Cervical Cancer Alt-Med Tragedy (an anecdote)

In tragically ironic timing with the AP finally doing decent work on any alt-med, yesterday I saw another victim of alt-med.  Our patient was a woman with cervical cancer who opted against conventional therapies. She’s now paying the price.

Yesterday I was at gyn-onc clinic. It was a pretty horrifying experience that will likely be it’s own post. Eventually… I want to get some positive posts in before that so I don’t become “that guy who blogs about death and dying people all the time.”

However we saw one case so emblematic of what my problem with alt-med is that I wanted to point it out now. Alt-med can kill you, so often when it gets brought up, the shruggies among the medical community say “what’s the harm?” 

Well one of our patients yesterday was a woman who had been diagnosed with cervical cancer. She was a relatively pleasant woman in her 40’s, with some odd beliefs about medicine. Unfortunately her odd beliefs included believing in conspiracy theories like “Chemo is just poison, and natural cures for cancer are just as effective!”

 Cervical cancer is one of the few cancers we can do something with! Except instead of getting treated in any of the early stages, our patient opted for herbal treatments. After the herbal treatments failed to work, she accused her doctors of lying, and went to Mexico for alternative therapies. Who knows what they did to her there. Whatever it was, it didn’t work. 

Either way, she returned to the states, still with cancer. She went to her old doctor, the one she had called a liar, and told him to F— Off. After that she came to our clinic. She presented to us with stage IVB cancer, which means the cancer has spread to distant organs. At this point all we can do is offer her chemotherapy and radiation. My textbook tells us that her chances of making it 5 years is now about 15-20%

To me, that’s tragic. It didn’t have to be this way at all.

Had she been born today,  she could have been vaccinated with gardasil. This is a vaccine against HPV (human papilloma virus), which works by vaccinating against the virus serotypes that most often lead to cervical cancer.

She didn’t have to be born today to get effective treatments though. Even without the vaccination, we can screen effectively for this disease. She got her annual pap test (no longer really a “pap smear”, we generally use a liquid based test now.) With that, we can identify precancerous lesions before they can become a major problem. When identified early, these lesions can be removed. One way is with a LEEP, an office procedure where the pre-cancerous lesion is removed with an electrocautery device. That may sound unpleasant, but it takes about 10 minutes, it’s very safe, and you don’t die of cancer. This is where our patient got out of the conventional medical system. She refused LEEP, or cone biopsy. She was sure she wouldn’t get cancer because her supplements kept her immune system “on top of things.”

If the lesion is too deep or for some other reason not amenable to a LEEP procedure, we can do a cold knife cone procedure. With that procedure, the doctor will take the patient to the OR, and cut away a larger section of the cervix with a scalpel. This takes slightly longer, but it’s an outpatient procedure. After a few hours of observation, the patient goes home.

If the lesion was larger, or extended into the vagina, the doctor could have used a laser to ablate the problem.

All of that is before the patient actually gets cancer. After the patient has cancer, there are still options on the table.

If it’s early stage cancer, meaning it hasn’t spread anywhere, the cone procedure mentioned above could be all the treatment they need. At that point her chances of being cured would still be 85-90%

 If the cancer is too late for cone to have worked, radiation therapy, or a radical hysterectomy would have been enough to be curative. Here, we still have 60-75% cure rate.

If the patient had cancer that had spread into the pelvis, what we would call stage III cancer, we would have to offer chemotherapy and radiation. Chance of cure: 35-45%.

Sadly, as with our patient, waiting until one has distant mets (spread of the cancer to far away from the cervix), we still only have chemotherapy and radiation to offer. Chance of cure: all the way down to 15-20%.

Thats where our patient was. Medicine has made great advances in treating cancer. We can do alot. But you need to use the system to benefit from it. People often say ‘well my chance of cure is still really high now, it’s not that bad, I’ll see if I can get by on alt-med.” That hurts them. They put off treatment when it’s early enough to be curative.

This woman could have had a LEEP. She could have had a one day office procedure, that would have cured her. She likely would never have progressed to cancer. She likely would never have gotten mets. She would have had a full life, and never had to deal with this nightmare.

Now for the price of a couple of years of herbal treatments, and whatever they did in Mexico, she’s got at best 1 in 5, or 1 in 6 odds of making it 5 years. Instead of a one day office procedure she has at least 6 cycles of chemotherapy and radiation to look forward to. 

So yea, alt-med can kill. There are alot of things medicine can do to cure or prevent disease. Still, we can’t help you if you don’t come see us.

Explore posts in the same categories: Medicine, OBGYN dreamin', Teachable Moments

Tags: ,

You can comment below, or link to this permanent URL from your own site.

9 Comments on “Cervical Cancer Alt-Med Tragedy (an anecdote)”

  1. Daniel Says:

    So after all this, why is she accepting treatment? Evil nuclear radiation no less! I’m sure there are more homeopathic remedies left to be tried, or whatever.

    • Her family held some kind of intervention. In the end, she wasn’t antiscience-wouldn’t-ever-listen-to-reason, she was just not properly educated on why her beliefs were wrong.
      She was basically, exactly the kind of person I want to educate with this blog. Someone who has some incorrect beliefs, and doesn’t know any better.

  2. ChristinePAS Says:

    It truly amazes me. Part of me thinks that that sort of mentality and behavior ought to be treated as a mental illness – paranoid delusions, etc. However, that doesn’t necessarily mean I think treatment should be forced… A less-human reason why this is frustrating is that the care she will receive now (assuming she pursues any) will be many times more expensive than the cost of adequate prevention and early treatment would have been.

  3. JLK Says:

    I’m just going to rant for a second here, I hope you don’t mind. I got an email today from my health insurance company reminding me to schedule a pap test “in order to reduce my risk of cervical cancer.”

    But the fuckers refuse to cover gardasil. I am reaching the end of the age eligibility, and I’ve been waiting for them to start covering it ever since it came out. Now I’m not going to be able to take advantage of it unless I pay the ridiculous $$$$ the drug costs out-of-pocket.

    • As always, nothing I say here is medical advice. You should discuss this thoroughly with your own primary care doctor.

      Most(not nearly all) doctors think that the vaccine works primarily by protecting you from HPV before you are exposed to it. A minority think that it helps you clear HPV even if you have already been exposed. It is my understanding that clinical trials are currently underway to determine if gardasil helps in patients who have already been exposed.

      Clinical trials are also underway to see if the age range for the vaccine can or should be expanded.

      All that being said, I understand that you’re near the current tail end of the vaccination window. You are also married. So long as you and your husband don’t have any additional partners, you most likely won’t be exposed now. If you haven’t been exposed, you’re relatively low (but not zero!) risk. If you have been exposed it’s at the moment unlikely that the vaccine would help significantly.

      Either way, the best screening for you really is an annual pap test. This goes just as much for people who have been vaccinated with gardasil, because gardasil doesn’t protect against 100% of the HPV variants that can lead to cervical cancer.

      None of that indemnifies the insurance company, because they should be all about paying for vaccines – something that protects your client without relying on your client to see their doctor yearly would save them some megabucks.

  4. Katherine Says:

    I still want to know why (in New Zealand at least) they are only offering the vaccine to girls. Surely a vaccine should be promoted to everyone, to get the best coverage, and hopefully eventually herd immunity. Not that I got the vaccine, it wasn’t offered to my age group and I have probably been exposed already. I hope you do end up reaching the people you mean to Whitecoat Tales (not tails 🙂

    • Doctors are asking the same question. It’s proven to work in women. It isn’t yet proven to work in men. The primary benefit is in prevention of cervical cancer, very common in women. The corresponding cancers in men – a type of penile cancer, and anal cancer, are not particularly common. As to whether immunizing men protects women from cervical cancer better, while it may seem like a slam dunk yes, we don’t know yet. It’s being studied as well.

  5. I’d like to find out more? I’d like to find out more

  6. Use the cover available to help you when
    you decide to make your move and pick your enemies off one at a time.
    Make yourself feel like an actual real pool club,
    and perform the angled or spinned cue strokes that will allow you outperform any player.
    Maximum loan amounts average at least $10,000, so you’ll have a ton of cash on hand.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: