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The Emerging Model of Breast Cancer Care
It's not all about the treatment.
Several years ago, I received a call from Ruth, a medical doctor who was part of a family practice based near Chicago, Illinois. About two years earlier, she was diagnosed with breast cancer. Things were not going well. "I need other options," she said.
As we talked, Ruth first shared how she'd recently become exceedingly depressed and quit her work to have time to heal. However, she was now stuck, overwhelmed by the thought that she may not live to see her two children become adults. She hoped I might share with her more details of the recent findings I'd reported at a conference she'd attended.
From the perspective of orthodox medicine, Ruth was strictly following protocol, doing everything perfectly. This included a mastectomy followed by both chemotherapy and radiation. She'd recently switched from tamoxifen to raloxifene because the reduced risks of adverse effects, especially blood clots, seemed to dictate that change to her. After talking for about twenty minutes, Ruth agreed to complete the Cancer Recovery Group's standard intake form and email it back to me. A follow-up appointment was set for two weeks.
Except for too much refined sugar in her diet, Ruth's responses to our questionnaire were standard. Our second phone call was anything but.
She first needed to talk about her surgeon, a man to whom she had often referred her own patients. They were professional colleagues, and their spouses even knew one another, she told me. Then Ruth angrily and tearfully unloaded.
"After my diagnosis was confirmed," said Ruth, "our entire relationship changed. Now I was told exactly what to do, to share the intimate details of my life, to describe my symptoms and even my monthly menstrual cycles and private sexual behavior. I was stripped naked, both physically and emotionally. I was just another patient. I saw the privileged status of doctor ripped away from me. To the medical system, I was now reduced to just another Stage II infiltrating ductal carcinoma. I was expected to do as I was told. And beyond genetic mutations, my doctors could provide no insights into why I contracted this god-awful disease."
The Question of Cause
There is no one cause for all breast cancers. Nor is there just one treatment for all breast cancers. Many factors contribute to cancer development, and many factors help prevent its development. This includes diet, exercise, toxin exposure, vitamin D levels, hormones, certain medical tests and treatments, as well as gender, age, genetics, race, and more. These factors, interacting together, impact breast cancer development and prevention. For each woman, the combination will be different. The emerging model of breast care recognizes this complexity.
In a sense, Ruth's doctors were correct. On the cellular level, breast cancer is an expression of genes that have mutated, resulting in cells that have gone awry. But bad genetics are not the cause of 90 to 95 percent of breast cancers. An unlucky draw from the genetic pool explains just 5 to 10 percent of the factors involved in the development of breast cancer.
Genes gone bad are actually the result, the outcome, of many other factors. Your genes turn off and on in relation to the environment in which those genes live. The good news is that even if we do have a gene that potentially predisposes us to cancer development, lifestyle factors can and will impact the degree to which that gene is expressed.
Dr. Dean Ornish, one of the world's most esteemed pioneers and integrated healthcare revolutionaries, stated, "People should realize that genes may be our predisposition, but they are not our fate. The fact is, massive positive changes in genetic activity are generated through lifestyle choices. Our choices are as powerful as our strongest drugs and occur rapidly in most individuals."
How powerful? Among the researchers who study lifestyle's impact on health, there is a consensus that 50 to 75 percent of cancers are totally and completely preventable. Excellent and compelling scientific evidence shows that eight of ten breast cancers could be prevented, actually stopped before diagnosis. I ask you to pause to consider these points for just a moment. Isn't that a startling revelation?
There's more. Prevention can be accomplished by minimizing or eliminating factors that predispose one to cancer development. These include reducing the consumption of animal fats, avoiding inactivity, eliminating the use of tobacco, and moderating the consumption of alcohol. Prevention of breast cancer is also accomplished by adding nutritional supplements that reduce genetic expression. We will have much more to say about this later in the book.
There's even more good news. If breast cancer can be prevented through these measures, common sense tells us that these same healthful self-care measures will also be of value in both the recovery process and in reducing the risk of recurrence. Happily, there is excellent emerging science to support the huge role that self-care plays in recovery.
There is significant resistance to these natural-healing ideas in much of the orthodox oncology community. Even though Hippocrates, the father of modern medicine, said, more than 2,500 years ago, "Let food be thy medicine and thy medicine thy food," many Western-trained doctors have little tolerance for such ideas. "Eat whatever you want" is what both my surgeon and my radiation oncologist told me. They were more concerned that I ate anything and everything, sugars and fats included, in order to keep my weight up.
Like most of us, doctors are busy people. Most do their very best to keep apprised of everything that is going on in their field. The good ones constantly read new scientific studies published in professional journals, attend conferences, and see pharmaceutical representatives several times a year. But as a result, there is a pervasive attitude that says, "If it were true, I would know about it." But clearly, this is an incorrect assumption, especially when it comes to more natural approaches to breast cancer.
Nutrition, exercise, social support, and mind / body / spirit matters are barely, if ever, on the curriculum in medical school. Following a talk I gave at the world-famous MD Anderson Cancer Center in Houston, Texas, a medical oncologist pulled me aside and said, "You must stop spreading these unfounded statements about diet." She went on to insist that double-blind studies were the gold standard by which to measure all cancer interventions. This is an accurate illustration of the state of mind in which most doctors live and work. There is a profound medical culture bias that dismisses natural approaches in favor of pharmaceutical solutions. She concluded by saying, "Patients don't want to change what they eat. And they sure don't want to exercise. They want to receive their treatment and then forget about it."
Some oncologists have also said to me, "Even if we lower the [research] standards, you experts can't even agree among yourselves. There's just no consensus in the natural health field." My response was that patients should do everything possible to help prevent and control cancer in ways that do not harm the body. Predictably, I was asked to provide proof there would be no harm. The demand for hard science stands in the way of common sense-it's the state of oncology in America and much of the world today.
That said, it is important to note that people who exercise regularly and eat healthfully can still develop breast cancer. Remember, breast cancer is not a single-cause disease. And for each person, the combination of causative factors is different. However, we can all learn to take better care of ourselves physically, emotionally, and spiritually. A diagnosis of breast cancer is the signal to do so, providing an opportunity to fully love and care for oneself. That truth stands as the premier attribute of the emerging model of breast care.
Conventional Western breast cancer treatment is exclusively focused on the disease. It's the tumor model. Following a myriad of tests, a diagnosis is made. Once diagnosed, the tumor or the blood-based cancer is attacked with surgery, chemotherapy, and / or radiation. Medical expertise is required to prescribe and administer these treatments, and thus a different specialist is necessary to implement each treatment type. The entire process is all about the tumor and precious little about the person.
For Ruth, walking through the gates and into the cancer treatment terrain started poorly. Prior to her initial surgery, she was told she needed a CT scan to determine if the tumor had attached to the chest wall. Ruth knew CT scans were not routinely used in a Stage II breast cancer diagnosis. But the surgeon was insistent. He said, "I need to know whether or not the tumor can be removed with mastectomy." Reluctantly, Ruth agreed.
The test did not go well. CT scans, also called CAT scans or computed tomography scans, require a dye, which acts as a contrast solution, be injected into your arm through an intravenous line prior to the test. "The technician who tried to insert the IV," said Ruth, "knew not what the hell he was doing. First, he couldn't find a vein. Then he dropped the entire IV kit on the floor. Instead of throwing it away and securing a new one, he picked it up and was about to use this now unsterile apparatus on me. I yelled at him, 'Stop it!' And I walked out the door.
"he didn't know who I was," continued Ruth. "He cared only about the procedure and nothing about me, his patient. There I sat in that god-awful gown in that cold exam room, afforded no human comfort, no respect, and no acknowledgment that I was a living and breathing human being let alone a medical professional. At that moment, I had this sinking feeling. I realized the system in which I was trained, and in which I practiced, would eventually fail me."
Breast cancer patients most often turn to the Cancer Recovery Group after the system has in some way failed them. Perhaps these women are concerned about the tests used to arrive at their diagnosis. Or they feel as if they are being rushed, even forced, into treatments without understanding their options. Many breast cancer patients reach out to us only after traditional medical treatments have failed and they've heard the frightening words "Your cancer is back."
Much too often, these brave women turn to us when they are physically so weak and fragile that they fear they can withstand no more treatment. "Radiation has me so fatigued I can't function," they say. Or "I cannot go through another round of chemotherapy." The sad fact is we spend a great deal of time and effort helping cancer patients deal with overtreatment.
I first became vividly aware of the problem of overtreatment in the early 1990s. A young California mother by the name of Nelene Fox turned to us for guidance. She had an advanced invasive ductal carcinoma. Her first words were surprising: "Can you help me raise the $250,000 I need for a bone marrow transplant?" Her insurance provider, Health Net, refused to cover the procedure because they considered it unproven and experimental.
Those were brutal days in breast cancer treatment. Oncologists boldly proclaimed that high-dose chemotherapy followed by bone marrow transplant offered the cure for advanced breast cancer. And medical journalists, especially in the major weekly news magazines, blindly fanned the flames of this optimism. Many in the breast cancer community proclaimed high-dose chemo and bone marrow transplant to be the Holy Grail.
The procedure was exceedingly dangerous. I retain a newspaper clipping in which one doctor describes the process. "We bring the patient to death's door through an intensive pretransplant regimen of chemotherapy and radiation. Our treatment involves a four-drug regimen and is 35 to 40 percent more intensive than the regimens used in the recently reported studies. We administer our regimen in a highly specialized transplant unit, not in the outpatient setting. Although the treatment itself is associated with a 21 percent mortality rate, the payoff may be a higher proportion of women surviving and being cancer free." Brutal by any standards.
While trying to persuade Health Net to pay for the bone marrow transplant, Nelene Fox did raise the funds to have the procedure. But eight months later, she died. Her brother, Mark Hiepler, is an attorney, and he brought a lawsuit against his sister's insurance company. He won, and the jury awarded the Fox family $89 million. Although the settlement was subsequently negotiated down to smaller sum, the case is considered a watershed moment in that thereafter most health insurance companies began approving high-dose chemotherapy with bone marrow transplant for advanced breast cancer.
This era spawned a desperate flurry of activities attempting to position this procedure as the quintessential answer to breast cancer. With the financial help of the biggest international pharmaceutical companies including Amgen, Aventis, Pharmacia, and Wyeth, the procedure was researched and promoted. Transplant doctors testified before Congress and appeared in the media. Breast cancer advocacy groups like the Susan G. Komen Breast Cancer Foundation, now called Susan G. Komen for the Cure, lobbied both federal authorities and state legislatures to mandate insurance coverage for the procedure. Hospitals from coast to coast proudly rushed to equip their facilities with bone marrow transplant units, encouraging their physicians to learn the procedure. Providing transplants for breast cancer patients was good business.
At that time, the Cancer Recovery Group was based in Southern California, where we ran the largest cancer support group in the nation. We always built our message around less toxic and least invasive prevention and treatment options. But in the early 1990s, our message was drowned out. For nearly five years, the number one request from patients and their family members was information on high-dose chemo and bone marrow transplant.
New drugs were introduced that made it possible to harvest marrow cells from blood rather than having to extract it from a woman's hip. And soon it was possible to administer high-dose chemo and transplant on an outpatient basis. It was all systems go to make high-dose chemotherapy and bone marrow transplant the new standard of care. Its efficacy was accepted as an article of faith.
It wasn't until 1999 at an American Society of Clinical Oncology (ASCO) meeting that researchers presented four studies that showed women did no better with the high-dose chemotherapy and bone marrow transplant treatment than those who received only lowdose chemotherapy. From that point forward, the procedure was discredited and today is largely abandoned.
More Is Not Better
The beliefs behind the more-treatment mindset die hard and are the reason so much unnecessary care is still delivered by doctors and hospitals. In the world of breast cancer care, it is widely agreed that surgery is the most effective treatment, contributing more to halting the progression of the disease than the other treatment modalities combined. Yet beyond surgery, there is little certainty about which drugs or which procedures actually work best.
Our culture seeks cures. Most people in developed societies believe fervently in the doctrine that modern medicine cures. Cure-it's almost a statement of faith, pervasive on every continent. And most breast cancer patients look to its high priests, the oncologists, as their saviors. We seldom question the ongoing march of science. In fact, we expect it, taking scientific progress as a given. Both patients and healthcare professionals are deeply in need of believing that medicine cures.
That belief fosters a more-treatment-is-better-treatment sentiment that is deeply imbedded in conventional Western oncology. It is driven by physician-specialists who don't really know which of the major treatment modalities are truly the most effective. It leads to massive overtreatment.
This is exacerbated by the hammer syndrome, something I first explored more than twenty years ago. The syndrome looks like this: If you are a surgeon, every answer looks like surgery. If you are a radiation oncologist, all your answers point toward radiation. And if you are a medical oncologist, every answer involves drugs. I'll have more to say about chemotherapy later. The point is, if you are trained in a narrow subspecialty, that's what you see as the answer. If you're a hammer, the whole world looks like a nail.
But there is much more to this overtreatment warning. Most oncologists lack the specialized training needed to independently interpret the evidence that is available to them. This leads even well-intentioned physicians to treat patients out of an understandable altruistic and humanitarian motive to help, even when they may not know what is the best thing to do.
Medical oncologists are famous for statements like "We will never know if this drug can help you unless we do just one more round." There is a vast array of evidence that suggests the last round is often the fatal round. The Cancer Recovery Group's work has led me to believe that thousands of patients die each year not from cancer but from cancer treatment.
Excerpted from BREAST CANCER by GREG ANDERSON. Copyright © 2011 Greg Anderson. Excerpted by permission of Red Wheel/Weiser, LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Foreword by Christiane Northrup, MD
Getting the Most from This Book by Erica A. Harvey
Part One: Understanding the Incredible Journey
Chapter 1 The Emerging Model of Breast Cancer Care
Chapter 2 Sources of Health and Healing
Chapter 3 Medicine: Consider the Whole
Chapter 4 Caution Signs on the Incredible Journey
Chapter 5 The Vitamin D Promise: Actual Prevention, Not Early Detection
Part Two: Integrated Breast Cancer Care
Chapter 6 The Holistic Model
Chapter 7 The 50 Essential Things You Can Do
The First Step on the Incredible Journey: Understand Your Diagnosis
#2 Put Yourself in Charge
#3 Ask Your Doctor These Questions
#4 Obtain a Second Opinion
#5 Become an e-Patient
#6 Reframe the Statistics
The Second Step on the Incredible Journey: Plan Your Treatment
#7 Understand Your Conventional Treatment Options
#8 Gauge Your Confidence in Your Medical Team
#9 Seek Conviction versus Wishful Thinking
#10 Reflect on the Treatment Decision
#12 Give Only Informed Consent
The Third Step on the Incredible Journey: Manage Your Treatment
#13 Believe in Your Treatment
#14 Overcome Fatigue and Nausea
#15 Make the Most of Your Appointments
#16 Monitor Your Progress
The Fourth Step on the Incredible Journey: Heal Your Lifestyle
#17 Live Well
#18 Operate Under New Assumptions
#19 Schedule Your Wellness
#20 Eliminate Active and Passive Smoking
#21 Adopt This Nutritional Strategy
#22 Purchase Real Food
#24 Know Why You Eat
#25 Determine Your Nutritional Supplement Program
#26 Take One Low-Dose Aspirin Each Day
#27 Make Exercise Part of Your Recovery Program
#28 Sleep More
#29 Find Positive Support
The Fifth Step on the Incredible Journey: Heal with Your Mind
#30 Analyze Your Beliefs
#31 Reframe Breast Cancer
#32 Evaluate Your Self-Talk
#33 Choose a Daily Affirmation
#34 Manage Your Toxic Stress
#35 Visualize Health and Healing
#36 Maximize Mind, Body, and Treatment
The Sixth Step on the Incredible Journey: Embrace Your New Life
#37 Understand the Message of Illness
#38 Live Now
#39 Take Time to Play
#40 Laugh to Foster Healing
#41 Evaluate Your Relationships
#42 Get Beyond "Why?"
#43 Practice Gentle Self-Discipline
#44 Choose Your Emotional Style
The Seventh Step on the Incredible Journey: Nurture Your Spirit
#45 See Life through Spiritual Eyes
#46 Value Personal Spiritual Growth
#47 Make Forgiveness a Way of Life
#48 Exude Gratitude
#49 Practice Unconditional Loving
#50 Share This Hope
Epilogue: You Have a Future
Food as Medicine Appendixes
Appendix 1: Sample Menus
Appendix 2: Clean Out Your Pantry and Refrigerator
Appendix 3: Cook and Shop Healthfully
Appendix 4: The Real Food Shopping List
Complementary Treatment Modalities Appendixes
Appendix 5: Meditation and Visualization
Appendix 6: Yoga
Appendix 7: Bodywork
Appendix 8: Energy Work
Appendix 9: Naturopathic Medicine
Appendix 10: Traditional Chinese Medicine
Posted December 17, 2012