Longtime readers of this blog are familiar with one major kind of blog post that I've done periodically ever since the very beginning of this blog, and that's the alternative medicine cancer cure testimonial, particularly breast cancer cure testimonials, but also testimonials for a wide variety of cancers allegedly "cured" by a wide variety of quacks. It started with Suzanne Somers and Lorraine Day, whose stories I deconstructed and showed not to be indicative of a cancer cure due to the quackery they were pursuing and continues to this day. Another, related category of post are early alternative cancer cure testimonials, in which a recently diagnosed cancer patient is featured in the newspapers, usually in a credulous story that frames her (and it's usually a breast cancer patient) as "bravely" going against the establishment. I detest both of these variants of alternative medicine cancer cure testimonial, but I particularly despise the latter, mainly because a cancer patient's best shot at a cure (or long-term remission) is the first shot. Anything that might influence new cancer patients to try quackery instead of effective medicine enrages me. I make no apology for that, because people can die from delaying their treatment.

I heard about just such a story the other day, as I was perusing my e-mail after getting out of the operating room after a long day operating on breast cancer patients. At first, I thought about whether I wanted to take it on. After all, this is the sort of crappy, credulous news story that I can practically deconstruct in my sleep after 12 years of doing this, and I've done many of these. So I didn't do it for yesterday's post. But, then, the social media furor over fake news and the particularly apt term inadvertently coined by President Trump's advisor Kellyanne Conaway, "alternative facts," and I got to thinking about the similarities between "alternative facts" and alternative medicine. No, I'm by no means the first to think of this parallel, and I'll have more to say about it either tomorrow or next week, either here or at my not-so-super-secret other blog. (Sometimes some concepts need a few days to percolate, even for the blog.) However, the other thing that Conaway's dissembling and lying reminded me was that, just as alternative facts can lead to "American carnage" (couldn't resist), alternative medicine also leads to death and suffering. That led me to examine this case in my usual inimitable fashion.

In this case, the woman's name is Sarah Valentine; the cancer is breast cancer; and the story appeared in the Mirror and entitled Mum-of-four battling breast cancer turns down traditional NHS treatment in favour of vegan diet: Sarah Valentine, whose youngest child is aged just one, says she is "100 per cent sure" her breast cancer is "emotional":

A mum-of-four with breast cancer plans to cure her illness with an alkaline-based vegan diet after turning down conventional NHS treatment. Sarah Valentine noticed an indentation on her left breast as she danced naked in front of her mum Annie Herbert's mirror on December 3 last year. The 36-year-old was later diagnosed with cancer and offered either a full mastectomy or a lumpectomy, and radiotherapy, on the NHS. However, she defied medical advice by declining both options.

Yes, this story checks all the irresponsible boxes of these stories. Appealing subject? Check. Valentine is young and attractive? Check. Appealing family? Check. (Complete with photos of her holding her toddler and with her husband There's even the angle of how she found her cancer, dancing naked in front of a mirror, to add some titillation. There's even a photo of her breast, looking all purple and green for a bit of shock value. Yes, it looks bad, but a breast surgeon (like me) knows that this is no big deal. Sometimes there's bleeding into the tissues after a needle biopsy, leaving a hematoma and bruises that look quite nasty. It's a known potential complication of core needle biopsy. The photo, of course, only adds to the sympathy for Valentine being stoked by the article with all the subtlety of Breitbart News.

Being a breast cancer surgeon, I always go straight to whatever information I can find about the diagnosis that lets me know the stage and prognosis, even before I look at the quackery being indulged in. First, here is the timeline:

Sarah discovered her lump after stepping out of the shower and dancing in front of a mirror at her 60-year-old mum's home in Bermondsey, south London. “I thought I’d lost weight, so was dancing around a bit,” she explained. “It was then I noticed the lump.” Two days later, on December 5, Sarah headed to her GP, who referred her to the breast clinic. On December 19, at Buckland Hospital in Dover, Kent, she was examined. Concerned, the doctor referred her to Kent and Canterbury Hospital, Canterbury, for an ultrasound, needle biopsy and mammogram. But it was not until December 30 at William Harvey Hospital in Ashford, Kent, that Sarah's cancer was confirmed. “I knew already,” she recalled. “As soon as I saw the indentation and felt a lump, I realised.”

This is not an atypical timeline in the US. Here I found:

Sarah said she hopes her extreme measures will reverse the progress of her currently Stage 1 cancer, which is made up of two tumours measuring 2.1cm by 1.7cm and 1cm by 1cm.

The surgical pedant in me can't help but point out that that is not stage 1 cancer. By definition, stage 1 cancers only go up to 2 cm in diameter. Valentine's cancer is stage 2, stage 2A to be more precise, although the stage could be higher if it's spread to her lymph nodes. We don't know whether it has or not because normally the way we find out if the lymph nodes are involved is to sample them using a procedure known as sentinel lymph node biopsy at the time of lumpectomy or mastectomy. I also wish I knew what the tumor markers were. Tumors that make the estrogen receptor, for instance, can be treated with anti-estrogen pills like Tamoxifen or an aromatase inhibitor. Tumors that don't almost always require chemotherapy. Tumors that make the HER2 protein require Herceptin. I can figure out a lot about potential prognosis and treatment from that information. Frustratingly, that information is rarely included in stories like these. There isn't much more in Valentine's video, but there is some:

For instance, she says her tumor is grade 1, which is good. That means it is well differentiated (i.e., looks more like normal breast tissue). Notably, this was shot before she decided not to have surgery.

In any case, this is a more unusual version of the alternative medicine cancer cure testimonial in that Valentine has refused all treatment right out of the gate. Usually, these testimonials take the form of a woman refusing chemotherapy and radiation after undergoing surgery. As I've explained more times than I remember, in such cases, it is the surgery alone that was probably curative. Radiation and chemotherapy are adjuvant therapies, which means that they are not the primary therapy. They basically "mop up" microscopic tumor cells that might have been left behind, thus decreasing (but not eliminating) the chances of tumor recurrence. In this case, there has been no surgery, just a biopsy.

I also can't help but comment on a disconnect. In the story, Valentine recounts all the things she's done to stay healthy and avoid cancer. The story recounts how she only ate "free-range eggs, well-sourced meat, and good quality butter," and how she was also careful not to take hormones in her food and favored natural producgts. She also did this:

“I used bicarbonate of soda instead of deodorant, never had any hormones in pharmaceuticals or food, ate healthily and breastfed all my children,” she said. “I couldn’t believe that I got ill.”

How often do we hear this refrain? "I can't believe I got ill. I did everything right! How can this be?" People prone to beliefs like Valentine's tend to have a vastly inflated view of the power of diet to prevent cancer. Everything is probabilities, and nothing is anywhere near 100% preventative, even diet. No, strike that. Particularly diet. Diet can decrease the risk of breast cancer, as obesity is a risk factor, but the strength of these risk factors is dwarfed by risk factors that are not under a woman's control, such as family history. That's not to say that it's not worth altering diet to decrease the risk of breast cancer. After all, altering diet and lifestyle to lose weight has so many more health benefits, although the reduction in breast cancer risk is modest. Yes, you can "do everything right" and still get breast cancer. I note that in one story about Valentine it's noted that her mom had cancer, but it is not mentioned which cancer. I'd bet it was probably breast cancer, given Sarah's diagnosis of breast cancer under the age of 40.

Be that as it may, this is what Valentine is doing:

Instead, Sarah, from Kent, says she plans to cure her disease through a combination of healthy eating, bitter almonds and purified water. She has overhauled her diet to eliminate meat and dairy - and says she is "100 per cent sure" that her breast cancer is "emotional". “I’ve chosen the natural way to show cancer the door, pronto,” she said.

"Healthy eating," unfortunately, does not cure breast cancer. No doubt she is eating almonds as a source of amygdalin (also known, incorrectly, as "vitamin B17" or Laetrile), but Laetrile is long-discredited quackery that's never been shown to have any anticancer activity, although it can cause cyanide toxicity. I also note that the claim that cancer is "emotional" is a common strand in cancer quackery. In particular, it is the basis of New German Medicine or its bastard offspring, Biologie Totale, a particularly vile form of quackery that posits that cancer is due to emotional trauma, sometimes unappreciated.

What she plans to do is described on her GoFundMe Page. Of course:

My treatment through the NHS will cost a minimum of 30k. But I want to do this as natural as possible and that's where I need your help. I need to get vitamin C drips, suppliments, a water distiller, thermo imaging to check tumour shrinkage, hormone testing reports, and generally taking the weight off my shoulders financially as my regular job was night work and that meant not sleeping properly so I've had to give it up while I kick start healing and get as much rest as I can. Did really love to get 'Shake your tits' trending as we should all be shaking, massaging, feeling our way around to spot any changes in our breasts as soon as possible.

Hmmm. £30,000 doesn't go as far as it used to, given that, as of last night, £1 = $1.26, which is way down from when I traveled to London in the fall of 2015. (Hmmm. Maybe I should go back soon.)

Actually, Valentine's GoFundMe page is somewhat vague. Thermal imaging is thermography, which has never been shown to be a useful means of screening for breast cancer or following a cancer's response to therapy. Naturopaths love it, though. Drinking only filtered water won't cure cancer, either.

Other stories revealed a bit more detail. For instance, she plans to buy a vitamin C and sodium sultanate drip. I've encountered high dose vitamin C quackery, but I've never encountered sodium sultanate. I wasn't able to find much about it other than that it's an emulsifier and that it might be used to remove heavy metals.

Also:

Sarah takes Golden Paste – a product made up of turmeric powder, water, oil and pepper – daily and has invested in a £300 water filter, which she attached to her tap, to purify all her water.

Turmeric extracts and various compounds from it do have anticancer activity, but it is modest at best, and the bioavailability is questionable.

OK, none of this stuff is likely to have any effect on Valentine's cancer, meaning that she is, in essence, going untreated. What is the likely outcome? What is the natural history of untreated breast cancer? This is not easy information to come by, because it's unethical to leave breast cancer untreated. We do, however, have some data from 100 years ago that is helpful. Basically, in the pre-mammography era, the median survival of untreated breast cancer was 2.7 years. 4% survived ten years. These are not good odds. Of course, it's hard to compare data from the 1800s to 1930 to today for the simple reason that all of them presented with palpable masses, not mammographic masses. We also have no idea about the grade or hormone receptor status of any of the tumors. It's likely, given her grade 1 tumor, that Valentine probably is on the more favorable end of the scale. Even so, without treatment, sooner or later Valentine will almost certainly die far earlier than she would have without treatment. And it won't be pleasant. She could well wind up like Michaela Jakubczyk-Eckert. Alternative medicine kills dead.

I also can't help but note that there are different levels of irresponsibility in publishing this story. The Sun, for instance, doesn't include a skeptical voice. METRO, on the other hand, at least quotes Cancer Research UK.

The other day, I discussed the phenomenon of fake news. There is also fake medicine, currently known as alternative medicine. Both endanger lives. There are more parallels, but that is a topic for another day.