The latest reports on needle biopsies certainly reopen a concern that has troubled many observers for a long time. I myself raised these concerns in my first book, The Cancer Industry (1980), quoting the 1974 ACS textbook cited above. I certainly respect Dr. Hansen’s cautious and scientific approach. It is true that the full clinical significance of these lymph node metastases is not known (that is, how many of them would go on to develop into full-blown metastatic cancers, and how many would remain dormant in the local lymph nodes).
What is more certain, however, is the devastating effect that the development of such metastases has on the patients involved. First, instead of being told that they have a tumor that is almost certain to be cured by localized treatment (surgery with or without adjuvant radiation), they learn instead that the cancer has now escaped out of a confined area and has been seeded into another part of their body. Second, they will almost certainly now be strongly urged to take highly toxic combinations of chemotherapy with all its unpleasant and dangerous side effects, a treatment that would not have been necessary had the tumor remained confined to its site of origin.
Imagine the outrage these patients will feel when they learn that many of these sentinel node metastases were caused not by the natural progression of their disease but directly by the actions of well-intentioned (but ill informed) doctors. Imagine, further, what will happen when patients find out that questions have been raised about the safety and advisability of needle biopsies for a number of years by some of the finest minds in oncology. Imagine the disruption of the smooth functioning of the “cancer industry” when patients start demanding less invasive ways of diagnosing tumors. And imagine the class action lawsuits.
I think it is because of nightmare scenarios like this that no one in the medical community has yet come forward to draw the obvious conclusions from this provocative study for the general public. Doctors are silent. Politicians are unaware. And journalists, whom we look to as a “fourth estate” in issues of public policy, are silent on this, as on most of the really outrageous developments in the cancer field.
How else do we explain the fact that despite the impeccable credentials of the John Wayne Cancer Institute team, and prominence of the journal in question, this report has generally been ignored, as has the equally disturbing report on liver metastases in the British Medical Journal. Although Reuters did cover the John Wayne study at the time it was published (June, 2004), a scant three months later I could find only a handful of websites that still mentioned it, out of 82,000 that mention needle biopsies in general.
Needle aspiration biopsy continues to be viewed as the gold standard of diagnostic aids (Crabtree 2004). The whole notion that biopsies may themselves spread cancer may be too hot to handle for most of the media and the medical profession. It is one of those medical secrets that, it seems, is best left unexplored.
NOTE: Readers will inevitably want to know what options are open to patients who want to avoid needle biopsies. First of all, one should fully explore imaging techniques such as CT, MRI, PET scans and ultrasound. PET scans are particularly sensitive, and can often detect minute metastases, even before they become clinically apparent. It should be borne in mind, though, that such scans do subject the patient to transient doses of radiation. Mammograms have become increasingly accurate over the years, although there, too, questions have been raised about the exposure to ionizing radiation involved, and there are also legitimate concerns about the compression of the breast that accompanies most such tests, which itself may on occasion be responsible for dislodging clusters of cancer cells, thereby facilitating spread.
An innovative and non-toxic kind of diagnostic test is thermography, which detects abnormal patterns of heat emanating from areas of high metabolic activity. Although thermography has had its ups and downs, the result of a four year, multi-center clinical trial, led by the University of Southern California, was unambiguous: “Infrared imaging offers a safe, noninvasive procedure that would be valuable as an adjunct to mammography in determining whether a lesion is benign or malignant.” The sensitivity of the test in this study was an astonishing 99 percent (Perisky 2003).