Tiresias: Something Close and Personal

"Everyone should know ….. that the major [cancer] research organisations are derelict in their duties to people who support them."

Linus Pauling (Laureate of two Nobel Prizes)

My friends,

Today Tiresias would like to tell a story that is very close to him. A very nice lady, from Tiresias's vantage point, quite young, had a breast lump two years ago. She went through the usual procedures of scans and several biopsies. The histology showed cancer. Postoperative histology raised the question of the “edge-problem”; the resection done by an eminent breast surgeon may not have excised whole cancer. She went back for second surgery six weeks later. This is a very common, almost normal process. The surgeon was again confident that "all cancer was removed". You may well ask how the surgeon could say this. Tiresias knows. It’s called bluff and bluster! Subsequent postoperative scan showed “all clear”. She had some adjuvant chemotherapy and then subsequent long course of radiotherapy. Subsequent local scans and whole-body scans showed that “all clear”. Her first year “check-ups” showed that everything was still all-clear. Last week she had her second annual check-up. The scan shows some new lesions, “recurrence” of tumour. For my friends, that word “recurrence” is a very useful euphemism. It’s not recurrence, it’s regrowth of cancer cells left behind in the first place.

This, my friends, is a story repeated many times daily around Australia and thousands of times around the world. Thirty percent of women who undergo lumpectomy for breast cancer have to have repeat surgery. The surgeons mostly do not use frozen section, for reasons Tiresias has outlined previously. They therefore cannot know if they are removing all the cancer cells. Apart from the inaccuracy and inconclusiveness of the frozen section, it delays the surgeon. There is nothing more that surgeons hate, in their emporium of the operating theatre, than being delayed by “lesser beings”, the histopathologist, prevaricating and not giving definitive answers. The surgeon is interested in getting in, getting out, closing up, and taking their fee, the more times the better. They then hand things over to other lesser beings, medical oncologists and radiation oncologists who proceed to poison and blast with radiation the hapless woman, on the assumption, which can be taken to be a certainty, that there are malignant cancer cells left behind. At the end of all of this therapy, what has been achieved. Well, they have removed or killed 99% of the cancer cells, bought a bit of time before the cancer regrows to the macroscopic level. You will recall that for a cancer to be macroscopically visible, there are approximately 10^9 cancer cells present. That’s 1,000,000,00 malignant cells. Removing 99% means there are 10^7 malignant cells left behind. That’s 10,000,000 malignant cells. Is that all they have done? No that’s not all. They have removed the most vulnerable cancer cells and have selected the most aggressive resistant cells which are survived these assaults, to make the cancer more malignant. What the hell is going on? Why is this happening? Why doesn’t somebody do something?

Optiscan has the technology which should have been accelerated and should be being used right now to be screening the operative field thoroughly to check for any cancer cells and deal with them either surgically, by local brachy-radiotherapy, and local topical medical agents. This first shot at the cancer is the single best shot for a cure. After that, there is no cure, it is just delaying the tide. So, why is this not accelerated? Well, there are many many reasons, some of them do not please Tiresias at all. There are of course pecuniary interest, at all levels. There are bureaucratic impediments. The “cancer organisations” and governments, which claims to support scientific medical research only pay lip service to real R&D. The recent government activities have shown how effective and efficient governments are when it comes to dealing with matters medical. This technology, our technology, should have been prioritised by the Federal government and by the cancer councils for a real "Moonshot" which could transform cancer screening and cancer treatment. But of course, in Australia, there are much higher priorities. There is an election coming

And as for Tiresias's friend, what does she face now? More of the same! The repeat biopsies are already taken; they are being “processed” and will be available in two weeks. This has involved repeatedly plunging a large bore biopsy needle in and around the general area. It is very much a hit and miss process, plagued with sampling error. What does this do? It's surely doesn't do any good for the cancer. There is a track and a disturbance of the cancer loosening of cells implanting them further afield or even were spreading them through the bloodstream. At best, Tiresias’s friend now faces a mastectomy and probably a double mastectomy, ongoing probably lifelong chemotherapy and a very problematic future. She is never cured!

It is sure time to tackle the real problems of cancer and not flirt at the peripheries and pretend that we are doing something. Where is the money from the Pink Test and all the other fundraising going to? "Breast cancer research"! Tiresias would like to finish with one more quote.

"It was recently discovered that research causes cancer in rats."

Stephen Hawking.