Winning the (propaganda) war on cancer
Where do you bury the survivors?
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A couple of years ago, the American Cancer Society gaily reported that cancer survival rates have been improving dramatically and steadily. A few weeks ago, Cancer Research UK announced a similarly sunny prognosis for the public at large: UK survival rates have doubled in 30 years. Yes, we are all "surviving" longer with cancer, the experts can assure us.
What fabulous news this seems to be: people diagnosed today are twice as likely to survive for 10 years than people diagnosed 30 years ago. As the press release says: "While survival varies widely between different types of cancer, on average, a patient with cancer now has a 46.2 per cent chance of being alive 10 years after diagnosis. This compares with 23.6 per cent 30 years ago".
Now, what do you suppose that means? Do you imagine that treatments have improved so much in 30 years that we are actually able, on average, to slow the disease's rate of progress by half? That we have actually doubled the life expectancy of cancer patients? That certainly is one message that we might take from the press release.
Well, those who actually bother to read medical literature know that what is being claimed here is a bit less fabulous than that. In the field of medicine, words like "survival" and "cure" are professional jargon with specific meanings and implicit qualifications. Researchers and doctors know what these terms mean, and they use them very carefully, assuming the implied qualifications are understood. Unfortunately, you and I might understand something quite different from what is meant.
So, what do professionals mean when they speak of survival? Typically, they speak of five-year survival in a way that gives patients a decent guess of their chance of still breathing five years after diagnosis. The doctor considers the specific form of cancer, its state of progress at the time of diagnosis, the patient's overall health, age, sex, and numerous other factors, and then a comparison is made between the individual patient and a group of similar patients.
So, it's common for a practitioner to compare your current condition to a large group of others previously diagnosed in similar circumstances, and tell you, for example, that among those similar to you when they were diagnosed, 60 per cent survived for five years.
Thus you would have a 60 per cent chance of surviving for five years. You might also be told that you have, say, a 30 per cent chance of surviving disease free (i.e., in remission), and a 45 per cent chance of surviving progression free (disease is detectable but not worsening), for five years, based on comparisons with others whose conditions were similar to your own at the time of diagnosis. Thus, "survival", in the professional sense, is relative.
But if survival is a relative measure, what can it mean when Cancer Research UK says that survival rates have improved overall? What, exactly, is being compared to what in that case? Does it mean that we have got so good at treating cancer that the disease typically progresses at half the rate it once did? Does it mean that patients are actually living twice as long as they did 30 years ago? I do wish I could say this is so, but then I would tell a lie.
Next page: A meaningless boost
COMMENTS
Interresting article
Loved your article, but you should at least give the oncologists credit that there are cancers that can be cured: Hodgkins Disease has a 90% chance of definite cure in stages I and II, and I know of quite a few patients with stage IV who have a 30 years survival history (had Hodgkins Disease stage IIa myself 11 years ago and did some extensive research in this field).
The same figures are true for cancers caused by papilloma virus (uterus, throat).
But if I continue your way of thinking, there is one thing absolutely certain: 100% of mankind will die of cancer unless they are not killed by something else. Cancer is mainly a phenomenon of old age (setting aside the genetical disorders like breast and colon cancers as well as leukemia and myelomas in young people who definitely are genetical phenotypes) so the probability to die of cancer is very high. Statistically, and I can only give you figures for Switzerland where I live and have the statistics in memory, the probability to die of cancer is 30%, 40% of death is due to cardiovascular diseases and 30% for other reasons.
There is only one thing you can count on: life is ended by death for everyone.
Depends on what you call 'alive'
I didn't quite get the point the author was trying to make here.
It seems that the author was upset that people that study a specialised field use jargon to describe the technicalities of their field, and that, within the field, these terms have extremely well-defined and precise definitions. Unfortunately, when people who are not experts within the field try and interpret the field, they often misinterpret the findings, or misuse the jargon. According to the author, this is the fault of the experts and represents a deliberate attempt by the experts to confound the public to profiteer from their ignorance.
The author then gives some general hypothetical examples of the kinds of confusion that this could cause, without actually providing any hard data in favour of his hypotheses. This is presumably because it's already beyond question that anybody involved in the healthcare industry is motivated purely by personal gain. It is, after all, the healthcare INDUSTRY; QED.
Had the author been interested in presenting an argument, rather than an anti-science rant, he may have been interested in presenting, what we in the medical research field, call "facts". For example, he might have mentioned that five year survival statistics are grouped by stage (i.e. stage IV compared to stage IV), largely negating his key argument that the improvement in five-year survival is an artifact due to earlier detection. Oops.
He could have mentioned that acute lymphoblastic leukemia, a disease that was universally fatal 50 years ago, is now treated with 80% success. Yes, 'success' in this case may not be the same kind of success that the man on the street would associate with the word, but there are hard data that describe a real improvement in treatment however you cut it.
It is still the case that some forms of cancer (and other diseases) are very poorly treated. Taken together with the fact that the pharmaceutical INDUSTRY makes profits, this is taken by the author as a cause for submission and surrender. Diagnosed with something that was previously incurable (polio, perhaps?), he would presumably refuse any treatment that may line the pockets of the capitalist pharmaceutical death-merchants, roll over and wait for a miserable death. I hope that other readers of this article will see beyond his narrow-minded scepticism. Progress has been made, but more progress still needs to be made. Misrepresenting the data is not in anybody's interest.
Article very misleading
Does the author know anything about multiple meyloma?
Its a very nasty blood protein disorder of a cancer.
My father was diagnosed in October of 1992. At the time, there were no "survivors" and the prognosis meant 36 months at best.
But because of the early detection, my father was able to last 5 years.
Within that period, the treatment options changed. Unfortunately because of early options, my father was unable to try the newer advances in treatment.
Fast forward almost 10 years since my father's death.
With newer treatments, there is now hope and a chance for remission. See:
http://www.medicalnewstoday.com/medicalnews.php?newsid=73112
So while the article wishes to be skeptical of the advances in science, they are truly there. I do agree that early detection is necessary in giving the patient the best chance of survival, but that doesn't mean that there haven't been advances in treatment.
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