Challenging Existing Concepts 

February 1999

I have begun to think about the effectiveness of the drugs we have to fight cancer. I have heard many conference speakers refer to the small increments of success. Each new drug takes us only a little further on the road to helping people with cancer.

When I think about the statistics, I realize that this is completely true. An example would be: Tamoxifen. Tamoxifen is a successful drug, well accepted as treatment because it reduces incidence of recurrence by 50%. The actual number of women who might be expected to have a recurrence ranges from 5-10%. That comes out to 5-10 women per 100. One problem that occurs to me is that 90 women are taking Tamoxifen who perhaps will not need to, and indeed are at risk of developing the toxic unwanted effects(often called Ďsideí effects). Five women are taking Tamoxifen who will have recurrence or disease progression anyway. Does this bother anyone?

We know that chemotherapy is effective about 30% of the time when used in breast cancer. Yet we continue to give it to huge numbers of women. That means that 70 out of 100 women are receiving NO benefit but are suffering the unwanted effects of treatment without reaping any benefit. Our studies and treatments are based on large groups NOT individuals.

What should be done? I propose that researchers spend time trying to discover how to tell the difference between the population of people who will benefit, from the people who cannot. Of course, one barrier to this information is who is going to pay for it? No drug company would be interested in reducing their market share by 70%, or in the case of Tamoxifen, by 90%. We, as patients need to keep in mind that fighting cancer is a big business. It is in our best interests to discover the differences between the groups, those who do benefit and those who do not.

Tamoxifen use for healthy women continues to be controversial. Many advocates have spoken about the many dangerous unwanted effects (drugs for healthy people should have higher standards), and the fact that a survival benefit has NOT been shown. The women who participated in the trial were at much higher risk than the criteria allowed for. Women over 60 or women with breast cancer and a first degree relative of any age are simply not at that high a risk for developing breast cancer. We still do not know which women were BRAC1 or 2 carriers. Primary care physicians will have to help anxious women determine their risk. Are they up to the task when the oncology community remains confused over who is at high risk. I developed breast cancer at age 45 but would not have qualified for the trial or as high risk by their standards. Something is wrong.

As always, I recommend that we ask NCI (possibly through our Congressional representatives) to support research into the areas outlined above as well as the exploration of natural, non-toxic "alternatives" to current conventional therapies. We need government supported research when there is no financial gain expected.

There are currently at least three new books on the market discussing the value of nutrition, supplements and vitamins in preventing cancer. They are an important adjunct to any cancer patientís recovery as we want to prevent more cancer. I encourage the use of organic foods, juicing, detoxification and vitamins/supplements. Studies show they are effective and relatively safe. Find out for yourself by reading Dr. Mitchell Gaynorís Cancer Prevention Book; The Strang Cancer Center Cookbook; Bob Arnottís The Breast Cancer Prevention Diet. Itís not our only defense but it cannot hurt to explore the natural, non-toxic whole substances area. Eat fruits and vegetables. Consider a diet low in fat (olive oil and flax see d oil are good), low in salt, high in fiber. Itís good for you heart and can help hypertension and diabetes too. As with treatment this information is based on a combination of epidemiological studies and animal, in vitro and a few in vivo studies. Encourage studies in this area.

Remember we are NOT Doctors and have NO medical training.

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