I follow Katie Ford Hall’s blog. In a post titled Birds and Rabbits she summarizes a portion an article by Christie Aschwanden on the Case Against Early Detection – where Cancer is categorized into four types. I’ll quote Katie here:
Here’s where she gets brilliant. She describes four types of cancer:
- The Turtle – a cancer so slow-growing that it will never become an existential threat.
- The Rabbit – a cancer that is growing and spreading rapidly. This is the “relentless progression” type. Again, however, the biology of the tumor dictates whether current treatment methods are curative, and as I am so fond of saying, we only know we are cured if we die of something else.
- The Bird – a cancer that will become fatal before it is detected. Some have speculated, for example, that some breast cancers hides in the bone marrow, inactive and undetectable, then reactivate as metastatic breast cancer in the future. This “seeding” might even happen before the initial detection, no matter what at what stage the primary tumor is discovered.
- The Dodo – a cancer that will die off on its own without treatment.
And here are interesting paragraphs from the original article by Christie Aschwanden (bolding is mine and not in the original article):
What’s clear is that cancers fall into a few general behavior patterns, which Welch and others have compared to animals that must be kept in the barnyard to prevent a deadly rampage. Papillary tumors are like turtles — they move very slowly and never pose an escape risk. They don’t need screening, because they will never cause trouble. Then there are rabbits, which are eager to hop away to other parts of the body, but can be confined if they’re found and fenced. These are the cancers that can be helped by early detection and treatment. Birds, on the other hand, are so flighty and quick that they can’t be confined. Screening makes no difference for bird cancers, because they’re so aggressive that they can’t be detected before they’ve begun their deadly course.
No cancer screening has ever eliminated the majority of cancer deaths. Instead, the best screening can do is reign in the rabbits. Birds remain unstoppable, and they’re the ones responsible for most cancer deaths. This is why, Welch says, three decades of mammography have failed to put a dent in the rate of women presenting with metastatic breast cancer upon their initial diagnosis. Women with breast cancers that behave like birds will almost never be helped by a mammogram, nor will men with the most aggressive prostate cancers be saved by PSA tests.
First I want to say that cancer is complicated. There is no one right answer. I agree that in some cases early detection doesn’t matter … in some cases early detection does more harm than good (over diagnosis/over treatment) … in some cases early detection saves lives.
In my case, I’m not convinced an annual mammogram would have made a difference. I am of the firm belief that if I had done an mammogram in January (when my doctor initially ordered one), it would have shown nothing, because I didn’t have cancer in January. Further, it would have been harmful if I were to rely on an annual or bi-annual mammogram and did not conduct my daily inspection of my breasts. I found my cancer early through breast self-exams.
When we talk about cancers using the classification above, I’m hoping that my cancer is of the Rabbit type. We know that it grew quickly, but I also caught it early. The primary tumor was certainly fast growing (that was confirmed by the initial biopsy). My current plan is to die of something other than breast cancer …