An article in today’s New York Times, based on an article by Zahl et al. to be published next Tuesday in the Achives of Internal Medicine (but already available on line), is about to stir up a hornets’ nest in the world of cancer research.
The study suggests that (at least in the case of breast cancer), there may be a significant incidence of “spontaneous remission” of early stage breast cancers. Specifically, in a study conducted in Norway, 22 percent more women were diagnosed with breast cancer among women who were regularly screened with mammograms and self-examinations than among women were were not regularly screened.
What does this imply?
Let’s think about this for a moment. Our immunological systems fight off disease all of the time, with greater and lesser degrees of success. We know that, at least in theory, cells in all of our bodies regularly can mutate and become cancerous, but most of those cells are chewed up and spat out by our immune systems, and we have no clinical signs of the disease.
So what happens if a cancer starts to grow because our immune system “misses” a few cells at first. One might compare this to the case when we get a worse case of the flu (as opposed to a few flu sniffles). Often our bodies will still fight off a bad case of flu, with the help of some aspirin and a couple of days of rest. We had the flu, but we overcame it. Isn’t it reasonable to imagine that this can happpen with cancer too?
And imagine the implications if we become able to define a “mild” case of cancer, that our bodies can be reasonably expected to fight off. Listen to what Dr. Laura Esserman, professor of surgery and radiology at the University of California, San Francisco, said about the breast cancer study.
“I am a breast cancer surgeon; I run a breast cancer program,” she said. “I treat women every day, and I promise you it’s a problem. Every time you tell a person they have cancer, their whole life runs before their eyes.
“What if I could say, ‘It’s not a real cancer, it will go away, don’t worry about it,’ ” she added. “That’s such a different message.”
Imagine how you might feel if your doctors could tell you that about an early stage prostate cancer!
Before the PSA era, we have no idea how many cancers may have gone into “spontaneous remission” like this. (None? Some? Lots?) What we do know is that there are men who have prostate cancer that doesn’t progress much or at all during their lifetimes. Is one reason for this that their immune systems can successfully fight off the disease? Might we be able to boost the immune system in some way to increase that potential possibility?
Naturally the arguments have already started about how “real” the results of the breast cancer study data are. Some are pooh-poohing the results completely. Others are dubious. In an editorial that accompanies the publication, Dr. Kaplan of the University of Chicago and Dr. Franz Porzsolt, an oncologist at the University of Ulm, say that, “If the spontaneous remission hypothesis is credible, it should cause a major re-evaluation in the approach to breast cancer research and treatment.”
Dr. Kaplan is further quoted in the New York Times as stating that, “I think everybody is surprised by this finding” and “Our initial reaction was, ‘This is pretty weird,’ … but the more we looked at it, the more we were persuaded.”
If I was a prostate cancer researcher today, I’d be looking for an opportunity to test this hypothesis in prostate cancer.