Cancer Decisions - Free Newsletter

HERE AT THE MOSS REPORTS

People facing a diagnosis of cancer must often make a series of crucial treatment decisions in very short order. It can be hard to make informed choices at a time when one is under such intense pressure. The sheer volume and complexity of the medical information that the newly diagnosed cancer patient must absorb can be overwhelming. While physicians would almost certainly like to spend more time with their patients, explaining things in more depth and answering questions more fully, the constraints imposed by today's managed care system are making the allocated time per visit shorter and shorter. Deprived of the opportunity to discuss their medical needs thoroughly with a physician, cancer patients often turn to the Internet for answers.

Certainly, the Internet has made vast quantities of formerly unavailable medical literature easily accessible to everyone. But it has also made available an abundance of unreliable and downright misleading information, much of it couched convincingly in pseudo-scientific language. Without the necessary background in the biological sciences, it can be extremely hard for the layperson to make sense of medical journal articles and technical literature, or to avoid falling for persuasively packaged snake oil.

For more than thirty years I have been studying cancer and its treatment, monitoring emerging research and writing about promising new approaches. The Moss Reports are the distillation of my long involvement with the field of cancer. There are now individual Moss Reports for well over two hundred different types of cancer. Each 400+ page report presents the available treatment options for that particular kind of cancer, discussing the rationale behind the treatment and objectively analyzing the expected success rate, drawbacks and alternatives. The reports also contain extensive dietary and nutritional advice both for those who are undergoing treatment and for those who are recovering from cancer and striving to regain full health.

If you would like to order a Moss Report for yourself or someone you love, you can do so securely from our Web site, www.cancerdecisions.com, or by calling 1-800-980-1234 (814-238-3367 from outside the US).

I also offer phone consultations to clients who have purchased a Moss Report on their particular cancer type. A phone consultation can be enormously helpful in drawing up an effective treatment strategy and getting one's options clearly prioritized. As a recent client put it:

"The consultation was extremely valuable in helping me choose among the many therapies I was considering. Dr. Moss was highly recommended by my own physician as an expert in the field of cancer therapies. He was able to save me a lot of time and money by objectively steering me away from treatments that would have been time consuming and expensive, and toward other options that I hope will support me in healing." - L.G.

To schedule an appointment, please call 1-800-980-1234 (814-238-3367 from outside the US) or send an email to Jacquie@cancerdecisions.com.

We look forward to helping you.

CURRENT TOPICS

Also available at our Web site are our Current Topics reports on important aspects of cancer treatment and prevention. Recently we launched a new report in the series, this one focusing on the controversial new anti-cervical cancer vaccine, Gardasil. This report - "On Guard - Gardasil" - and the others in the Current Topics series (listed below), can be purchased for $9.95 each and downloaded directly from our Web site, www.cancerdecisions.com:

On Guard - Gardasil
Mammography, Biopsy and the Diagnosis of Breast Cancer
Herceptin or Deceptin? (An evaluation of the use of Herceptin in breast cancer)
Avastin: Your Money Or Your Life. (A clear-eyed look at the targeted drug Avastin)
Do Antioxidants and Chemotherapy Conflict?
The Politics of Hope: Andrew von Eschenbach and the Decline of the National Cancer Institute
The Mexican Cancer Clinics in the Era of Evidence-Based Medicine

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BIG BLOW TO RADIATION THERAPY FOR BREAST CANCER - PART I

Radiation is widely used as a follow-up (adjuvant) treatment after surgery for breast cancer. It is primarily administered to prevent recurrences and is quite effective at doing so. But a study published in the March 7th Journal of the National Cancer Institute has shown that radiation also increases the risk of heart disease in women who receive it following surgery for breast cancer. Using modern radiation delivery techniques shifts the pattern of harm, but does not remove it.

It has long been acknowledged that the type of radiation used in the 1960s and 1970s elevated women's risk of subsequent cardiovascular disease. But techniques have changed since then, and radiation oncologists have often stated that newer radiation delivery procedures have been deliberately designed to minimize this sort of heart damage. The dangers of radiation to the heart have therefore frequently been dismissed as a thing of the past, and countless women have been told that the procedures performed on them were safe.

For example, in "Clinical Oncology," a textbook published in 2001 by the American Cancer Society, the problem is downplayed. In the course of two paragraphs, its seriousness is minimized half a dozen times!

"Cardiac toxicity due to irradiation is rare...Effects on the endocardium are rare...Below a total dose of 4500 cGy, radiation-induced damage is uncommon...Tamponade [a life-threatening compression of the heart resulting from a collection of fluid in the pericardium (the sac surrounding the heart), ed.] occurs infrequently. In general, pericarditis is self-limited... Chronic pericarditis is uncommon. Acute myocardial infarction [is] rare..." (Lenhard 2001: 243-244).

Many Web sites similarly claim that modern radiation therapy is entirely safe. Here is an example of such a statement from breastcancer.org:

"Radiation therapy techniques have changed dramatically since then [the 1970s, ed.]. New technology allows doctors to use the lowest dose of radiation possible. They can also more precisely target the radiation to the breast and away from the heart - so the heart receives a minimal amount or none at all."

This is what the medical profession believed, and wanted us to believe. However, the facts now speak otherwise. The JNCI study is unquestionably a major blow to the profession's insistent claims that radiation has evolved into a safe modality for the post-operative treatment of breast cancer.

In the JNCI study, researchers at the Netherlands Cancer Institute in Amsterdam evaluated 4,414 breast cancer patients who survived for at least 10 years after receiving radiotherapy between the years 1970 and 1986. The patients were followed for a median of 18 years. These patients' rates of cardiovascular disease were then compared with those seen in the general population (Hooning 2007). In other words, this was a very large and prolonged study.

There were a total of 942 "cardiovascular events" during the follow-up period. The good news was that radiation therapy limited to the breast itself did not increase the risk of cardiovascular disease. However, when either the left or right internal mammary chain of lymph nodes was included in the radiation field, as is common in post-operative radiotherapy, it did significantly increase that risk.

Internal mammary chain irradiation performed during the 1970s increased the risk of a heart attack (myocardial infarction) by 2.55 times compared to no radiation. It also raised the risk of congestive heart failure 1.72-fold. Radiotherapy given in the 1980s was also associated with an increased risk of heart disease: a 2.66-fold greater risk of heart failure and a 3.17-fold greater risk of dysfunctional heart valves. (This was one of the first studies to investigate radiation-related heart valve failure.)

In the 1980s, it became common to add adjuvant chemotherapy to radiotherapy. The standard chemotherapy regimen used during the 1980s was CMF (which stands for the three drug combination of cyclophosphamide, methotrexate and 5-fluorouracil). However, this study found that the addition of CMF chemotherapy to radiation conferred a 1.85-fold increased risk of congestive heart failure. This finding has caused a great deal of surprise since this combination was never thought to be particularly cardiotoxic.

It is chilling to realize that nowadays CMF chemotherapy has been replaced by regimens based around so-called anthracycline drugs, the most prominent of which is Adriamycin (doxorubicin). This class of drugs is already well known to carry serious risks of cardiotoxicity, including life-threatening congestive heart failure. This risk increases exponentially the greater the lifetime dose.

A recent review in Seminars of Oncology concluded that "10 percent to 26 percent of patients administered cumulative anthracycline doses above those recommended...develop congestive heart failure, and that more than 50 percent of patients administered these doses will experience measurable functional impairment months to years after the end of therapy." Also, the susceptibility of patients to anthracycline-induced cardiotoxicity varies widely, with a dramatic increase with advancing age (Jensen 2006).

The risk is further augmented by the addition of Herceptin (trastuzumab), another cardiotoxic drug that is increasingly used in the treatment of breast cancer. Herceptin can cause heart damage ranging from mild and transient to life-threatening congestive heart failure. To quote the package insert warning, mandated by the Food and Drug Administration, Herceptin "has been associated with disabling cardiac failure, death, and mural thrombosis leading to stroke" (FDA 2003). (Mural thrombosis is the formation of a fibrinous clot on the endocardial lining of the heart, or on the wall of a large blood vessel).

In view of these ominous warnings, studies focusing on the cumulative cardiac risk of radiation therapy in patients who have also been given Adriamycin and/or Herceptin-containing chemotherapy regimens are urgently needed.

The JNCI study also found a disturbing three-fold increase in the risk of heart attacks among radiotherapy-treated patients who also smoked tobacco. The authors properly caution that "irradiated breast cancer patients should be advised to refrain from smoking to reduce their risk for cardiovascular disease." Easier said than done! The more logical solution would surely be to refrain from giving adjuvant radiation to patients who insist on smoking.

To be continued, with references, next week.

--Ralph W. Moss, Ph.D.

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IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.