Tuesday, January 12, 2010

Paradigm Shifts in Cancer Care

By Jacob Schor, ND FABNO

Small cell carcinoma, CAM 5.2 immunostain (400x)
Photo by euthman, via flickr, used under the Creative Commons License.

A big change is occurring in the way scientists view cancer and we need to keep up. Perhaps we may need to update our terminology. Or perhaps go back to some older phrases from years ago.

My ruminations are triggered by an article Gina Kolata wrote that appeared December 29 in the New York Times titled, “Old ideas spur new approaches in cancer fight.”

In her article, Ms. Kolata describes the work of Mina Bissell, Bert Vogelstein, Barnett Kramer and other researchers who are reshaping the way cancer is seen. The current view is that cancer is the result of genetic damage allowing malfunctions to accumulate. The blame is laid on individual cells that become cancerous and pass on their dysfunction to their offspring. The new paradigm that Kolata describes is different: “Gene mutations are part of the process of cancer, but mutations alone are not enough. Cancer involves an interaction between rogue cells and surrounding tissue.”

Early ideas on cancer once dismissed, such as that, “… a blow to the breast might spur cancer, an infection might fuel cancer cells, a weak immune system might let cancer spread…” are being reconsidered. The rapid decrease in breast cancer rates seen after hormone replacement therapy went out of favor is a prime example of why the old explanations are inadequate. Because breast cancer rates dropped too rapidly to be explained by genetic changes, Kolata offers us a more plausible explanation, “…that the hormone treatment somehow changed the environment of naturally occurring cancer cells…”

This isn’t that different from the ‘fertile field’ debate that modern medicine thought ended with Louis Pasteur several centuries ago. On the one side are those who favor a simple causative explanation for disease as in, ‘Germs cause illness.’ Our profession has favored, or at least given credibility to, the ‘Fertile Field’ concept, that ‘Germs won’t grow unless they find a suitable host, a fertile field.’ The changing views Kolata points out in her article run parallel to this idea. Cancer won’t grow unless it finds itself in a suitable environment.

I admit to having fallen under the sway of this ‘genetic damage’ model of cancer. Many of the therapies and supplements we have suggested to patients have focused on attacking cancer on this level; supplements that encourage DNA repair or that trigger apoptosis (cellular suicide). Both of these processes have been aimed at the cancer cells rather than on the ‘cancer environment’ in the patient’s body.

In recent years though, more and more, my thoughts and those of my colleagues who specialize in naturopathic oncology have shifted. Rather than thinking of a ‘fertile field’ in which a germ can take root and grow, I find myself using analogous terms like, ‘weather, climate and season,’ that can be either favorable or unfavorable for cancer growth.

We have been paying increasing attention to the effects on cancer of various hormones, growth factors and inflammatory markers. Goals like changing levels of insulin-like growth factor 1 (IGF-1), transforming growth factor Beta-1 (TGFB-1), or NFKappaBeta (nfKappaB) have become the focus of our therapeutic choices. We are trying to understand the effect mast cells have on tumor growth, the consequences of chronic inflammation and the chemicals this triggers. Fluctuations in these chemicals mark the daily ‘weather’ in the body. As TGFB-1 increases, single breast cells find it easier to metastasize. As IGF-1 increases, tumor cells grow as if fertilized. The long-term overproduction of these chemicals and others may be a barometer to gauge the body’s climate.

If we stretch this analogy one step further, might we say that vitamin D marks off the seasons in the body’s internal calendar? Certainly it is in the winter when vitamin D levels drop to their lowest point that cancer finds the most favorable environment to grow.

How different the clinical approaches these different result in was brought home to me last week. Nathan Seppa writing in the January 2, 2010 issue of Science News described a recent report on vitamin D’s effect on lymphoma: “Sunshine vitamin may play protective role against common form of the blood cancer.”

In the article, Seppa describes a presentation by Matthew Drake of the Mayo Clinic at the annual meeting of the American Society of Hematology. [Vitamin D deficiency is associated with inferior event-free and overall survival in diffuse large B-cell lymphoma. Abstract # 1953, American Society of Hematology 51st Annual Meeting, New Orleans, Dec. 5–8.] Preliminary abstract available online here.

Seppa writes,

“From 2002 to 2008, the researchers analyzed blood samples from 374 newly diagnosed patients with diffuse large B-cell lymphoma, …..

“The blood tests revealed that half were deficient in vitamin D at the start of treatment, having less than 25 nanograms per milliliter of blood.

“….. patients who were deficient in vitamin D were twice as likely to die, compared with patients who had adequate vitamin D blood levels at the outset. Patients with low vitamin D concentrations were also about 50 percent more likely than the others to have their cancer worsen….”
This information comes as no surprise. In the last dozen years, close to 6,000 papers have been published in the medical literature on vitamin D’s positive effects against cancer. Low vitamin D levels are now well established to be a component in the ‘climate’ that allows cancer to flourish.

Shortly after reading Seppa’s article, I received a phone message from a patient, at her oncologist’s office for chemotherapy. Her oncologist didn’t think it necessary to measure her vitamin D levels, a test that we had suggested she ask him to do. Measuring vitamin D levels and supplementing as needed to assure patients are not deficient is routine these days in naturopathic oncology. It apparently is still not routine in medical oncology.

This juxtaposition of medical paradigms could not have been clearer. Our goal is to create an internal environment in the patient so that cancer will not flourish. The oncologist’s goal is to destroy cancer cells using the tools at his disposal. The problem, as we are beginning to see it, is that these tools can be harsh and create an environment in which cancer flourishes. During and after standard oncology treatment, the various chemical factors that we use to measure the internal ‘weather’ describe a ‘climate’ conducive to cancer growth. To use the older phrase, chemotherapy and radiation creates a ‘fertile field’ in which cancer grows.

Researchers are ahead of the clinicians and we must strive to keep up with their advancing knowledge and paradigms in order to best serve out patients. Though our past ambition to help destroy cancer cells remain valid, we must expand our vision and think in terms of the internal environment that allowed cancer to take root in the first place and the climate left by chemotherapy and radiation treatments that aid cancer to grow.

This is a paradigm shift that comes easy to naturopathic doctors. In a way, it is how we’ve always approached disease.

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