MOSS REPORTS - PLAYING WITH NUMBERS – PART ONE

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20 Feb 2006 00:05:36 -0000

" Cancer Decisions " <

THE MOSS REPORTS Newsletter (02/19/06)

 

 

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Ralph W. Moss, Ph.D. Weekly CancerDecisions.com

Newsletter #224 02/19/06

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THE MOSS REPORTS – CANCER DECISIONS NEWSLETTER

 

 

If you listened to the mainstream media last week, you might have

thought that the end of cancer was in sight. The cancer death rates

are down

at last, we were told, for the first time in over 70 years. " It's a

notable milestone, " said Dr. Michael Thun, head of epidemiological

research for the American Cancer Society (ACS). When you look more

closely at

the statistics in question, however, you find that the advance is more

symbolic than substantive.

 

To read this week's newsletter, please click or go to:

http://www.cancerdecisions.com/021906.html

 

 

--Ralph W. Moss, PhD

 

 

Article----

 

 

PLAYING WITH NUMBERS – PART ONE

 

 

" Huge. "

" Historic. "

" A milestone. "

" A first. "

" A dramatic turning point. "

" No small matter. "

 

If you listened to the mainstream media last week, you might have

thought that the end of cancer was in sight. The cancer death rates

are down at last, we were told, for the first time in over 70 years.

" It's a notable milestone, " said Dr. Michael Thun, head of

epidemiological research for the American Cancer Society (ACS).

 

" That's momentous news, " said Andrew C. von Eschenbach, director of

the US National Cancer Institute. " It proves that our expectation of

continued progress against cancer is well founded. "

 

When you look more closely at the statistics in question, however, you

find that the advance is more symbolic than substantive. A review of

US death certificates by the National Center for Health Statistics

found that the number of cancer deaths had dropped to 556,902 in 2003.

In the previous year it had been 557,272. That represents a decline of

370 deaths. That's right, just 370 out of 557,272 cases, or around

seven hundredths of one percent (0.066) between 2002 and 2003. At that

rate, cancer deaths in the US should be entirely eliminated by the

year 3508, which is a little more than 1,500 years from now.

 

While deaths fell in men by 778, at the same time they rose by 409 in

women. Didn't hear about that, did you? In an alternate universe, the

headlines might have read: " Cancer Deaths Among Women on the Rise! "

 

There was really not much new in this news. In fact, the death rates

for several kinds of cancer have been falling slightly for about a

decade, a fact that has been easily discernable in the annual graphs

published by the ACS. However, apologists for conventional therapy

jumped on the latest bandwagon and tried to attribute this minuscule

change to improvements in diagnosis and treatment. I will clarify why

I do not feel this is a likely explanation.

 

Changes in Therapy?

 

 

The most noticeable change in cancer statistics over the last few

decades has been the decline in deaths from stomach cancer (gastric

carcinoma). In 1930, the US death rate from gastric carcinoma in men

was around 38 per 100,000. Today, it is around 6.9 per 100,000 for men

and 3.4 per 100,000 for women. But this dramatic decline had little or

nothing to do with improvements in diagnosis or treatment; indeed,

outside of radical surgery for early stage disease, there are still no

effective treatments for most cases of gastric cancer. Adding

chemoradiation after surgery will only extend life by an average of

nine months (Macdonald 2001).

 

Experts are unsure of the reason for this demographic shift, but some

attribute the falling stomach cancer death rates in the US to a

variety of environmental causes, such as better food preservation,

better dietary habits, and a down turn in Helicobacter pylori

infection associated with dietary improvements.

 

The most precipitous death rate decline in recent years started around

1990, when lung cancer deaths among men began falling. The rate has

continued to drop steadily ever since. Many commentators have pointed

out that most of this decline can be attributed to a reduction in

cigarette smoking. In 1965, 42 percent of all American adults age 18

years and older smoked; in 2003, only 22 percent smoked. Although 45

million Americans continue to smoke cigarettes, the decline in smoking

has been reflected in a parallel drop, albeit delayed, in lung cancer

mortality among women as well as men.

 

In other words, cancer incidence and deaths rates tend to change over

time, and that can be independent of any new treatments or diagnostic

procedures. To suggest, without evidence, that the decline is due to

improved medical care is simply unwarranted, and smacks of self-promotion.

 

Prostate Cancer Rates

 

 

Prostate cancer deaths have also declined since 1990, but here the

reasons are even less clear. I think it is premature to declare that

this decline is due to more widespread screening or to more effective

treatments. In fact, a recent large study concluded that screening men

for elevated levels of prostate specific antigen (PSA) or utilizing

the older technique of the digital rectal examination (DRE) does not

actually save lives. John Concato, MD, and colleagues at Yale

University, New Haven in a study of 71,000 veterans, failed to show

any benefit from either PSA or DRE used as screening method. The paper

was published in the Archives of Internal Medicine (an AMA

publication) on January 9, 2006.

 

But this sobering fact has not dampened the self-congratulatory mood

at the American Cancer Society (ACS). " For years we've proudly pointed

to dropping cancer death rates even as a growing and aging population

meant more actual deaths, " said John Seffrin, PhD, ACS chief executive

officer. " Now, for the first time, the advances we've made in

prevention, early detection, and treatment are outpacing even the

population factors that in some ways obscured that success. "

 

But wait a minute! Where are the studies to prove that the modest

decline in prostate cancer deaths is actually due to improvements in

diagnosis and treatment? Dr. Seffrin's triumphant statement about the

efficacy of early detection is undercut by the factual Concato study.

I am also unaware of any dramatic improvements in prostate cancer (PC)

therapy over the past few years that could account for this decline.

 

One could with more plausibility point to the dramatic growth of PC

support groups, such as US TOO, a cancer information and support

network. Many men with PC are now speaking to each other, attending

lectures by experts, and taking charge of their own health, the way

women with breast cancer have done for many years. They are more

proactive about seeking out the best treatments. From my experience,

they are also exercising more, watching their weight, and becoming

involved in the preparation of food. Finally, they are exploring the

use of supplements, some of which have been shown in various studies

to positively impact prostate cancer survival. For instance, a

randomized controlled trial from Holland recently showed that a

mixture of supplements (soy isoflavones, lycopene, silymarin and

antioxidants) led to " a 2.6 fold increase in the PSA doubling time

from 445 to 1,150 days for the supplement and placebo periods. " In

other words, it significantly slowed the growth of prostate cancer

(Schroder 2005), which could lead to a reduction in the death rate.

 

Why is it that when ACS and others in the cancer establishment

speculate on the reasons for the decline in prostate cancer deaths

they exclusively focus on the things that oncologists do (such as

diagnosis and treatment) but fail to acknowledge the contribution made

by patients themselves through diet, exercise, supplements, etc.?

 

According to other reports, " one of the most important reasons for the

decline in deaths is a huge shift in how technology is helping medical

professionals screen for cancer " (Seben 2006). But I repeat: changes

in screening and diagnosis have little if anything to do with this

decline in cancer deaths. In fact, as has been convincingly shown by

William Black, MD, and Gilbert Welch, MD, of Dartmouth Medical School,

Hanover, NH, what we are doing as a society is inflating the number of

people diagnosed with cancer through the over-diagnosis of

" pseudo-cancers " – that is, the detection of asymptomatic and often

totally harmless precancerous lesions that in many cases would never

progress to full-blown malignancies (Welch 2005).

 

Role of Autopsies

 

 

I would also point to another factor that may be responsible for

diminishing the number of registered cancer deaths: the decline of

autopsies. Cancer registries such as the NCI's SEER database rely

exclusively on information provided by death certificates, and death

certificates by no means always list cancer as the cause of death,

even when a patient has been in the advanced stages of the disease in

the months leading up to his or her death.

 

Autopsies are the most reliable means of establishing the actual cause

of death. Pathologist Elizabeth Burton, MD, of Louisiana State

University, New Orleans, studied this problem for ten years. She and

her colleagues performed 1,105 autopsies. One hundred and eleven

malignant cancers were discovered in 100 of these bodies, which had

either been misdiagnosed or had gone entirely undiagnosed during life.

In 57 of these patients, the immediate cause of death was attributed

to the undiscovered cancers. " The discordance between clinical and

autopsy diagnoses of malignant neoplasms [cancers, ed.] in this study

is 44 percent, " they wrote (Burton 1998).

 

George Lundberg, MD, then editor-in-chief of the Journal of the

American Medical Association, in which Burton's article was published,

explained that this startling data called into question all

cause-of-death data in the United States. Upon re-evaluation, he said,

cancer might turn out to be far more prevalent as a cause of death

than conventionally realized.

 

Dr. Lundberg lost his job soon after these comments. According to ABC

News, he was fired in part for criticizing doctors " for having moved

away from performing large numbers of autopsies. " To this day, the

decline in autopsies is a factor that is almost never discussed in

relation to cancer mortality statistics.

 

It is also striking that the country with some of the highest cancer

death rates, Hungary, also has the highest rate of autopsies in

Europe. In other words, there are probably many more cancer deaths in

Western societies than meet the eye. The seeming " decline " in cancer

mortality statistics may be due, in part, to a failure to look for it

as a cause of death.

 

And even when a death is ultimately a result of cancer, the immediate

cause of the patient's demise may not be recorded as such, but as

something else - pneumonia, hemorrhage, or abdominal obstruction

leading to peritonitis, for example. This is not even to mention

deaths from acute toxicity due to treatment itself, or deaths due to

complications of surgery for cancer, which are also generally not

recorded as cancer deaths. The aforementioned Dr. Welch has found, for

example, that " some deaths that are conventionally attributed to

surgery are not being attributed to the cancer for which the surgery

was performed " (Welch 2002).

 

Together, this combination of overdiagnosis of pseudo-disease and

underdiagnosis of occult (hidden) cancer makes any statistic on the

absolute number of genuine cancer deaths very much a matter for

debate. And correspondingly, since death rates are calculated on the

assumption that incidence and prevalence figures are a genuine measure

of the amount of cancer in a population, the figures for death rates

are equally debatable. As Welch and Black have pointed out, the use of

'cancer-specific death rates' as the measure of treatment

effectiveness in clinical studies obscures the very real possibility

that deaths from treatment itself are being systematically overlooked

in the statistical calculations.

 

 

TO BE CONTINUED, WITH REFERENCES, NEXT WEEK

 

 

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