Cancer Survival and Treatment

Cancer is not one disease it is hundreds of diseases making generalizations difficult. We have made progress in a few cancers such as early Hodgkin's lymphoma and seminoma but for the overwhelming majority such as lung, breast and bowel cancers, survival figures are not much different from those observed many years ago.

Doctor Kauffman has done an incredible job of summarizing just where we are today. His major contribution on this subject is helping the reader understand confusing and misleading terminology.

The use of the term cure rarely applies to a cancer survivor. The correct term for judging effectiveness of cancer control is the five-year survival rate, that fraction of patients alive after five years from diagnosis. When a cancer expert says current treatment has a 60% success rate, they mean 60% will still be alive after five years, but in many the cancerous cells still silently lurk.

Kauffman points other pitfalls of false claims and misleading cancer survival information when alarmists talk of increasing cancer deaths from a specific type of cancer without age adjustment.

As the population ages, so must the specific deaths, yet when corrected for age these apparent epidemics become usual and customary trends. To one unfamiliar with the twists and turns of bio-statistics, it is easy to be confused. We desperately need reviewers such as Kauffman who are thoroughly trained in statistics and epidemiology to lead us by the hand as we try to absorb the immense amount of, at times, conflicting data on this subject.

Having been through my own PSA crisis I agree that the sudden surge of prostate cancer cases is nothing more than the inevitable consequence of having initiated widespread PSA screening programs, a result of which is earlier detection of cases that might have taken years to manifest otherwise. And, of course, in the senior age group, many would "pop off" with stroke and heart attack allowing the prostate cancers to remain hidden.

And no one will argue with the side effects of traditional radical surgery, radiation therapy and the "seeds". When I told my urologist I wanted the "seeds", he first asked me how long I expected to live. He then proceeded to remind me that the side effects of radiation burns to the bladder and bowel would start in roughly eight years. I said, "According to the literature the seeds don't do that." He laughed and reminded me that with the bladder and bowel only a millimeter or so from the prostate margins you cannot seed-irradiate the entire prostate without hitting those other vital structures. So there I was between a "rock and a hard place."

Then this doctor described for me the revolutionary new approach of radical laparoscopic prostatectomy. "We'll deliver the entire prostate through your navel and send you home within 24 hours with five band-aids on your abdomen and practically no discomfort. I went home in 14 hours assured that when I finally depart this place, it will be likely be from heart attack or stroke but it will not be from prostate cancer.

So for prostate cancer the scales of choice have shifted recently because of technological innovation, but, as Kauffman reminds us, for much of cancer the treatment effects on life quality are so frequently discouraging that treatment often is a "coin toss".
So, much of our apparent therapeutic progress in cancer is nothing more than earlier detection. Various groups in our society will be either alarmed or pleased depending on their interpretation of the cancer statistics but nowhere in my opinion will you find a better review.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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