Modest Proposal

A modest proposal to save lots of breast cancer-money and get healthier too

There is a lot of talk lately on the issue of the cost of health care.  Needless to say, this is of great interest to us-cancers, an issue of death and life actually.  The dearth of specialists is especially acute.  We have heard of lots of potential solutions, eg to have e-consults where family doctors ask specialists questions about their patients on-line rather than having a more time-consuming appointment, pay specialists fee-for-service, and others. However, regarding breast cancer at least, I have not heard anything about many obvious ways to save lots of money and improve health care enormously at the same time.

In fact, there is lots that can be done for the (1) reduction in incidence, (2) early detection of breast cancer, and (3) treatment. All while saving lots of money!

Here are some ideas from a survivor-basic scientist:

1.-  Reducing the incidence:  We may all marvel at the progress of science and Cell Biology since the war.  But, according to the latest Canadian (and US) Cancer Society statistics, the incidence of breast cancer today is about 1 woman in 7 or 8.  Did you know that back in the 1950’s the incidence was one in 50?  Let alone that the age at diagnosis is now getting younger and younger too. In fact, Breast Cancer Action Kingston recently started support groups for young women and some members are in their early 20’s wondering and worrying what will happen to their little kids if they are not there anymore… The incidence is higher even for women that are not overweight, not diabetic and who never took hormones, and despite the fact that smoking has been reduced dramatically since the 1950’s.

            Of course, as a basic researcher I fully appreciate the importance of advancing knowledge, regardless of application. However, because of the monstrous, nearly 7-fold increase in chances of getting breast cancer in the first place, the chances of dying from it are the same today as in 1950, when even the double helix of DNA was not known, never mind cancer genes, signal transduction etc etc.  Let alone that you may live longer after diagnosis but with the misery of surgeries, radiations, chemo.  That is, the increase in incidence largely negates all the efforts of the Canadian and US and European and worldwide cancer agencies, the efforts of the researchers, and the public that funds everything… 

            Why this dramatic increase in incidence?

Some of it could be because of an increase in obesity, some because of an increase in diabetes, some because of hormones (contraceptives or for menopause), some because of better detection machines.   But, I was always too skinny, no diabetes and no hormones. Same with many of my friends. Still, breast cancer showed us its ugly face…

            Diet is one of the documented factors.  Of course, a healthy diet includes lots of fruits and vegetables.

But, there lies the problem: Fruits and vegetables often contain pesticide residues, which may raise health concerns.  In fact, over 90% of dietary exposure to pesticides is in fruits and vegetables1

            What is their effect upon human health?

            After taking into account all factors, the International Agency for Research on Cancer (IARC) the research arm of the World Health Organization (WHO) reported on the carcinogenic effects of several commonly used organophosphate insecticides and the herbicide glyphosate.  Their assessment, published in Lancet-Oncology in 20152, classified the herbicide glyphosate (Round-up) as “probably carcinogenic to humans” (Group 2A), ie worse than several organophosphate insecticides.

Round-up is used for killing weeds prior to seeding.  After spraying you have to wait for the herbicide (literally “plant-killer”) to lose activity before planting because any residues will kill the crop-plants. So, hopefully by the time we eat the bread etc the Roundup may be inactive.

However, there is another use for the Roundup: It is widely used as a “desiccant”, that is, it is applied to facilitate drying of ripe crops such as wheat, canola, pulses and others, ie to kill the plant artificially to harvest faster, rather than wait for it to mature and dry naturally.  In this way, the herbicide goes on our food-plants right before harvest (!), with hardly any time to decay.  To top it off, the most “healthy” kind of bread, whole wheat or bran bread, contains the highest amounts of herbicide, as it sticks to the outside of the grain… 

As a result of the IARC report and other evidence, judges recently awarded 2 billion US dollars to a couple who got cancer after using glyphosates for years without any protection, and as of this month there are over 43,000 pending lawsuits in the US alone. As it came up during trials, the manufacturer (Monsanto) knew about glyphosate’s carcinogenicity for years, but hid the evidence…

Already, many municipal governments prohibit the use of glyphosate sprays in gardens, because people may walk on the grass…  What about the glyphosate we gulp down in whole wheat bread, that is supposed to be a “healthy choice” to boot???  

That is, the science regarding carcinogenicity of major pesticides is there, coming straight out of the mouth of WHO2, no need for more data.  Denying that is akin to denying that climate change is real, or denying the Holocaust!

Can you imagine if the chances of getting breast cancer go back to what they were in the 1950’s???  It would be a huge celebration!

Of course, the technology is there, it has been there all along. If it sounds like a joke it is because it is…

The Canadian Cancer Society and the National Cancer Institute of Canada (and their US counterparts) have been at the forefront of the fight against smoking. It is to a great extent thanks to their efforts that smoking has been reduced dramatically in the last 50 years. Pesticides in foods we eat should be the next target, and it should be far easier, because these agencies would not be up against an addiction.  Nobody feels the urge to eat Roundup, very much unlike smoking. Besides, unlike losing weight or exercising, no time or effort are required to consume pesticide-free foods. There are many agricultural techniques to dramatically reduce or eliminate pesticides. Crop rotation, ploughing to kill weeds and others.

Below is the CCS website section on pesticides. I am sorry but I fail to understand why it is so out of date, and out of truth. The CCS has all the knowledge and research power to give accurate information. Frankly, I would expect the CCS to be at the forefront of promotion of healthy, organic food consumption. I fail to understand their official position on this matter, as described in their website.  http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-informed-decisions/know-your-environment/?region=on

2.- Early detection.  The Task Force on Preventive health care is a Government of Canada agency tasked with public health and infectious and chronic disease control and prevention, formed in the 70s and disbanded in 2005 and then resurrected under the Harper government in 2010. The Task Force is tasked with making guidelines for 18 conditions, ranging from Hepatitis C, Prostate, Breast and Ovarian cancer screening, to cognitive impairment and diabetes.

Regarding breast cancer screening, the Task Force guidelines are to be used by 36,000 family doctors in their interactions with 9 million women aged 40-74 of average breast cancer risk (which is one woman in 7…).  https://canadiantaskforce.ca/guidelines/   https://breastcancer530667969.wordpress.com/do-i-have-breast-cancer/

            Despite what the Ministry of Health says, there is not a single imaging expert on the panel tasked to give recommendations on screening mammograms for early detection. The panel consists of 14 members:  8 family doctors, one occupational therapist, one Emergency doctor, one nephrologist, one pediatrician. The chair is a psychologist. Not surprisingly, the Task Force decision was, contrary to scientific evidence, to not have mammograms till age 49.  I am sorry but the age of the breast cancer monster is getting younger and younger, some BCAK members are in their 20’s. By waiting till age 50 you may miss the boat.

            The Task Force report is also advising against ultrasounds or MRI’s for women with dense breasts.  It has been known for over 30 years that 40% of women have moderate to high breast density. High breast density not only puts them at higher risk for cancer, but at the same time, cancerous tumours are masked by the dense breast tissue in a mammogram (ie X-rays of the breast), so that an MRI or ultrasound are needed instead.  A paper just published in the New England Journal of Medicine (November 28, 2019) definitively demonstrates that MRIs do find additional cancers in women with dense breasts3.

Again, the CCS logo is on the Task Force page, ie the CCS supports the report (!!!). Interestingly, the American Cancer Society did not endorse the report from a similar committee.

 3.- Treatment:  Once you find the lump, then a biopsy may show that it is invasive, ie cancer.  Surgery comes next, to take out most of the cancer. At that stage, the cancer may be spreading but you have to line up to wait your turn…  Pamphlets from the Canadian Partnership Against Cancer say that patient “perception” or opinion, “increases anxiety”.  Oh, brother!  Is it just our “perception”???  According to a paper published in Lancet4, a 3-month delay in breast cancer surgery increases 5-year rates of mortality (not just relapse…) by 12% !  I am sorry, but if you don’t worry after reading about this very inconvenient truth, then you have Alzheimer’s, not just cancer.

            I was told that “there is lots of published evidence that it makes no difference whether you are operated right away or in two months from now”.  Yes, this is the standard that all of my breast cancer friends in Canada are told, time and again. I was told to “do yoga” or “go biking” to “deal with the stress of waiting”, as the cancer might be spreading…   Please, this mockery is dangerous… Tell us the truth, so that we try to go elsewhere!

            I have more than 20 friends who have had breast cancer, in Germany, France, England, Poland, South Africa and Greece.  All, even with carcinoma in situ, had surgery within one to three days after the first detection of the tumor.  All were told that it was critical to have surgery right away.  Why are cancer patients in Canada told that waiting does not matter?  Cancer surgery is not “elective” or cosmetic, but a matter of death or life (death is the default…).

For the health economists, I have to stress that the delay in breast cancer surgery results in a huge waste of money, not the other way around.  The cancer will not go away by itself no matter what, unless you die… If it spreads, then a small incision to remove an in situ lump becomes major surgery (~10,000$). Then chemotherapy may be needed (~30,000$), perhaps Herceptin (~40,000$) or other drugs that are even more expensive.  If it has invaded the lymph nodes and they are removed, then lymphedema can set in, at a cost of ~3-4,000$/yr for life. 

Needless to say that this does not take into account the loss because of sickness, and threat of an untimely death.  Besides, the loss of a mother is not just her salary; you cannot give 100,000$ to a baby and tell him to grow up. It doesn’t work. 

Again, there is NO need for more studies.  Just eliminate the wait times. Ask Zimbabwe for advice! 

            In short, we can save lots of cancer-money by:

1. Reducing the incidence of cancer by restricting the use, or banning pesticides in food crops, not just sidewalks.

2. Detecting cancers early using screening mammograms or ultrasounds in women with dense breasts, to catch them before they spread. Educate women on the risks of dense breasts and to do self-exam.

3. Operating on cancers quickly. Having to go to India, Turkey or Ethiopia, countries that are not in the G-8 or G-any for surgery is a disgrace.

            Just close your eyes and imagine the chances to get breast cancer down to 1 in 50, then catching it early, and taking it out quickly?  Mortality would take a dive, AND lots of health care money saved.

The research is all done, nothing left to be discovered. Back to the mean 1950’s!

The above beg the question:  How come this huge waste of money is accepted?  What is behind this huge elephant in the room that nobody seems to see?  Why do the powers that be, i.e. politicians and administrators allow sickness-pesticides, then not using known detection techniques enough and finally, by allowing the cancer to spread?

I doubt that the major decision makers do not know the cost since they can google it, if they don’t have any knowledgeable advisors, which they certainly do. The mere existence of the delays creates that nagging feeling, could the real reason be the ghost of forcing privatization of health care hanging above us? 

Leda Raptis, PhD

Professor, DBMS – December, 2019

References

 1 Holzman, D. C. Organic food conclusions don’t tell the whole story. Environ Health Perspect 120, A458 (2012).

2 Guyton, K. Z., et al, IARC. Carcinogenicity of tetrachlorvinphos, parathion, malathion, diazinon and glyphosate. The Lancet-Oncology 16, 490-491 (2015).

3 Bakker, M. F. et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med 381, 2091-2102 (2019).

4 Richards, M. A., Westcombe, A. M., Love, S. B., Littlejohns, P. & Ramirez, A. J. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353, 1119-1126 (1999).

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