Thyroid Cancer Epidemic of Overdiagnosis


Thyroid Cancer Epidemic of Overdiagnosis

Thyroid Cancer Epidemic of Overdiagnosis

The last 40 years have shown triple the incidence of thyroid cancer in women, yet the mortality rate has remained the same.  Why are physicians so quick to diagnose women with thyroid cancer?

American Idol Alum Jax Cole

The American Idol finalist Alum Jax Cole announced that she underwent thyroid surgery in April after discovering a “lump in her neck”.  She is now receiving radiation treatments, presumably radioactive iodine (I-131), after the finding of thyroid cancer at surgery.(1-3)

Alum Jax Cole Thyroid Cancer Epidemic of Overdiagnosis

An Epidemic of Overdiagnosis of Thyroid Cancer  In Women

According to Dr Gilbert Welch in 2014 Otolaryngology, there is an epidemic of overdiagnosis of thyroid cancer in young women.(4)

Since 1975, the incidence of thyroid cancer in women has more than tripled from  6.5 to 21.4 per 100,000 women, mostly from papillary cancer.

However, the “mortality rate from thyroid cancer was stable between 1975 and 2009 (approximately 0.5 deaths per 100 000).”  

In other words, mortality from thyroid cancer did not increase, even though the incidence tripled.  If this was real cancer, one would expect increase in mortality numbers.  There was none.

Dr Welch concludes:

“There is an ongoing epidemic of thyroid cancer in the United States. The epidemiology of the increased incidence, however, suggests that it is not an epidemic of disease but rather an epidemic of diagnosis. The problem is particularly acute for women, who have lower autopsy prevalence of thyroid cancer than men but higher cancer detection rates by a 3:1 ratio.”

Alum Jax Cole Thyroid Cancer Epidemic of Overdiagnosis

Above Chart shows thyroid cancer rising incidence females (GREEN Arrow), while thyroid cancer mortality is unchanged (flat line RED Arrow). Chart courtesy of Davies, Louise, and H. Gilbert Welch. (4) “Current thyroid cancer trends in the United States.” JAMA Otolaryngology–Head & Neck Surgery 140.4 (2014): 317-322.

Dr Robert Udelsman reported in Thyroid 2014, on”The Epidemic of Thyroid Cancer in the United States”. (16)   He says:

“The increased detection of thyroid cancer results in surgery and radioactive thyroid treatment that may be of limited benefit.”

“The autopsy prevalence rate of occult thyroid cancer in the Finnish population is 35.6%, suggesting that thyroid cancer is both common and clinically insignificant for the vast majority of individuals”

“It is likely that the majority of diagnosed thyroid cancer patients will not benefit from surgical and/or adjuvant interventions. “

Pathologists:  Many Thyroid Cancers Should be Reclassified

Dr Nikiforov writes in JAMA Oncology 2016 that many thyroid cancers are really not cancer and should be reclassified.(6)  An example is the encapsulated follicular variant of papillary thyroid carcinoma.  These cases are treated as having conventional thyroid cancer, yet they are not really cancer,  Dr Nikiforov says this type of pathology does not require radioactive iodine after surgery.

In 2016, Dr Lester Thompson reviews 94 cases of thyroid cancer with the pathology diagnosis of “Encapsulated follicular papillary thyroid carcinoma”. (17)  Because of the indolent nature, they recommended changing the pathology classification to Noninvasive Follicular Thyroid Neoplasm”  Dr Lester  Thompson went on to say: These are “exceedingly indolent tumors, best managed conservatively by lobectomy or thyroidectomy alone, without radioablative iodine or suppression therapy.”(17)

Thyroid Cancer: What are the Drivers of Overdiagnosis:

1)  Advent of High Resolution Ultrasound imaging and thyroid screening programs which detect ever smaller “abnormalities”.

2) Commercial and professional vested interests. Hospitals make more money if they do more thyroid biopsies, thyroidectomies, and radioactive iodine treatments.  Thyroidectomy creates a patient on thyroid medicine for life.

3) Conflicted panels such as the American Thyroid Association, and the Endocrine Society write guidelines that expand disease definitions and encourage overdiagnosis.

4) Malpractice Litigation punishes underdiagnosis but not overdiagnosis.

5) Health system incentives encourage more testing and more treatment.

6) Cultural beliefs that more is better; faith in early detection unmodified by its risks. (12)  Paraphrased from Ray Moynihan. “Preventing overdiagnosis how to stop harming the healthy .” Bmj (2012).

Medical Iatrogenesis in Women

Dr. Adriane Fugh-Berman states very clearly,  “there is a tradition in U.S. medicine of excessive medical and surgical interventions on women”.(14)

Over-Diagnosis of “Hysteria” in Women.

Perhaps one of the early examples of medical iatrogenesis in women occurred in the 1800’s in Paris with the over-diagnosis of “Hysteria” by Dr Charcot   Dr. Martin Charcot of the Paris hospital La Salpetriere diagnosed, ten “Hysterical” women each day,  The number of women diagnosed as “Hysteria” increased 17-fold from  from 1% in 1841 to 17% in 1883.(13,14)

DES  Diethyl-Stilbestrol

A more recent historical example of medical iatrogenesis in women is the 1938 story of DES (Diethylstilbestrol) the first synthetic hormone replacement drug.  This carcinogenic monster hormone was approved by the FDA and given to millions of women from 1940 until it was banned in 1975 because it was shown carcinogenic.  The first report of cervical cancer in the daughters of DES treated women was published in April 1971 in the New England Journal of Medicine.(15)

Premarin

Our next example of medical iatrogenesis in women is Premarin, a horse estrogen isolated from the urine of pregnant horses.   Available since FDA approval in 1942, Premarin has caused an estimated 15,000 cases of endometrial cancer, representing the largest epidemic of serious iatrogenic disease ever reported.(15)    One might think this would be the end of any drug.   However Premarin was promptly rehabilitated with the addition of another synthetic hormone, a progestin, to prevent endometrial cancer.  Thus, in 1995, Prempro was born, a synthetic hormone pill containing both Premarin (the horse estrogen) and Provera (the progestin).  Again, this was FDA approved,  thought safe and handed out freely to millions of women.

Prempro

Our next example of medical iatrogenesis in women is Prempro , the combination of Premarin with Provera (medroxyprogersterone) found to cause breast cancer and heart disease.  Four large scale studies showed increased breast cancer and heart disease from this estrogen-progestin combination pill.  The  Breast Cancer Detection Demonstration Project, published in 2000, showed an eight fold increase in breast cancer for estrogen-progestin users.(15)  The Swedish Record Review, published in 1996, had a fourfold increase in breast cancer with progestin use.(15)  The Million Woman study, published in Lancet in 2003, had a fourfold increase in breast cancer for estrogen-progestin combination users compared to estrogen alone users.(15)  Finally in 2002, JAMA published the Women’s Health Initiative (WHI), an NIH funded study terminated early because of increased breast cancer and heart disease in the estrogen-progestin users.(15)  Incredibly, the medical system is still dispensing this discredited drug to women.

SSRI Antidepressants Shown to be No More Effective Than Placebo

The next example medial iatrogeneiss in women is SSRI antidepressant drugs that were shown to have little benefit for patients with mild to moderate depression.  The benefits of SSRI drugs are equivalent to placebo pills.(15).  Adverse side effects include sexual dysfunction, movement disorders, increased suicidality, mania and violence and withdrawal effects.  In spite of this, the discredited SSRI drugs are still being dispensed freely to millions of women.

Mistreatment of Women by the Medical System – Excessive Hysterectomies  

The National Women’s Health Network has written extensively on the overuse of hysterectomies.  Ernst Bartsich, M.D., a  surgeon at Cornell in New York. says ” Of the 617,000 hysterectomies performed annually, “from 76 to 85 percent” may be unnecessary. “(CNN)  Thus representing another example of mistreatment of women by the medical system.(15)

More Discredited Treatments Used on Women: 

Radical MastectomyA disfiguring operation which provided no benefit compared to lesser procedures such as lumpectomy.

Bone Marrow Transplantation for Breast CancerWhich was abandoned when studies showed it offered no benefit.(Welch BMJ 2002)

Kyphoplasty for Osteoporotic FractureWas discredited when studies found no benefit compared to a sham procedure

Arthroscopy for OsteoarthritisWas abandoned after studies found no benefit compared to conservative treatment.

Screening mammogramsFor under 50 age women offers more harm than benefit.

Conclusion:

Drs Welch, Udelsman, Nikiforov and Moynihan have come forward to alert the public to the “Epidemic of Overdiagnosis of Thyroid Cancer”,  a form of medical iatrogenesis in young women.   Since Alum Jax Cole’s pathology report was not made public, we don’t know if her particular case was overdiagnosis.

Based on the epidemiology data alone, many young women with thyroid cancer are overdiagnosed.  How many?  For every 43 women diagnosed with thyroid cancer, one (2.3%) will die from metastatic thyroid cancer, and the other 42 (97.7%) will eventually die from other causes.  About 1,070 women die from thyroid cancer annually. This number has not changed over 30 years in spite of aggressive detection and treatment.  For comparison, about 41,000 women die from breast cancer annually.

Update August 2016:  Autopsy studies do not mirror the increasing incidence of thyroid cancer, again indicating a problem with overdiagnosis (23):

“the observed increasing incidence (of thyroid cancer) is not mirrored by prevalence within autopsy studies and, therefore, is unlikely to reflect a true population-level increase in tumorigenesis. This strongly suggests that the current increasing incidence of iDTC most likely reflects diagnostic detection increasing over time. ” (23) by  L. Furuya-Kanamori,  Prevalence of Differentiated Thyroid Cancer in Autopsy Studies Over Six Decades: A Meta-Analysis. Journal of Clinical Oncology, 2016.

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The ADHD Controversy.


ADHD was already a controversial diagnosis; are Jerome Kagan’s recent criticisms of it warranted?

Is attention deficit hyperactivity disorder (ADHD) a legitimate diagnosis or is it mostly a fraud? The answer has important implications for many individuals and for society. The diagnosis is accepted as legitimate by the psychiatric profession, but continues to have its vehement critics. Recently, noted psychologist Jerome Kagan has been giving tremendous weight to these criticisms by calling ADHD mostly a fraud. There are significant problems with his criticism, however.

What is ADHD?

ADHD was first described in children in 1902, and was understood as an impulse control disorder. It was not formally recognized as a diagnosis, however, until the second edition of the DSM in 1968. The first approved drug used to treat ADHD was benzedrine in 1936. Ritalin, which is still used to treat the disorder, was approved in 1955.

Here is the official DSM diagnosis:

  • A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
    • Six or more of the symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Please note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), five or more symptoms are required
  • Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
  • Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities)
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic or occupational functioning
  • The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)

There are a few aspects of this diagnosis worth pointing out. First, this is what we call a clinical diagnosis, it is based entirely on signs and symptoms without any objective diagnostic tests. You cannot see ADHD on an MRI scan of the brain, an EEG, or a blood test. This is not unusual in medicine, especially for brain disorders. The same is true, for example, of migraine headaches. It is entirely a clinical diagnosis.

This, by itself, should not call the diagnosis into question. Brain function relies not only on the health of the cells and the absence of identifiable anatomical or gross pathology. It also depends on the pattern of connections among brain cells, the density of their connections, and the details of their biochemistry. We are just starting to be able to image the brain at this level.

As an example, raise someone in a closet for 20 years and I guarantee you they will have a psychological disorder, but you would not be able to tell that from looking at their brain with any tool we currently have.

Because mood, thought, and behavior largely rely on brain function that cannot be imaged, psychiatrists have relied on elaborate schemes of clinical diagnoses to at least have a common language for thinking and talking about mental illness. It is imperfect, and extremely fuzzy around the edges, but it has its utility.

That fuzziness is partly based in the limits of our current technology and understanding. But it is also based in the fact that humans are neurologically heterogeneous and the fact that the brain is an extremely complex system. This means that the same end result (behavior, for example) might result from almost endless permutations of interactions among various systems in the brain and their interaction with the environment.

You can see this in the formal description of ADHD above. There is a sincere attempt to capture a real neurological phenomenon, and to filter out other factors that might contribute to or cause similar symptoms. Signs used to establish the diagnosis cannot be temporary, or isolated to only one environment, or related to other conditions or situations that might provoke them. You need to have many symptoms persistent over a long time without other identifiable causes and to a sufficient degree that they cause demonstrable harm.

There is also an attempt to separate out those who have a real disorder from the typical spectrum of human behavior. This is also a common problem in medicine. Many disorders, like high blood pressure, do not have a sharp demarcation line. The curves for normal blood pressure and hypertension overlap. Experts have to decide where to draw the line, either capturing more people with the disorder but also more people just at the upper range of normal, vs excluding those who are just at the upper range of normal but also then missing more people with the disorder.

Eventually such clinical questions evolve from, “Who has the disorder” to “Who benefits from treatment for the disorder.” That is the real question.

Neuroanatomical Correlates

Despite the fact that ADHD is a fuzzy clinical entity, we have made progress in understanding what is happening in the brain of most people with ADHD. The current consensus is that ADHD is a deficit of executive functions. The frontal lobes carry out many critical functions, some considered executive functions: they include being able to focus your attention, maintain focus, switch among tasks, filter out distractions, and impulse control. Executive function includes the ability to weigh the probable outcomes of your behavior and then make high-level decisions about how you will behave.

As an adult neurologist I see patients with executive function disorder frequently, usually from head trauma. Car accidents in particular result in frontal lobe damage as it is common to hit your head against the windshield during many types of accidents. Patients frequently develop the symptoms of ADHD after frontal head trauma. They have poor focus, and poor impulse control. In one dramatic case a patient’s entire personality changed. She lost all ability to control or moderate her behavior (as have others). Often these patients respond favorably to the same stimulants we use to treat ADHD.

When we look at the brains of those who meet the clinical diagnosis of ADHD with our modern imaging techniques, such as fMRI and EEG, we find a similar pattern of brain dysfunction:

Convergent data from neuroimaging, neuropsychology, genetics and neurochemical studies consistently point to the involvement of the frontostriatal network as a likely contributor to the pathophysiology of ADHD. This network involves the lateral prefrontal cortex, the dorsal anterior cingulate cortex, the caudate nucleus and putamen. Moreover, a growing literature demonstrates abnormalities affecting other cortical regions and the cerebellum.

At this point there is no reasonable disagreement about the fact that ADHD is a disorder of brain function. Children who meet the strict diagnostic criteria are demonstrably different, in consistent and predictable ways, than children who do not (controlling for other possible factors). They have impaired executive functions, and we can see this in changes to the relevant parts of the brain. We still have a lot to learn (again, the brain is complex) but a consistent picture is emerging.

Jerome Kagan’s criticism

Jerome Kagan is a preeminent psychologist. This gives his opinions about a psychological topic a great deal of weight. The press loves him because he has a sensational story to tell and he has impeccable credential. Articles about Kagan often spend an entire paragraph or two touting those credentials.

Unfortunately this is a common mistake that mainstream journalists make when discussing scientific topics. They confuse the expertise of an individual with scientific authority. No individual ever represents the consensus of scientific opinion, they can only represent their own quirky opinions (which may or may not be in line with the consensus).

This is a classic example of this error. Kagan’s opinions do not conform to the current consensus of scientific opinion, but he is presented as an unimpeachable authority. Further, all reporting that I have seen on Kagan’s opinions regarding ADHD fail to put his expertise into a reasonable context. Kagan is a psychologist. He is not a psychiatrist, nor a neuroscientist.

Often related fields covering the same question have different opinions. Geologists and paleontologists disagree about the relative contribution of a meteor impact to the extinction of the dinosaurs at the K-Pg boundary. If a reporter talked only to a geologist they would not capture the true state of the broader scientific opinion.

Many psychologists have opinions about psychiatry that do not reflect the consensus of psychiatric opinion. In essence, even though Kagan has relevant expertise, he is not a clinician, and therefore is an outsider when it comes to the practice of psychiatry. He also does not seem to be up to date on the neuroscience of ADHD.

Yet his recent interview with Spiegel is being widely reports as definitive criticism of the diagnosis and treatment of ADHD. Here are some of the highlights: He says:

Let’s go back 50 years. We have a 7-year-old child who is bored in school and disrupts classes. Back then, he was called lazy. Today, he is said to suffer from ADHD (Attention Deficit Hyperactivity Disorder). That’s why the numbers have soared.

We are familiar with a similar criticism of autism diagnoses. Yes, diagnostic practices have changed. Awareness of the diagnosis has changed. The implication here is that the 1950s diagnosis (a bored child) was better than the current diagnosis of ADHD.

But, if you recall the diagnostic criteria from above, displaying ADHD behavior in school alone is not sufficient to establish the diagnosis. So, Kagan’s example is simply wrong. The child in his example should not be diagnosed with ADHD.

Being generous, he may be implying only that doctors are overdiagnosing ADHD and not following their own diagnostic criteria. This is a real issue, but here is a far more nuanced discussion from an actual clinician:

ADHD is real—it’s not made up. But it exists on a continuum. There’s no marker or white line that says you’re in the “definite” or “highly likely” group. There’s almost unanimous agreement that five or six percent clearly have enough of these symptoms for an ADHD diagnosis. Then there’s the next group, where the diagnosis is more of a judgment call, and for these kids, behavioral therapy might work. And then there’s a third group, on the borderline. These are the ones we’re worried about being pushed into an inaccurate diagnosis.

The real issue is – are schools pushing for more kids in the gray zone to be diagnosed because of funding and regulation issues? Also, there is a real “demarcation problem” with the diagnosis, and we have to carefully consider the risks and benefits of using looser or tighter criteria. These discussions are happening within the profession, and are very evidence-based and nuanced. Kagan’s criticism, by comparison, is shooting from the hip and simplistic. (I will add the caveat that the interview may not reflect the full depth of his opinion, but he is responsible for how he communicates to the public, especially given how widely his opinions have been spread.)

He continues:

SPIEGEL: Experts speak of 5.4 million American children who display the symptoms typical of ADHD. Are you saying that this mental disorder is just an invention?

Kagan: That’s correct; it is an invention. Every child who’s not doing well in school is sent to see a pediatrician, and the pediatrician says: “It’s ADHD; here’s Ritalin.” In fact, 90 percent of these 5.4 million kids don’t have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they’ll make the corresponding diagnosis.

That characterization, while you might dismiss it as hyperbole, is irresponsible. “Every” child? Again, this does not meet the official diagnostic criteria for ADHD which requires more than just not doing well in school. His reference to “dopamine metabolism” is just weird. It is true that some studies show some children with ADHD have impaired reward system function. This may be playing a role in some subtypes of ADHD. It is not a core feature of ADHD, however, and the evidence is still very preliminary. Invoking what is essentially a preliminary side point about the neuroanatomical correlates of ADHD as reason to doubt the diagnosis is, to be kind, highly problematic.

Kagan then broadens his criticism to encompass psychiatry in general:

We could get philosophical and ask ourselves: “What does mental illness mean?” If you do interviews with children and adolescents aged 12 to 19, then 40 percent can be categorized as anxious or depressed. But if you take a closer look and ask how many of them are seriously impaired by this, the number shrinks to 8 percent. Describing every child who is depressed or anxious as being mentally ill is ridiculous. Adolescents are anxious, that’s normal. They don’t know what college to go to. Their boyfriend or girlfriend just stood them up. Being sad or anxious is just as much a part of life as anger or sexual frustration.

This is a typical anti-mental illness statement. This is simply a straw man of what psychiatry does.

He is saying that we should not confuse the normal range of behavior with a disorder, as if this is a huge insight. This understanding has already been incorporated into clinical thinking. As I pointed out above – there are great pains taken when defining mental disorders to separate true disorders from the healthy range of human behavior.

Further, being “seriously impaired” is already part of the diagnosis, so what is he talking about?

He goes on to argue that some people are depressed in response to a life event. Right – psychiatrists call this a “reactive depression” because it is already recognized, and not confused with a chronic depression. That is why the diagnosis of clinical depression excludes depression that follows a major trigger, and must continue for greater than six months to be considered a disorder.

From reading the entire interview I am left wondering, exactly what Kagan is criticizing? He is certainly not criticizing the standard of care within psychiatry. He seems to be tilting at a straw man of the worst possible malpractice that deviates from that standard. He is raising issues as if these are not already part of a vigorous evidence-based discussion within psychiatry itself.

A kernel of truth

We often take a sharply critical approach to medical science here at SBM. Self-criticism is critical to improvement. That is the essence of science itself, it is designed for error correction through self-criticism.

Our nuanced position is that science basically works, but there is a lot of room for improvement. Enemies of science, however, or those with a specific ideological axe to grind, use the same evidence to argue that the institution of science is fatally flawed and can be comfortably dismissed or ignored.

I find the same is true of much of the public criticism of psychiatry. There is a lot to criticize in the profession (as in medicine in general), and a lot of room for improvement. Some of that is just the current status of the science. We don’t know everything, and yet medicine (including psychiatry) is an applied science. We have to make important decisions with limited information.

There are also many issues of quality control. Medicine is hard, and keeping quality standards high is challenging.

So there are many legitimate criticisms of ADHD and psychiatry, but that does not mean ADHD is a fraud. The scientific evidence, both clinical and neuroscience, is robust. Kagan’s criticisms are mostly greatly exaggerated, or they are straw men because they are already incorporated into the standard of care.

Unfortunately, you will not be exposed to any of that from reading any of the popular press breathlessly reporting that ADHD is a fraud.

Source:https://sciencebasedmedicine.org

Overdiagnosis accounts for increased thyroid cancer incidence


The incidence of thyroid cancer worldwide has consistently been increasing in recent decades and may be attributable to the use of new diagnostic techniques coupled with increased medical surveillance and access to health care services, according to a perspective published in The New England Journal of Medicine.

However, no substantial change in thyroid cancer-related mortality has been observed despite rising incidence, according to Salvatore Vaccarella, PhD, of the International Agency for Research on Cancer in Lyon, France, and colleagues.

Vaccarella and colleagues calculated the number of overdiagnosed cases of thyroid cancer in 12 countries — Australia, Denmark, England, Finland, France, Italy, Japan, Norway, South Korea, Scotland, Sweden and the United States — using data from the International Agency for Research on Cancer’s reference publication Cancer Incidence in Five Continents.

“Countries such as the [United States], Italy and France have been most severely affected by overdiagnosis of thyroid cancer since the 1980s, after the introduction of ultrasonography, but the most recent and striking example is the Republic of Korea,” Vaccarella said in a press release. “A few years after ultrasonography of the thyroid gland started being widely offered in the framework of a population-based multi-cancer screening, thyroid cancer has become the most commonly diagnosed cancer in women in the Republic of Korea, with approximately 90% of cases in 2003 to 2007 estimated to be due to overdiagnosis.”

Researchers conclude that overdiagnosed cases in women from 2003 to 2007 account for 70% to 80% of cases in the United States, Italy, France and Australia and 50% of cases in Japan, the Nordic countries, England and Scotland. Overdiagnosis in men for the same period accounted for 70% of cases in France, Italy and South Korea, 45% in the United States and Australia and less than 25% in the other countries evaluated.

“More than half a million people are estimated to have been overdiagnosed with thyroid cancer in the 12 countries studied,” Christopher P. Wild, PhD, director of the International Agency for Research on Cancer, said in the release. “The drastic increase in overdiagnosis and overtreatment of thyroid cancer is already a serious public health concern in many high-income countries, with worrying signs of the same trend in low- and middle-income countries. It is, therefore, critical to have more research evidence in order to evaluate the best approach to address the epidemic of thyroid cancer and to avoid unnecessary harm to patients.” – by Amber Cox

National Cancer Institute and JAMA Medical Journal Admit: “Oops… It Wasn’t Cancer After All”


After decades of wrongful cancer diagnoses and treatments, and millions harmed, the National Cancer Institute and high gravitas journals like JAMA (the Journal of the American Medical Association) finally admit they were wrong all along.

The National Cancer Institute Admits ''Oops... It Wasn't Cancer After All''

Back in 2012, The National Cancer Institute convened an expert panel to evaluate the problem of cancer’s misclassification and subsequent overdiagnosis and overtreatment, determining that millions may have been wrongly diagnosed with “cancer” of the breast, prostate, thyroid, and lung, when in fact their conditions were likely harmless, and should have been termed “indolent or benign growths of epithelial origin.” No apology was issued. No major media coverage occurred. And more importantly, no radical change occurred in the conventional practice of cancer diagnosis, prevention, or treatment.

Essentially, in one sleight of the semantic hand, entire swaths of the U.S., and global population, who thought they had “lethal cancer,” and were subsequently treated for it, often with violent procedures and treatments, were being told that“oops… we got that wrong. You never had cancer after all.”

If you look at the problem through just breast cancer overdiagnosis and overtreatment in the U.S. over the past 30 years, it has been estimated that approximately 1.3 million women were wrongly treated. Most of these women still have no idea they were victims, and many have identified with their “aggressors” in Stolkholm syndrome like fashion, because they think their “lives were saved” by unnecessary treatment, when in fact the side effects, both physical and psychological, have almost certainly reduced both the quality and duration of their lives.

When the National Cancer Institute report was released, it was a sort of vindication for those of us who had been advocating the position that a commonly diagnosed form of so-called “early breast cancer” known as ductal carcinoma in situ was in fact not inherently malignant and should not have warranted the conventional treatments of lumpectomy, mastectomy, radiation, and chemotherapy. I based this position on available research on the natural history of DCIS, and the extremely high survival rates from DCIS, as well as the fact that breast cancer-related mortality had not declined in pace with the expansion of so-called “zero” or “early stage” cancers detected through mammography screenings, as would be expected if these diagnoses actually represented harmful clinical entities.

Since then, I have watched the problem of overdiagnosis and overtreatment closely. I get daily updates from pubmed.gov on the topic, and increasingly, high impact and gravitas journals are reporting on this highly concerning phenomenon. Particularly relevant is a review published late last year, which I reported on in my article titled, “Astounding Number of Medical Procedures Have No Benefit, Even Harm – JAMA Study.”

The JAMA study found that a wide range of standard medical procedures and interventions that millions are subjected to annually, are not evidence-based, as commonly assumed, and have little to no benefit, and may even be causing significant harm. As a result, I now believe that good medicine often involves doing as much as nothing as possible. I also think that people should be aware that any conventional cancer diagnosis has the ability to exert lethal harm via thenocebo effect, regardless of its accuracy (i.e., even a misdiagnosis can result in lethal consequences because the power of belief).

Thyroid Cancer Epidemic Caused by Misinformation, Not Cancer

Another topic I have been trying to spread awareness about is thyroid cancer overdiagnosis and overtreatment. When I first reported on this two years ago in my article, Thyroid Cancer Epidemic Caused by Misinformation, Not Cancer, a series of compelling studies from around the world revealed that the rapid increase in diagnoses in thyroid cancer reflected their misclassification and misdiagnosis. As was the case with screening detected breast and prostate “cancers,” and even many ovarian “cancers,” the standard of care often required the removal of the organ, as well as irradiation and chemotherapy — two interventions known to promote not inhibit cancer.

As is typical of research that undermines the conventional standard of care, there has been little reporting on the topic. That is, until now.

On April 14th 2016, in an article titled “Its Not Cancer: Doctors Reclassify a Thyroid Tumor,” the New York Times reported on a new study published in JAMA Oncology which should forever change the way we classify, diagnosis and treat a common form of “thyroid cancer”:

An international panel of doctors has decided that a type of tumor that was classified as a cancer is not a cancer at all.

As a result, they have officially downgraded the condition, and thousands of patients will be spared removal of their thyroid, treatment with radioactive iodine and regular checkups for the rest of their lives, all to protect against a tumor that was never a threat.

Their conclusion, and the data that led to it, was reported Thursday in the journal JAMA Oncology. The change is expected to affect about 10,000 of the nearly 65,000 thyroid cancer patients a year in the United States. It may also offer grist to those who have been arguing for the reclassification of some other forms of cancer, including certain lesions in the breast and prostate.

The reclassified tumor is a small lump in the thyroid that is completely surrounded by a capsule of fibrous tissue. Its nucleus looks like a cancer but the cells have not broken out of their capsule, and surgery to remove the entire thyroid followed by treatment with radioactive iodine is unnecessary and harmful, the panel said. They have now renamed the tumor. Instead of calling it “encapsulated follicular variant of papillary thyroid carcinoma,” they now call it “noninvasive follicular thyroid neoplasm with papillary-like nuclear features,” or NIFTP. The word “carcinoma” is gone.

Many cancer experts said the reclassification was long overdue. For years there have been calls to downgradesmall lesions in the breast, lung and prostate, among others, and to eliminate the term “cancer” from their name. But other than the renaming of an early stage urinary tract tumor in 1998, and early stage ovarian and cervical lesions more than two decades ago, no group other than the thyroid specialists has yet taken the plunge.

In fact, said Dr. Otis Brawley, chief medical officer at the American Cancer Society, the name changes that occurred went in the opposite direction, scientific evidence to the contrary. Premalignant tiny lumps in the breast became known as stage zero cancer. Small and early-stage prostate lesions were called cancerous tumors. Meanwhile, imaging with ultrasound, M.R.I.’s and C.T. scans find more and more of these tiny “cancers,”especially thyroid nodules.

“If it’s not a cancer, let’s not call it a cancer,” said Dr. John C. Morris, president-elect of the American Thyroid Association and a professor of medicine at the Mayo Clinic. Dr. Morris was not a member of the renaming panel.

Dr. Barnett S. Kramer, director of the division of cancer prevention at the National Cancer Institute, said, “There’s a growing concern that many of the terms we use don’t match our understanding of the biology of cancer.” Calling lesions cancer when they are not leads to unnecessary and harmful treatment, he said.

The article goes on to discuss the fact that, while some major medical centers are starting to treat encapsulated thyroid tumors less aggressively, this is still not the norm in the rest of the country. It is a consistent pattern that there is a lag of over a decade between changes in evidence and the clinical practice of medicine, which therefore makes medical practice far less “evidence-based” than is commonly claimed and/or assumed.

Clearly, the truth about cancer’s true nature, and the cancer industry’s misrepresentations, is beginning to come to light via the very institutions like JAMA and the major media who have been responsible, historically, for generating so many commonly held misconceptions on the topic.

Decades of Data Point to Overdiagnosis from Breast Cancer Screening.


Since breast cancer screening came into widespread use in the United States in the 1970s, more than 1 million women may have been diagnosed with cancers that never would have caused them harm or required treatment, a new study suggests. These women may have been exposed unnecessarily to the adverse effects of treatment, the authors reported in the November 22 New England Journal of Medicine.

The detection of cancers that do not grow or grow so slowly that they would never cause illness is known as overdiagnosis. Previous studies have shown that screening mammography, which looks for breast cancer in the absence of symptoms, can lead to overdiagnosis.

Overdiagnosis may account for nearly one-third of newly diagnosed breast cancers among women aged 40 and older in the United States, the authors of the new study estimated. In 2008, for example, more than 70,000 women may have received an unnecessary diagnosis, they noted.

“This is a significant public health concern,” said co-author Dr. Archie Bleyer of St. Charles Health System in Bend, OR. “Women need to be aware of the potential benefits of screening, as well as the downsides—including being diagnosed with cancers that [are not life-threatening].”

To look for evidence of overdiagnosis, Dr. Bleyer and Dr. H. Gilbert Welch of Dartmouth Medical School in Hanover, NH, used NCI’s Surveillance, Epidemiology, and End Results (SEER) database to analyze trends in breast cancer incidence between 1976 and 2008.

The authors reasoned that if screening leads to the earlier detection of cancers that are destined to become lethal, detecting more breast cancers at an earlier stage—when they tend to be curable—should lead to a corresponding drop in late-stage cancers. But the SEER data did not show this to be true: The rise in early-stage breast cancers over three decades (an absolute increase of 122 cases per 100,000 women) was not matched by an equivalent drop in late-stage cancers. Instead, there was an absolute decrease of 8 cases per 100,000 women. This imbalance, the authors concluded, must be due to overdiagnosis.

This estimate of overdiagnosis is generally consistent with estimates from other countries. A recent Norwegian study found that as many as 1 in 4 invasive breast cancers diagnosed in that country through its population-based mammography screening program never would have caused harm.

Nonetheless, comparing studies can be a challenge because of differences in study design. For instance, Drs. Bleyer and Welch counted noninvasive tumors known as ductal carcinomas in situ among the early-stage breast cancers, whereas the Norwegian researchers did not.

A limitation of the current study was the fact that the authors had to infer overdiagnosis from incidence statistics in the population, because overdiagnosis cannot be directly observed at the individual patient level.

The study does not clarify whether an individual woman should be screened for breast cancer, the authors acknowledged. But they noted that the potential harms of unnecessary diagnoses are clear: emotional stress and anxiety, surgery, radiation therapy, hormonal therapy, chemotherapy, or, as is often the case, a combination of these treatments—all for abnormalities that would not have caused illness.

“Women need to understand that screening has positive and negative consequences,” said Dr. Stephen Taplin of NCI’s Division of Cancer Control and Population Sciences, who has studied screening for 25 years but was not involved in this study. “But they also need to know that a decision about screening is not a forever choice. A woman can choose to be screened later, or not at all.”

He added, “This is one of many studies that is expanding the discussion about screening. It demonstrates that women need to make decisions based on their circumstances, not just based on recommendations.”

Source:NCI.