When to stop cancer treatment

The mathematician Hannah Fry received a cervical cancer diagnosis in January 2021. The oncologist informed her that it was still unclear whether the disease had been at its third stage and had progressed to the lymph node system when she obtained her diagnosis. Fry had a 90% chance of surviving if it hadn’t. However, those chances were roughly 60% if it had spread. We weren’t really certain, but it appeared that the cancer was in four of the the nodes, she adds. “The doctors made the decision to perform a highly aggressive and drastic surgery. In essence, they removed a third portion of my abdomen.

Fry struggled with the risk assessment needed to decide whether to pursue a certain cancer treatment despite her clear worry. These are not pleasant procedures; they have far-reaching effects, she claims. “When you have cancer, you frequently battle an elusive foe who might or might not exist. And even if it exists, it might or might not provide a serious threat.

There is proof for this statement. For instance, a team of Danish pathologists examined 77 recently expired women during autopsies in the 1970s. They had never been given a cancer diagnosis and had passed away from a variety of causes, such as heart attacks or vehicle accidents. In order to look for symptoms of cancer, the researchers conducted double mastectomies, and they discovered aberrant tissues—cancerous or precancerous—in roughly in approximately 25 percent of the group. “This is an astonishing result,” Fry says.

“This study has been conducted repeatedly for other cancer types, including thyroid and prostate cancer. The best estimates we currently have show that, at any given time, between 7 and 9 percent of all of us are unaware that we have cancer in our body.

Fry puts this estimate in perspective by pointing out that it is only roughly 10 times as many people as actually receive a cancer diagnosis. “What means is that, the majority of the time, our bodies have become quite good at identifying cancer cells, killing them, and removing them,” she explains. “Even when our bodies fail at that, the cancer frequently grows so slowly that you will die of something else.”

In a different study, researchers examined over 1,600 men who had received a prostate cancer diagnosis. Three groups were created from this cohort: one underwent surgery, one received radiotherapy, and the third did not receive any medical attention but was instead under constant observation. “At the conclusion of this study, after a couple of years, there was no disparity in overall survival,” claims Fry. And yet, as a result of the radiotherapy, those who underwent a medical procedure were left with issues like erectile dysfunction (ED), incontinence, and gastrointestinal disorders. A third study in South Korea examined the impact of a countrywide thyroid cancer screening program on mortality rates. The result was the same. Despite an increase in diagnoses and therapies, the mortality rate remained the same.

Fry remembers going to a cancer clinic while undergoing treatment. There she encountered a middle-aged woman who had recently had a breast mass removed. Her physician walked her through her options, stressing that even though all of the diseased tissue had been removed that had been found to be cancerous, there was still a chance of a recurring, which might then be incurable. She was then given the choice of continuing her chemotherapy and quitting it, according to the doctor. Her odds of surviving were already 84 percent very good. According to statistics, treatment would only slightly boost those chances. She was clearly very scared, according to Fry. She said, “Okay, I’ve thought about it, and decided to have the chemo, because otherwise I’ll die.” Fry was in awe. Was paying the price for such a slight increase in her chance of survival worth enduring such a torturous medical procedure?

Fry is aware that it can be challenging to make a decision based on statistics when faced with a dreadful cancer diagnosis. She experienced the same decision-making process. She counts herself among the fortunate because she has been disease-free for almost two years, but as a result of her treatment, she now has lymphedema, a chronic ailment that causes her lower limbs to swell. Although we were unaware of it at the time, she claims, “we took a very cautious route that we didn’t need to.” “Remorse isn’t actually the issue. Simply put, I think the decision was taken without giving me a chance to consider what really mattered to me.

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