningless, then survival is the only reliable measure of effectivenss of intervention.

    • What do cancer patients want? 1) they want to live (survival), 2) they don’t want to go through this again (recurrence), and 3) they don’t want the cancer treatment affect their quality of life (long-term side effects).

      Yes for early stage breast cancer, you can have lumpectomy alone without RT and take a higher risk of recurrence. And yes even if you have a recurrence, it won’t affect your survival and you just need another lumpectomy (less likely) or a mastectomy. Without RT, you don’t risk having cardiovascular disease.

      The point is how many percentages of breast cancer patients suffer from heart disease after RT? What are the risk factors? How does the dose/fraction affect the outcome? Does more advanced RT techniques lower the risk? There are tons of unanswered questions.

      This particular study was conducted on ER+ve patients whose cancer can be controlled by tamoxifen. What happen to ER-ve patients?

      And sorry, I don’t agree that recurrence is meaningless if you can still survive after the recurrence. Again, each of us have to do our own research and make our own decision. Once you have made a decision after thorough reading and thinking, believe in it and move on.

    • Compelled to add to the cogent commentary of D. Benjamin, I note the following excerpt in Chapter 1 (entitled “Cancer is a Systemic Disease”) of a recent monograph [Cancer Interventions, 2010] I completed:

      “For example, it was reported in a case study [NEJM, 2003; 348(6):567-8] in the New England Journal of Medicine, one of the world’s most respected medical journals, the case of a 47-year-old woman who had a melanoma lesion removed 16 years before her death (not related to cancer), and she seemed cancer-free up to the time of her death when she died of a brain hemorrhage. Her kidneys were donated and transplanted to two people. However about 18 months after the kidney transplant, the first organ recipient was found to have melanoma, and then a few months later, the second organ recipient was also found to have melanoma. What does this tell us? The woman organ donor likely was suppressing any clinical manifestation of cancer during her life, but the recipients’ immune system, suppressed in order to keep the body from rejecting the organ transplant, allowed the latent cancer in her donated organs to erupt. As Dr. Ralph Moss concluded regarding these cases, “The health of the immune system was critical … a fully functioning immune system prevented cancer from reasserting itself in the original donor. The lack of an unhindered immune system also resulted in the reappearance of cancer in the unfortunate recipients.

      So in short, her cured but deadly melanoma skin cancer was in fact systemically hanging around in all her organs, and once the immune suppression was initiated for the organ transplant people, the cancer quickly asserted itself. For this reason, if you are now cancer-free after some oncology treatment, you still need to stay on some maintenance protocol to prevent “recurrence” of a cancer that never went fully away.

      Likely similar data was given by a speaker at the national Breast Cancer Symposium in 2003 [Oncology Times, February 25, 2003, p. 6]. The first case he reported was a woman with breast cancer who completed conventional therapy and then seemed cancer-free. Shortly thereafter she had a boating accident, received a compound fracture in her leg, and not 6 months later, developed multi-site metastatic breast cancer. The speaker then gave another case of a woman who had no evidence of cancer 7 years after her mastectomy, and then 3 months after a breast reconstruction, was “riddled with metastases.” The speaker concluded “the time had come for another conceptual revolution or paradigm shift.” — end of excerpt.

      Note particularly that the first case developed “multi-site metastatic cancer” and in the second case, the patient was “riddled with metastasis.” All of this is serious food for thought and may be correlated with D. Benjamin’s observations.

      Actually, cancer historically was always thought to be systemic, but as the War on Cancer launched by Nixon yielded little in the way of results, oncologists shifted their perspective to one of anatomical sites, with this perspective now allowing them to claim apparently better outcomes (“I think we got it all”) for the therapeutic tools they employed. This history is documented in the literature by far more astute medical commentators than I.

      I would also be prone to give far more credit to doglover’s wise use of herbals and mushrooms toward her well-being but of course I cannot be certain about this.

      Finally, although I had promised myself to leave it alone, I will add that I am sorry that my purely hypothetical and purposely extreme example about recurrence rates and rates of heart disease was taken as the presentation of data rather than a comment only intended to recall again the pitfalls in the use of relative percentages by medical commentators.

      I can relate to doglover’s position since I have had patients such as the one who had the earliest staging of DCIS, what some pathologists do not even consider breast cancer at all, who then elected to have a double radical mastectomy. She too had a Ph.D., another medical-related degree, is a respected and competent researcher, researched the matter for months, but the idea that there was some cancer possibly still there was intolerable to her. Others have had little fear of cancer [knowing we all have some level of it ongoing all the time]. For them, only selected alternative support strategies were appealing. So in this regard, we all do differ in our perspectives.

      I trust this helps to keep the blog commentary useful and supportive without creating un-needed animosities since I think all are just trying to get a handle on the issues compatible with their own needs and perspectives.

      • I do agree that cancer is a systemic disease even for early stage of cancer. However, I think we need to clarify one thing, having residual cancer cells which are undetectable by modern technologies is different from a cancer recurrence. I suppose small clusters of cancer cells can be treated with alternative / complementary therapies but a cancer recurrence will usually involve more aggressive conventional treatments, such as more radical surgery. That’s why I think everyone should seek the support of alternative treatments after surgery and RT to take care of the residual cancer cells and improve the immune system. On the other hand, it is hard to convince the cancer patients that recurrence is meaningless because it does mean that they have to subject to more aggressive and invasive procedures.

        I will not go that far to have double mastectomy for early stage cancer although this option has been suggested to me. Even though mastectomy can reduce recurrence rate, there are reports showing that if you have a recurrence after mastectomy, the chance that the cancer cells will invade the chest wall is higher, leading to a more advanced disease.

        I do enjoy reading Dr Moss’s blog and the experience and comments shared in this blog although we may not agree with each other in some aspects.

        Steven, mushroom extracts (reishi, maitake, cordyceps) are used extensively to support cancer patients in Asia. Chinese herbalists also consider cancer as a systemic disease and breast cancer is often caused by liver qi stagnation. I have experienced a great improvement in health after consulting the herbalists a few years ago. But due to shortage of time and space, I will not be able to elaborate here.

  17. I really appreciate this discussion. It is reaffirming my belief that strengthening the whole body (and mind!) and the immune system it what make us less vulnerable to “stray cells” causing a problem. I feel that when I was feeling run down, that was when I developed cancer. FYI, people may be interested in checking out Cell Quest, made entirely from the banana plant from the Amazon, which was formulated to “promote the healthy division of cells.” I took it under guidance of a TCM practitioner, and don’t know how widely known it is. It felt very effective, and that and good nutrition and mushroom extract, etc. made me feel I was taking strong actions to support my body.

  18. When diagnosed with stage IIB low grade ER and PR+ Breast CA 8 yrs ago, I was able to resist chemo, especially with the the good features of my pathology, while taking traditional chinese herbs other CAM, and tamoxifen. Yet while I hesitated for a few months on radiation, I finally succumbed to the pressure of friends and family– like many people I think it was hard to totally go my own way while needed support from those around me. I have been sorry that I did so, and welcome this blog. There are other negative health effects of radiation not mentioned that affected me– by the end of radiation the fatigue and extreme skin blistering, itching and pain caused me to have less energy to exercise, cook healthy food, and other things that actually contribute to well being and decreased risk. Four months after finishing radiation I came down with shingles, further debilitating me. Since then I have had numerous episodes of cellulitis on my radiated breast, no doubt due to compromised lymph system of the breast, a combination of surgical axillary lymph node dissection and further damage due to radiation fibrosis and other damage. Thanks for continuing to pursue this important issue

  19. Just as a point of information that may be helpful for those who feel they “must” do radiation to appease family, others, etc., I note that there is a trial ongoing here in Omaha and numerous medical institutions worldwide using a device called Intrabeam which provides just one single solitary dose of radiation as the official Protocol. Dr. James Edney, Chief of Surgical Oncology at the Nebraska Medical Center is quoted [in a recent newspaper article about the trial] as saying, “I am convinced this is the future.” With this device, called the Intrabeam, immediately after surgery, a probe is placed inside the cavity created by removing the tumor [assumes a lumpectomy], and then that area receives one high radiation dose for about a half hour. The report in the Omaha World Herald stated that in about 1000 lumpectomies using conventional radiation therapy [about 30 treatments over 6 weeks] and about 1000 with the single dose radiation, the study has found no statistical difference in the frequency of recurrence. The trial started in 2000 and continues. [note: I have no connection with the trial or the participating institutions or the maker of the device — I’m just reporting here about advances in radiation therapy]. Dr. Edney is also quoted as saying the side effects were minimal with the Intrabeam compared to conventional treatment [but remember, he is heading up the trial]. The device costs about $400,000 but I suspect hospitals will not be rushing to spend a half million [counting indirects] until there are data two miles high for this approach, while it reduces revenue significantly and makes vastly expensive prior x-ray equipment potentially obsolete.

    To expand the discussion slightly, many years ago my mother moved here to Omaha, was later diagnosed with cancer, and for her particular case [whose explicit attributes may not correspond to anyone who has written in or may write in on this blog], I printed out about a foot high of research that indicated chemo and radiation would not likely benefit her case. Her surgical oncologist agreed. So far so good. Her friends in Houston (where she had lived) called every two or three days to beg her to return to Houston and come to the MD Anderson Cancer Center where they would surely provide chemo and radiation which apparently had not reached Omaha as yet. Every two or three days, I would review the foot high stack of paper with her — and then at her request, we would visit her surgical oncologist over and over who reiterated he would not advise further treatment if it were his mother.

    This continued unendingly for months — her friends in Houston liked her while who could be sure about her son, and what the heck after all might he know after only 25 years of cancer research? Finally her surgical oncologist would not see her any more — to repeat the same conversation –- but referred her to a young, newly-minted, dynamic oncologist at the University of Nebraska Medical Center. She certainly advised chemo and radiation and more!! My mother never received any of these treatments, lived a very long time after her lumpectomy, never had a recurrence, and fretted about her situation after every call from her friends all the remaining years of her life. The point of this story is to deeply commiserate with Marion Feinberg above, appreciating the pressure that comes from helpful and well-meaning people. My solution — which was to have the patient move next door to me and let me review the research [as it pertains to the case in point] every two days for the rest of her life — is not too generally applicable.

    After Christmas, I will create and make available [no fees, no charges — you know the drill] what I think is a reasonable, compliance-easy, inexpensive cardiovascular minimal support regimen for anyone who has had radiation for breast cancer. With Dr. Moss’ permission again [to make this offer], you may email me — sevans@gsm-usa.com — put in the subject line “Dr. Moss’ site — radiation support protocol”” and I will email it to you for your review. All recommendations in it are inexpensively purchased on the web [we are a non-profit and we also do not sell commercial products]. There are some pro-active things I believe you can do in this regard [above and beyond the many wise suggestions from other women above using diet, supplements, etc. to address cancer remission itself].


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