(NOTE ADDED 12/7/2010: Kim Tinkham has died of what was almost certainly metastatic breast cancer.)
Cancer is scary. It’s very, very scary, even when it is a cancer that is treatable and potentially curable. It’s such a common disease that, by the time we reach a certain age, the vast majority of us have seen at least one friend or loved one die of some form of cancer. All too often, that death is horrific, and even when it is not the wasting and weakness that is often seen before the end provokes a visceral reaction matched by few diseases. Moreover, the treatments of cancer can be toxic. For solid tumors, surgery, sometimes disfiguring, is often required. Radiation therapy may be needed, or, most feared of all, chemotherapy. Contrary to what is said on many websites dedicated to “alternative” medicine, doctors do not “cut,” “burn,” and “poison” cancer patients (as proponents of unscientific treatments for cancer often characterize cancer trieatments) because we enjoy it or because of failure of imagination. We use them because they are the best treatments that we currently have, and, for several common malignancies, they are quite effective.
However, given the fear of cancer and, almost as equally, the fear of cancer treatments, it is not surprisingly that nonscientific treatments flourish and many people, unfortunately, fall prey to them. Of course, it is not science that drives these sorts of therapies, although they are often dressed up in “science-y” sounding terminology in order to obscure what to an oncologist or cancer investigator would obviously be the extreme biological or even physical implausibility of the remedy. These treatments do not relay in randomized clinical trials to demonstrate their efficacy and safety, either. Rather, they rely on testimonials, and, alas, I’ve found a doozy. It’s an instructive example, though, which is why I’m going to discuss it.
The testimonial is about a woman with breast cancer named Kim Tinkham, and here is her story:
After a mammogram and a biopsy, Tinkham’s doctor told her that she has stage three breast cancer. That moment, she said, was one of the rare times in her life that she broke down and didn’t know what to do.
“My 50th birthday was a milestone. I started thinking, ‘What am I going to do for the next 50 years?’ I never, ever planned for this,” Tinkham said. “I’m not someone who breaks down. It was a scary time for me and it wasn’t a situation I wanted to deal with, but it wasn’t going to go away. I had that feeling of hopelessness and that feeling when you finally realize, ‘I’m not immortal.’”
Her doctors wanted to perform a partial mastectomy immediately, as well as remove her lymph nodes. She had 15 minutes to call her husband before going through more tests and discussing a combative plan.
This is very typical of breast cancer testimonials. There is the diagnosis. Then, the doctors seemingly pressure the patient into surgery, heedless of what she wants. Whether true or not, the woman perceives it to be this way. Be that as it may, this story gives me a fair amount of information, as vague as it is. Stage III breast cancer tells me that at least one of two things must be true: Either the tumor must be large (greater than 5 cm in diameter), and/or there must be significant lymph node involvement. Furthermore, stage III is divided into IIIA, IIIB, and IIIC. Of these, only Stage IIIA is considered operable, while Stage IIIB and IIIC are defined as “locally advanced” (defined as the tumor having grown into the skin or chest wall or has produced numerous positive lymph nodes) and require treatment with chemotherapy first to shrink them before surgery. (Stage IIIB also include inflammatory breast cancer that hasn’t spread beyond the breast and lymph nodes). Consequently, from this story, we can reasonably conclude that, if Tinkham’s account is correct, her tumor was stage IIIA. Finally, because we do not know how many of her lymph nodes were positive, we can speculate that the reason her tumor was stage IIIA is because her tumor was large, greater than 5 cm in diameter, although it’s possible that she had enough tumorous lymph nodes on physical examination and a smaller tumor. Moreover, we can assume that, whatever the status of her nodes, the primary tumor must not be that much larger than 5 cm, because otherwise a partial mastectomy without preoperative chemotherapy to shrink the tumor would not have been possible, given that it is the size of the tumor relative to the size of the breast that determines whether breast conserving therapy in the form of lumpectomy is possible. Finally, looking at the picture of Tinkham examining her own mammogram, I have a hard time seeing the mass. Although there are exceptions, usually, stage IIIA cancer is pretty obvious on a mammogram, even from across the room. This leads me to speculate that the most likely reason Tinkham was told that she has stage III cancer is because of extensive lymph node involvement, with a smaller tumor.
The treatment options for stage IIIA cancer include lumpectomy or total mastectomy plus lymph node sampling in the form of a procedure called sentinel lymph node biopsy, which tests to see if the lymph nodes are involved. If the patient has clinically positive lymph nodes on physical examination or by a fine needle aspiration of an axillary lymph node or if the sentinel lymph node is positive for cancer, then complete removal of all the lymph nodes under the arm in the form of an axillary dissection is performed. For a patient with stage IIIA cancer, the chances are very high that one (and usually several) lymph nodes will be involved; so most patients undergo axillary dissection. Also, since by definition stage IIIA implies a large tumor, many of them undergo mastectomy as well, although an attempt at breast conservation can be made by giving chemotherapy first to shrink the tumor with an equal chance of survival. Surgery is then followed by chemotherapy and radiation. Given that Tinkham was offered a partial mastectomy (i. e., lumpectomy), one can assume that she was probably in the better prognosis stage IIIA patients.
The next step of the testimonial is the “courageous” decision to “go alternative”:
Hours and hours of research followed, and Tinkham realized that an alternative solution would be best for her.
“I knew, for me, the best route would be alternative. I don’t like surgery. I guess I don’t like the loss of control,” Tinkham said. “After thinking about it, there’s a quality of life that is involved. It’s not about just existing. For me, the quality wouldn’t be there if I had the surgery and went through the other things. I decided not to do it. That was a big step.”
In deciding to treat cancer without surgeries and chemotherapy, she had to tell her husband, Scott, son, Garrett, and her family and friends.
I really hate when this happens, because a patient who decides to forgo effective conventional therapy for unscientific woo is giving up her single best shot at surviving her cancer. This is not a woman with metastatic disease that is incurable. Patients with stage IIIA cancer, although they don’t have the best prognosis in the world, are definitely eminently curable with conventional therapy. Unfortunately, Tinkham found one Robert O. Young, a proponent of the pseudoscientific idea that essentially all disease is due to “excess acidity” and can therefore be treated with alkalinization. I’ve dealt with acid-base pseudoscience before, as well as Young’s belief that cancer is a “liquid“; so I won’t belabor why I believe Young’s diagnostic tests and treatments to have no basis in science. For purposes of this post, I’m more interested in the testimonial and why this woman clearly believes she is now “cured” of her disease or that it is in remission and unlikely to harm her for decades. How can she believe this? One reason that women with breast cancer who decide to opt for “alternative treatment” come to believe that their treatment cured them is because they have had a biopsy that completely excised the tumor. Remember, radiation and chemotherapy only decrease the chance of the tumor recurring after lumpectomy; the lumpectomy itself cures cancer in a significant proportion of cases. However, Tinkham did not undergo an exicisonal biopsy or lumpectomy, only Young’s unscientific and useless treatments. So, after “hyperalkalinizing” her body by changing her diet radically and imbibing all sorts of supplements, did her tumor shrink radically?
She can still feel the tumor just underneath the surface of her skin, where it will probably remain for a while.
But she knows it’s harmless. Now, it’s simply her badge of honor – the reminder that she, Kim Tinkham, defeated cancer without any surgery, invasive procedures, radiation or chemotherapy.
The tumor is still there! Note also that no mention is made of whether the tumor has grown or shrunk. What is most likely going on is that Tinkham is fortunate enough to have a relatively indolent, nonaggressive tumor. It is probably slowly growing; so that in the ten months or so since her diagnosis it may not be obvious that it’s grown unless she regularly undergoes ultrasounds, mammograms, or MRIs, which would give an objective measurement of its size. So, if the tumor is still there and is not obviously shrinking, how on earth can Young tell Tinkham that her tumor is gone? Here’s how:
A recent blood test proved that the stage three breast cancer diagnosed in February is absent from her body. But she really didn’t need a blood test to tell her that. Just hours after she had her blood taken for the test, and days before she knew the results, she was confident that her new lifestyle had allowed her body to fight the cancer.
There is no blood test that can tell a woman that she is breast cancer free. None. Unlike PSA for prostate cancer and CEA for colorectal cancer, tumor markers for breast cancer are notoriously unreliable. Moreover, even if she did have a blood test that told her she is tumor free, if the tumor is still there, she should pay attention to the tumor, not to any dubious “blood test” that a dubious practitioner represents to her as having any validity whatsoever in determining the status of her tumor.
How anyone could believe this testimonial is beyond me. Then I did a seearch on her name, and it became clear in accounts of how Oprah Winfrey had Tinkham on her show to discuss her decision to treat her breast cancer with “natural” methods that Tinkham really, really believes in The Secret. The same sort of wishful thinking that led her to fall for nonsense such as the “Law of Attraction” has led her to fall for the science-free nonsense that Young is telling her about her cancer. Both Robert Young and Oprah Winfrey, in my opinion, will have been complicit in Tinkham’s death when her tumor progresses, and this sort of story is the reason that I have lost what little respect I had left for Oprah. She has become about as woo-friendly as they come.
The bottom line is that, to those with little knowledge of medicine, testimonials can sound convincing. However, there has to be a Secret-like element of really, really wanting to believe. After all, how else could Tinkham believe she is cancer free when her cancer is obviously still in her breast? Moreover, even someone without much medical knowledge but with halfway decent critical thinking skills and some skepticism should be able to come up with the right question, namely: How on earth can Tinkham claim that she is cancer-free on the basis of a blood test alone when her tumor is still there? Such a person will see this testimonial for what it obviously is, and that person won’t necessarily have to be highly educated to do it. The person who will swallow these sorts of testimonials, hook, line, and sinker for whatever reason has an inherent need to believe in this stuff.
I just hope Tinkham sees a real breast surgeon and a real oncologist and undertakes effective therapy before it’s too late, as her life might still be saved. She may be incredibly lucky that she has what appears to be an indolent, slow-growing tumor, but even indolent tumors eventually grow and kill, usually in particularly unpleasant and nasty ways.