When it is over-diagnosed and over-treated, for the doctor’s financial benefit, not for the patient’s health and safety.
And that happens a great deal; especially in the USA.
Now a working group sanctioned by the National Cancer Institute has come up with a position statement, making it pretty clear that no-one accepts this current situation as ethical. In fact it’s criminal.
Very dramatically, the working group has stated that a number of pre-malignant conditions, including ductal carcinoma in situ and high-grade prostatic intraepithelial neoplasia (means iffy-looking growth but not cancerous changes), should no longer be called “cancer.” Instead, the conditions should be labeled something more appropriate, such as indolent lesions of epithelial origin (IDLE).
Indolent means slow to heal, grow, or develop; inactive or relatively benign: an indolent ulcer [http://www.thefreedictionary.com/indolent]
The report was published online July 29, 2013, in JAMA.[1]
“Use of the term ‘cancer’ should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated,” write the 3 people who make up the working group.
This will create a furor the like of which we have never heard before (either that or it will just be buried), because over-diagnosis of non-malignant “cancers’ is where the industry gets most of its figures for supposed success. They want non-cancers in the net, so they get more money…and can claim more success, because these phoney tumors would never kill anyone anyway.
It only looks like a “cure”.
It’s going to be a hard slog and the NCI work group has wisely suggested the convening of an independent group (if there can be such a thing, in the corrupt medical world of the USA), charged with the task of revising the naming of lesions now called cancer and creating a new classification system that includes explicit recognition of the indolent slow-growing non-malignant lesions now falsely labelled cancer. 
No need to worry: tests which can accurately identify these slow-growing, relatively harmless lesions are well established and proven (but of course they are kept from the public by corrupt clinicians and the cancer industry).
These proposed reforms are needed because, over the past 30 years or so, cancer screening in the United States has become highly problematic, the group explains.
The most shocking part of this whole fiasco is that–contrary to industry propaganda–there is NO significant improvement in survival of late-stage cancer. Orthodox therapies are more or less worthless.
So they have padded out the statistics with these harmless or slow-growing early “tumors”, to make it look like they are getting some traction.
Take away the IDLE inclusions and the miserable truth emerges: SURVIVAL RATES FOR LATE-STAGE CANCER ARE UNCHANGED OVER MANY DECADES.
In other words, while national data demonstrate significant increases in early-stage disease, there is no proportional decline in later-stage disease. Wouldn’t you expect that, if catching the cancers early led to better treatment and longer survival, the late-stage cases should drop?
Well they don’t. All that is happening is that screening procedures are identifying more cancers that are “potentially clinically insignificant” (the working party’s own wording). They are still missing and failing on the clinically dangerous cancers.
Let’s look at the figures:
- Over a 35-year period, from 1975 to 2010, the incidence rate of thyroid cancers jumped 185% — from 5 to 14 per 100,000. However, the mortality rate remained at roughly 0.5 per 100,000.
- In addition, the incidence rate of melanoma rocketed up 199% — from about 8 to 23 per 100,000. But the mortality rate did not drop; it actually increased from 2.07 to 2.74 per 100,000!
- In 1975, before mammography screening was prevalent, the incidence rate for breast cancer was 105 cases per 100,000 population. In 2010, the rate was 126 cases per 100,000 — an increase of 20%. Over that time period, there was a related 30% mortality decrease — from 31 to 21 deaths per 100,000. However, “at least two thirds of the mortality reduction is believed attributable to adjuvant therapy,” the working party note.
The position of the working party mirrors, in a number of key ways, a 2009 essay by Drs. Esserman and Thompson that called for a “rethinking” of prostate and breast cancer screening, in part because of the over treatment of indolent and low-risk lesions. [2]
That essay prompted the chief medical officer of the American Cancer Society to famously declare, in an interview with a major news outlet that, “the advantages to screening have been exaggerated,” which triggered a firestorm of controversy.
See, the industry doesn’t want their dirty game leaking out and becoming known. Screening for the majority of oncologists is not a health measure; as I have famously said on many occasions, it’s a marketing measure. It’s sells scare tactics and beings patients to their knees with fright, so they opt for chemotherapy.
It’s totally unjustifiable on the real figures buried in this report. In fact, as we know, chemotherapy and radiation, and/or surgery are completely unjustified, with the results currently being achieved.
Whereas I recognize the right of every patient to choose for themselves–and knowing many will opt for chemo, maybe through fear–it cannot be serious recommended as effective.
The Other Proposals
This remarkable position paper, or “viewpoint” as they call it, had other things to say about serious flaws in the existing system.
The first is a public relations effort. “Physicians, patients, and the general public must recognize that over cancer diagnosis is common and occurs more frequently with cancer screening,” the working group writes.
Another proposal is to create observational registries for lesions with low malignant potential. This would improve information about related disease progression, which would help in the uptake of “alternative treatment strategies, such as active surveillance,” the group explains.
They propose a range of strategies, designed to “mitigate over-diagnosis” — which includes ways to reduce the detection of indolent disease, such as reducing low-yield diagnostic evaluations (that means worthless tests!) appropriately; reducing the frequency of screening examinations; focusing screening on high-risk populations; and raising thresholds for recall and biopsy.
Currently, far too many patients are recalled (and terrified) by lesions which are described as “suspicious”.
These changes will not be popular, among the greedy, insane and criminally inclined oncologists. However, it’s nice that a few voices do see the need. Remember, not all oncologists are crooks (just misguided!)
Moreover, there are good findings to be gleaned. In a number of cancers, screening has significantly helped, WITHOUT this inclusion of fake or indolent tumors. There is a real trend of success. It usually occurs where there are clearly identifiable pre-cancerous lesions.
Colon and cervical cancer are the best examples of this. The incidence rate of colon cancer dropped 31% from 1975 to 2010 — from about 41 to 29 per 100,000. The mortality rate dropped 45% — from 28 to 15 per 100,000.
The improvement in cervical cancer was even more dramatic. The incidence rate dropped 55% over the study period — from about 15 to 7 per 100,000. The mortality rate dropped 59% — from 5.5 to 2.2 per 100,000.
Basically, the group’s recommendations amount to tying screening procedures to the cancer’s growth rate. If a cancer is fast growing, screening is “rarely” effective. However, if a cancer is slow growing but progressive, with a long latency and a precancerous lesion such as colonic polyps or cervical transitional changes, “screening is ideal”.
But it has to be less (e.g., 10 years for colonoscopy, not the current fad for annually).
The really exciting thing about this position paper to me is that at least the scamming and the misuse of oncology tools is being recognized and talked about by orthodox doctors and scientists.
Whether that will lead to any significant improvement in ethical standards remains to be seen.
References:
1. JAMA. Published online July 29, 2013.
2. JAMA. 2009;302:1685-1692