From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)
Gayle DeLong has been diagnosed with what she refers to as “autism-induced breast cancer”. She’s even given it an abbreviation, AIBC. Unfortunately, as you might be able to tell by the name she’s given her breast cancer, she is also showing signs of falling into the same errors in thinking with respect to her breast cancer as she clearly has with respect to autism. As a breast cancer surgeon, regardless of my personal opinion of DeLong’s anti-vaccine beliefs, I can only hope that she comes to her senses and undergoes science-based treatment, but I fear she will not, as you will see. Her brief post announcing her diagnosis and blaming it on autism, however, does provide what I like to call a “teachable moment” about cancer.
We’ve met DeLong before on this blog. For instance, she published an execrably bad study that—of course!—tried to link vaccine to autism and failed miserably, despite doing some amazing contortions of analysis, combining diagnoses willy-nilly, all in the service of the discredited vaccine-autism hypothesis. As I said at the time, it just goes to show that someone who is an associate professor of economics and finance shouldn’t be doing epidemiological research. As I also described at the time, if the sorts of analytical techniques she used in her study are acceptable in the world of economics and finance, no wonder our economy has been so screwed up for so long. Another time, DeLong wrote a broadside against the regulatory machinery that oversees vaccine development and safety that was full of the usual antivaccine misinformation, tropes, and pseudoscience and hugely exaggerated perceived “conflicts of interest” among the various parties.
So it’s not surprising that DeLong latches on to dealing with her autistic children as the cause of her cancer:
I have autism-induced breast cancer (AIBC). While I am not absolutely certain that the 1.9 centimeter lump that grew in my left breast is the result of the stress of raising two autistic children, all indications point in that direction. There is virtually no cancer in my family, I eat organically, I exercise, I’m a good weight. OK, so I live in the toxic dump known as New Jersey, but that is the only other major risk factor. No, the drop in cortisol levels whenever one kid’s school calls or the other kid has a public “flare up” is enough for the cancer to take root.
First of all, it’s very telling to me that she blames her breast cancer diagnosis on having to take care of her autistic children as the root cause of her breast cancer. The implication, of course, is that her decision to vaccinate her children is what led to their autism and her breast cancer. Be that as it may, notice how DeLong is very emphatic in proclaiming her healthy lifestyle bona fides and that there’s “no cancer in my family.” It’s a very common misconception about breast cancer (indeed, nearly all cancer) that it must be familial. In the case of breast cancer, while it’s true that there is a familial component and that there are genes, such as BRCA1 or BRCA2, that, when mutated, result in an enormously elevated lifetime risk of breast cancer compared to women without them, the simple fact is that only around 10-15% of breast cancer cases have a familial or genetic component. That means around 85% of breast cancer cases are what we in the biz call “sporadic.” That basically means “we can’t identify a specific cause.” True, there are well-characterized risk factors for breast cancer, such as age, early menarche, late menopause, nulliparity, and others, but the magnitude of the risk increase due to these factors is way less than, say, a strong family history (i.e., a first degree relative with breast cancer) or an identified cancer-predisposing mutation in BRCA1.
Of course, people don’t like the concept of “sporadic” cancer, mainly because humans crave explanation. The default assumption is that everything must happen for a reason and there must be a cause for every disease or cancer. Perhaps the most emphatic statement of this that I’ve encountered thus far comes from (who else?) über-quack Mike Adams when he heaped contempt on the idea of sporadic disease as “spontaneous disease.” He did this in the context of a story four years ago when America’s quack, Dr. Mehmet Oz, followed recommended care and underwent screening colonoscopy to look for polyps and was shocked that he actually had some:
Dr Oz even seems to think he has a perfect health record, saying, “I have done everything right. I don’t have any family history, and yet I’m high risk now.” His personal physician, meanwhile, is implying that even though Dr Oz’s “healthy” diet was perfect, it wasn’t enough to prevent colon polyps, and therefore you might get them too. (And therefore everybody should get screened…)
This led Adams to bloviate:
Colon polyps, in other words, appear without any cause! Mainstream medicine, you see, believes in the theory of “spontaneous disease” that “strikes” people at random.
Sort of like disease voodoo.
No matter what you do, they say, you can’t be totally sure that you’re disease free. Therefore, you need all their disease screening protocols, mammograms, and CT scans (which irradiate your body and can actually cause cancer, by the way).
What a bunch of nonsense. As any real scientist knows, everything that happens in our universe has a cause. It’s a cause-effect universe, and unless you’re God or can magically change the laws of the universe, you can’t alter the laws of cause and effect.
So if you develop colon polyps, there is a cause for it, and that cause is without question related to the foods you’re consuming, because that’s what is in contact with your small intestine, large intestine and colon. (It’s not the only factor, but it’s the primary factor.)
This is exactly the sort of thinking DeLong is exhibiting. It’s understandable, particularly when you’ve been diagnosed with a potentially life-threatening disease. Indeed, it’s quintessentially human. We all want to know why, and our default is to assume that there must be a cause. It’s also wrong. At least, it’s wrong in the sense that while, yes, there are causes of breast cancer (or colon polyps or whatever), they are often highly multifactorial and can’t be placed into a simple “box” of diet, lifestyle, or failing to do the “right” thing. This whole idea feeds into magical thinking (which I’ve seen voiced before many times) that every disease can be prevented, if only you would do the right thing. The dark side of such thinking, of course, is the opposite assumption, which goes something like this: If every disease has a definite non-inherent (i.e., non-genetic) cause, such as crappy diet, then it’s the victim’s fault, in part or in whole, for getting sick. We’ve seen this same thinking from Bill Maher before as well when a few years ago he attacked the flu vaccine and proclaimed that the “soil” matters much more than the seed; i.e., if you live a healthy lifestyle and eat a healthy diet, your “soil” won’t be conducive to the flu virus and you won’t get the flu. This reached a ridiculous extreme when Maher proclaimed that he was so healthy that he wouldn’t get flu even if exposed in a closed-in space like an airplane, leading Bob Costas to snort, “Oh, come on, Superman!” Sometimes this thinking goes beyond even Maher’s, in that cancer or other diseases are blamed on “psychic trauma” or some other psychological factor. This idea is at the very heart of the quackery known as German New Medicine or its variant Biologie Totale. The attraction of such ideas is obvious: They give the illusion of control, that you as a cancer patient can cure yourself if only you will it enough and act on that will. The dark side of this idea is an even worse version of what I just described. Now, it’s not only your fault for being sick because you didn’t live a “good” lifestyle, but you’re sick because you either lack the will not to be sick or you secretly want to be sick.
As for the idea that stress can cause cancer, even the National Cancer Institute proclaims the evidence that stress can cause cancer to be “weak,” further pointing out that there is “no strong evidence that stress directly affects cancer outcomes.” Indeed, the evidence with respect to stress and cancer is at worst conflicting, at best quite negative, with the occasional study hyped in dubious outlets like the <cite.Daily Mail being proclaimed as evidence that stress causes cancer, but a recent meta-analysis of 116,000 people, found no significant correlation between stress and bowel, lung, breast or prostate cancers. So, despite it being a very common and intuitively seemingly-reasonable idea that stress and cancer are linked, they almost certainly are not, at least not as far as causation. That’s not to say that chronic, unrelenting life stress is a good thing for your health, but evidence strongly suggests that it doesn’t increase the risk of cancer. So, while it’s understandable that DeLong might think the stress of her raising two autistic children is the cause of her breast cancer diagnosis, she’s wrong about that. What’s more disturbing to me is how she views her children’s autism as the cause of her cancer to the point of even calling it “autism-induced breast cancer” and giving it an abbreviation AIBC.
Even worse is how she views autism itself as being as bad as cancer. Actually, I get the distinct feeling she views it as worse than cancer, given the title of her post “The Lesser of Two Evils: Breast Cancer and Autism“. Look at her comparison between how cancer is viewed and her perception of how autism is viewed:
So, I speak from experience when I say Stage 1 breast cancer has nothing on autism. The differences are vast and significant. Unlike autism, no one is telling me to “celebrate” my cancer. No one is telling me that cancer is “just a different way for cells to grow.” People have told me that we’ve always had cancer, but no one is using that is an excuse for not doing anything about it. No one is blaming me (or my mother) for my cancer. Unlike a person with autism, society does not say my cancer is my fault. Another difference is that in three years, I’ll either be dead or cured. Autism is not tangible, so it neither exists concretely nor definitely leaves the body. Although cancer could do to me what autism did to Avonte Oquendo, the chances of dying from a tumor that I treat properly are small and growing smaller.
First off, unless DeLong’s cancer is a certain subtype called triple negative (and even then not entirely), it’s not true that in three years she’ll be cured or dead. Such a binary outlook! Estrogen receptor-positive [ER(+)] tumors can recur 5, 10, 15, and even 20+ years later, and the treatment for ER(+) tumors involves Tamoxifen or an aromatase inhibitor for at least five years. Indeed, trends based on clinical research showing better results are moving towards the recommendation of ten years of anti-estrogen therapy to reduce recurrence risk. Triple negative tumors, while more aggressive at the outset, tend not to recur after five years, usually recurring within three years, but they certainly can recur later. More offensive is her explicit likening of autism to cancer, in which she proclaims that “no one is telling me that cancer is ‘just a different way for cells to grow.’” This suggests to me that she views her autistic children as cancers or at least their autism as bad as any cancer, hence her resentment at the neurodiversity movement that seeks to destigmatize autism.
Avonte Oquendo, by the way, was a teenage boy with autism who walked out of his school to go missing and whose remains were found months later. In other words, DeLong makes the connection between her view of cancer and her view of autism even more explicit: Both to her are killer diseases, but there is a difference. Her cancer is potentially curable.
Finally, if there’s one similarity we see between antivaccine thinking and other quackery, it’s made explicit by DeLong:
However, one major similarity exists between breast cancer and autism: the “wisdom” of the experts. The standard of care for cancer includes popping this sucker out of my breast, and I’m fine with that. However, I’m more than a bit uneasy about the radiation treatment that the surgeon has recommended post-op. Taking a sledge hammer to my breast may indeed kill the cancer, but what about the organ that lies directly under my breast, my heart? If 10 or 20 years from now I develop a heart condition – which is also unheard of in my family – would it be the result of the radiation or just bad stuff happening to good people? The cancer experts don’t care; after all, the cancer didn’t return! Except that sometimes (often?) cancer does return, perhaps because radiation can cause cancer? And don’t get me started about chemo! I didn’t question the established wisdom concerning vaccines, and my kids have autism. I won’t repeat that mistake. I’ll look for alternatives, weigh the options, and determine the best path for me. Amazing how a little pain in the breast can turn one into a huge pain in the derrière.
So her magical thinking with respect to vaccines is leading to magical thinking with respect to her cancer. I find it rather odd many times how patients often have no problem with surgery for their cancer but have so much trouble with other options. Of course, “cutting out” the tumor makes intuitive sense, so much so that I’ve not infrequently had patients show up in my clinic expecting that I would be doing just that that very day. In the old days, surgery alone was it, too; it’s the oldest and most reliable treatment for early stage breast cancer.
I’m assuming that the surgeon recommended a lumpectomy/partial mastectomy because DeLong has a stage I cancer (clinically, at least) and he’s recommending radiation. What DeLong doesn’t understand is that there’s a reason for the radiation. If she undergoes lumpectomy and doesn’t follow it up with radiation, the local recurrence rate (the chance of her tumor recurring in her breast near the surgery site) is 30-40%. With radiation, it’s in the range of 5-8%. That’s a huge difference. Of course, as I’ve described in many of my analyses of breast cancer testimonials going right back to the very beginning of this blog and beyond, in which women undergo surgery but refuse chemotherapy and radiation, it’s still more likely than not that the tumor won’t recur, but a roughly one in three chance of recurrence are not odds that I would be willing to take, particularly when the risk of serious heart impairment due to “collateral damage” from the radiation is so low when modern techniques are used. She’s also quite incorrect that radiation oncologists “don’t care” if she gets radiation-induced cardiac disease because “the cancer is gone.” They care very, very much. An enormous amount of research over the last three decades has gone into developing techniques that minimize the risk of heart damage.
The other question is chemotherapy. If DeLong has a stage I tumor, then it’s quite possible she might not even need chemotherapy! If her tumor is not HER2(+) but is ER(+), and she doesn’t have any positive lymph nodes, what will be recommended is Tamoxifen if she’s premenopausal or an aromatase inhibitor if she is postmenopausal. If she’s triple negative (negative for ER, progesterone receptor, and HER2), chemotherapy will be recommended, as it will if she’s node positive regardless of markers. If she’s HER2(+), chemotherapy with Herceptin or one of the newer anti-HER2 agents will be recommended. In any case, the benefit of chemotherapy in early stage breast cancer tends to be relatively low as an absolute percentage; so it’s quite possible to refuse chemotherapy and do fine. The veritable plethora of “I refused chemotherapy and I’m fine” breast cancer testimonials that I’ve analyzed over the years attests to that. It’s just that DeLong should understand that if she refuses recommended chemotherapy she is increasing her risk of recurrence and death due to cancer. In early stage breast cancer, that increased risk might only be a few percent, but she needs to understand now that if she refuses chemotherapy and does well, it will be because of the surgery that removed her tumor and (if she accepts it) the radiation that reduced the risk of local recurrence, not due to any “alternative” treatments she ends up choosing to use after surgery.
What I fear we’re seeing right here is the beginning of yet another alternative breast cancer cure testimonial. DeLong will likely have surgery and then refuse radiation and chemotherapy. Assuming she doesn’t have any positive lymph nodes (which might or might not turn out to be true), the odds are more likely than not that she’ll probably be OK, but her survival and failure to recur, assuming that’s what happens, will be due to surgery and a lot of luck to have dodged the 30-40% chance of local recurrence. Her odds could be so much better if she just accepted everything modern oncology has to offer for treating breast cancer, and her survival and lack of recurrence. Our locations on opposite sides of the divide over vaccines notwithstanding, I sincerely hope she does just that, because I hope that she does not become this kind of breast cancer testimonial.