As a doctor, I got very uncomfortable with today’s Howard Stern interview with Jim Breuer. I think Jim seems like a very likeable, talented, and smart guy.
On the May 30 episode, he talked about his wife having being diagnosed with breast cancer after discovering a lump in her breast. She decided to have aggressive surgery and had a double mastectomy. It turned out she also had an early cancer in her other breast, so it was a good thing she was so aggressive with surgery.
The part that concerned me is when he talked about his wife’s decision to not have chemotherapy. It may very well be that avoiding chemotherapy was a very reasonable choice, but he didn’t present enough information in the interview to know if that was the case. Howard moved the interview along, which is probably why Jim didn’t get that information out. Instead of getting to the real reasons why chemotherapy wasn’t the right choice, Jim gave a few good anecdotes about one doctor with apparent frotteurism issues and a fixation on support networks, and another who just didn’t seem interested in having a real discussion about alternative and holistic treatment options.
Maybe Jim exaggerated some of his encounters to make for better stories (they were good stories). But one part he seemed serious about was the “biochemist” who analyzed his wife’s blood in order to optimize her treatment. Jim presented things as if the biochemist was suggesting that she got cancer because of using birth control. He claimed that 90% of the people he sees with breast cancer had been on the pill. This isn’t much of a stretch, as around 80% of women have taken the pill at some point (see table 1). It would be interesting to see if the rate of oral contraceptive use is higher in attractive women, which made the biochemist’s guess even more likely to be true in this case.
Regardless of how the biochemist made his conclusion, there is pretty good evidence that oral contraceptive use increases breast cancer risk slightly, with prolonged use (greater than 10 years) increasing risk more. To say that oral contraceptive use caused someone’s breast cancer is a big stretch, though. I don’t think any respectable doctor would make that claim. A very good summary of the cancer risks (and benefits) of taking birth control pills can be found at the National Institute of Health’s National Cancer Institute website. They do reference one very large study which shows a slight but statistically significant increased risk for current birth control use, but no significant increased risk for women who previously took birth control. One interesting and probably important finding was that most of the increased risk was associated with a specific type of oral contraception, known as triphasic pills.
When I started writing this blog post, I was working under the assumption that there was no evidence that diet can significantly affect cancer, and that Jim’s claim that “cancer loves sugar” was completely baseless. However, after spending a few hours reading some reliable research, there may actually be some connection. I was very disappointed when doing a Google search on the topic, as the internet is filled with claims that are not supported by research, but many websites present this information as if it were fact. Many of these websites were claiming the ketogenic diet can “starve” cancer, but I haven’t found any studies in humans to support the claims. I turned to reliable sources of research, mostly pubmed which includes research from peer reviewed scientific journals.
There has long been an interest in the association of diet and breast cancer. There was a very nice summary of theories as early as 1978. Back then they had pretty good data on animal models that a low fat, low protein, calorie restricted diet inhibited tumor growth, but these studies did not easily translate into human benefits. In 1993, one review said that there was a suggestion that high intake of saturated fats contributed to breast cancer in post menopausal women, but that most studies looking at diet and breast cancer were inconclusive, probably because it is a difficult to get accurate data. In 1998, one summary suggested that diets “that include increasing fruit and vegetable consumption, eating a low fat diet, reducing cooked meat consumption, and avoiding alcohol are likely to be of potential overall benefit in lowering the risk of human breast cancer.” A very well designed study showed that implementing a diet of high fruits, vegetables, and fiber and low fat did NOT make any difference in breast cancer survival. A good recent review from 2012 states
The available literature suggests that both low-fat and high-fiber diets may be weakly protective against breast cancer, whereas total energy intake and alcohol appear to be positively associated. Fiber may be weakly protective possibly through modulation of estrogen, whereas fruit and vegetable intake is not clearly associated with risk. Obesity is a risk factor for postmenopausal disease, and adult weight gain should be avoided to reduce risk. In survivors, diet has the greatest potential influence on overall mortality rather than breast cancer-specific events.
There are quite a few large, well designed studies looking at the incidence of diabetes and cancer. There is definitely an association with some cancers, but the association is only a slight one when it comes to breast cancer. The risk is increased the most for liver, pancreatic, and endometrial cancers. One interesting study found that the increased rate of breast cancer in diabetics is only noticed in the first few months after the diagnosis of diabetes is made. They also didn’t find any increased risk in pre-menopausal women. There is also some good data to show that people who have diabetes and breast cancer have a shorter survival compared to people who don’t have diabetes, but the way the two diseases affect each other isn’t understood at this time.
As best I am able to tell, there is no evidence (yet) that following a specific type of diet can either prevent breast cancer or reduce the recurrence of breast cancer, but evidence does suggest that there is a very slight association between certain diet types and breast cancer. If anyone wants to point me in the direction of good research to show how diet can impact cancer, I’m happy to amend my comments. I hate websites that prey on people with serious illnesses with unrealistic claims. People have a right to know good information and make informed decisions.
Howard gave Jim a hard time about his wife’s choice not to have chemo. Howard never let Jim fully explain his rationale. Jim started to talk about his wife having immune system issues, and started to mention her sugar level was high. It didn’t sound like he was saying she was diabetic, and sugar isn’t really a measure of immune system strength. Obviously, other medical conditions would need to be factored in when recommending treatments.
As I said above, there is no way to know if chemo was even indicated in his wife’s case. I hope and assume Jim and his wife got the facts from one of the oncologists before deciding chemo wasn’t for her. Jim started to say that he felt the oncologists were biased in favor of chemo in order to make more money. As I am and have always been a salaried physician, the thought seems foreign to me. Unfortunately, there is going to be some level of motivation to recommend treatments which provide the most profits, no matter how ethical someone tries to be. Many biases are not on a conscious level. It is sad that you should have to go through the effort to find out if your oncologist is salaried and not likely to be influenced by financial incentives. There was actually a study done on financial incentives for oncologists.
Fortunately, though, in many situations, there are pretty clear treatment recommendations based on solid scientific evidence. While I’m a critic of the pharmaceutical industry for doing many unethical things and making the pool of scientific research suspect, I also think that most respectable scientific journal articles are done properly and try to minimize bias.
Back to the question of whether chemotherapy was even indicated, there is a nice simple overview of situations where chemotherapy is generally recommended in breast cancer patients. While Howard may have presented it as a black and white decision, there are often many personal factors that have to be weighed in making these major decisions.
I really hope the best for Jim and his family. Cancer sucks, and especially so in young people with young families. It pains me to think how I would handle such a situation. He is such a talented guy. I really think this year is going to be his breakout year.
By the way, if some of my blog post here seems a bit disjointed – I lost my first draft and the backup was about 25% complete. I probably should spend some more time editing it now, but I just don’t have the patience. I hope I at least got some of my main points across.