Man Without Qualities

Monday, June 27, 2005

And The Number One Cancer Myth Is...

... accepted as a well known fact among cancer surgeons and leading cancer researchers at Harvard Medical School?

I haven't read through the original paper, but Reuters reports:
When US adults were polled about certain erroneous cancer 'myths', the most widely believed misconception was that surgical removal of a cancer can cause it to spread throughout the body. .... The new findings, which appear in the medical journal Cancer, come from a telephone survey of 957 randomly selected adults who reported never having been diagnosed with cancer. Forty-one percent of subjects believed that surgery could, in fact, spread a malignancy to other regions of the body, lead author Dr. Ted Gansler, from the American Cancer Society in Atlanta, and colleagues note.

And that deranged 41% apparently includes Judah Folkman, one of the country's leading cancer researchers, and, if Dr. Folkman is correct, most cancer surgeons. In his 2003 paper Fundamental Concepts of the Angiogenic Process, Dr. Folkman, who works at Boston's Children's Hospital and Harvard Medical School, wrote this:
It is well known among surgeons that removal of certain primary tumors may lead to rapid growth of secondary metastases, reviewed in [O'Reilly, M.S., Holmgren, L., Shing, Y., Chen, C., Rosenthal, R.A., Moses, M., Lane, W.S., Cao, Y., Sage, E.H. and Folkman, J. (1994) Cell 79, 315-328.].
Well, that's how some medical "myths" get around so fast and wide. The leading faculty at Harvard Medical School is spreading them in leading medical journals!

UPDATE: I have now read through the original paper, and the most relevant paragraph appears to be this (omitting footnotes):
The most common misconception in our study was the third statement (Treating cancer with surgery can cause it to spread throughout the body). Only 46% of respondents recognized this statement as incorrect. Surgery is a highly effective treatment for localized cancer and an important part of multimodal therapy for many advanced-stage cancers. Approximately 75% of patients with cancer undergo a major surgical procedure as a part of their treatment, and nearly all have undergone a biopsy before definitive surgical, medical, or radiation therapy. Certain surgical procedures have been shown to increase the risk of local spread of some cancers, such as ovarian and testicular cancers. However, surgical oncologists are aware of these issues and plan surgical therapy of these diseases to minimize this risk. A probable origin of this misconception is that until the past several decades, most cancers were detected at an advanced stage when prognosis was very unfavorable. Without modern imaging techniques, patients often underwent exploratory surgery, after which their poor outcomes were attributed to the surgery rather than to the advanced stage disease at the time of diagnosis. The consequence of this misconception is that patients who believe this may forego or delay surgery that might improve the length and/or quality of their lives.
What is perhaps most curious about this discussion is its lack of any reference to Dr. Folkman's claim that it is "well known among surgeons that removal of certain primary tumors may lead to rapid growth of secondary metastases." Yet Dr. Folkman's claim is pretty close to the survey's formulation of the first erroneous cancer "myth," and very close in layman's terms. Nor in the survey's analysis is there any discussion of Dr. Folkman's suggestion that angiogenic processes may explain this "well known fact" or "most common myth" - the choice of phrasing apparently depending on what top refereed medical journal one happens to be reading.

And the "first myth" keeps spreading! Dr. Folkman isn't the only one writing about such matters, as in this US government paper:
A growing body of clinical data links the degree of angiogenesis in the primary tumor to the risk of developing metastatic disease, and more importantly to duration of disease-free and overall survival.
Darn those cancer myths!

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