Fact-Checked: Surgery and Biopsies Do Not Spread Cancer

This is the ChrisBeatCancer.com post that changed my perspective as to whether Wark was intentionally misleading.   The “information” he shares is profoundly factually wrong and cannot be reconciled with what the research actually says.

Two possibilities exist:
1. Wark never read the actual research document he references , he misleads the reader into believing he has and therefore misleads readers into beleiving his analysis of the research is accurate, or;

2.  Wark read the research document, cherry picked data that served his bias, and mislead people as to the study authors’ real conclusions.

You decide.

The video titled “Should you have surgery for cancer? Chris Wark of Chris Beat Cancer”, featured in this blog post and published on Youtube,  contains many cherry-picked data points, misleading conclusions, and outright factual inaccuracies.   A hint as to the conclusions our fact-checking has revealed – almost nothing in this video is accurate.

:30 I have learned a lot in the last, almost ten years about cancer.

Chris begins the video by setting himself up as someone quite knowledgeable about cancer.  But is he?

At 1:14 “..a 5 centimeter tumor, which is tiny, has about a billion cells, cancer cells…and 5 centimeters is the smallest tumor size they can detect.”

Five centimeters is approximately 2 inches which is HUGE for a cancer.  In a research study titled, “Limits of Tumor Detectability in Nuclear Medicine and PET”[1], the authors concluded that among nuclear medicine’s “armamentarium” of diagnostic scanning machinery that the smallest detectable tumors were as follows:  PET –  7mm, CT – 3mm, and SPECT – 1.0 cm.   The study was published online in 2012, a year before Chris published his surgery video.  Breast cancer detection of tumors via 3D mammography has advanced to such a degree that tumors as small as .5 mm can be found.  That’s 100 times smaller than the 5 cm tumor Chris refers to.

One could assume Chris got the cm number incorrect and he really meant 0.5 cm but as the image shows, a .5 cm tumor would have approximately 25 million cancer cells, not a billion.

1:30 But here’s the thing, those same cells are circulating throughout your body. They may be concentrated in the tumor but they are not completely contained in that tumor.  So removing a tumor does not cure you of cancer.”

If this statement were true, conventional medical doctors would be prescribing chemotherapy and radiation for EVERY case of cancer regardless of staging.  Just  a minute later in the video, Chris will contradict himself.

Clearly Chris either is unaware of or does not understand Sentinel Lymph Node Biopsy (SLNB) and the mechanism by which metastatic cells spread.

In the 1940s, studies by Gilchrist [2] and Zeidman and Buss [3] demonstrated that metastatic cells spread through regional lymphatics in an orderly and reproducible manner, thus paving way for the evolution of SLNB. The sentinel lymph node (SLN) is the initial nodes that drains the lymph from a particular organ before draining into subsequent nodes (non-SLNs).[4]

A sentinel lymph node biopsy is a procedure that was developed to identify metastasis of  cancer to the lymph nodes. The first lymph node to encounter cancer cells is the sentinel lymph node. In a sentinel node biopsy, surgeons remove only this initial lymph node, the sentinel lymph node.  Radiographers identify the sentinel lymph node with a dye.   A negative Sentinel Node biopsy usually means all other lymph nodes are cancer free and that means no chemotherapy is recommended .  Prior to SLNB, a common treatment for breast cancer and melanoma was to remove dozens of lymph nodes as a precaution with no idea as to which ones actually had cancer cells.  In some people I know as many as 27 lymph nodes were removed which can create a side effect of lymphadema whereas SLNB removes from 1-3 nodes.   SLNB are considered extremely accurate, saves the patient additional surgery to remove unnecessary lymph nodes and limits the use of chemotherapy to patients shown to have metastases in lymph nodes.

2:42 We know 50% of cancers are cured by surgery but that figure is actually misleading because that figure includes skin cancer .  You can’t really compare a mole , a tiny mole, that’s quote unquote cancerous to a golf ball sized tumor in your large intestine which is what I had.

Just 1:15 minutes earlier Chris stated that surgery does not cure cancer.   He cavalierly dismisses skin cancer and surgery’s key role in curing it despite the fact that melanoma is rising in younger adults and is projected to be the fifth most common cancer for both men  and women  in 2019 in the US.[5]  That “tiny” melanoma mole, depending on its Breslow Depth Level and final staging after SLNB, can be quite deadly.

At 3:40 in the video Wark references a study conducted at 2003 John Wayne Cancer Institute claiming that the study concluded that  patients with invasive breast cancer who had a needle biopsy before surgery had a 50% increase in metastases when compared to patients who just had the breast tumor removed with no biopsy.

At 4:09:  “The group that had the biopsy first had a 50% increase in malignancy. That means the cancer spreading after surgery.  Just that tiny, little needle biopsy caused seedingwhere you poke a tumor and cancer cells spill out and they spread around in the surrounding tissues and that can cause the tumor to spread.”

The study CHris references is titled “Manipulation of the Primary Breast Tumor and the Incidence of Sentinel Node Metastases From Invasive Breast Cancer” by Nora M. Hansen, MD; Xing Ye, MS; Baiba J. Grube, MD; et al and is published at http://jamanetwork.com/journals/jamasurgery/fullarticle/396893 The research hypothesis was: “The incidence of sentinel node (SN) metastases from invasive breast cancer might be affected by the technique used to obtain biopsy specimens from the primary tumor before sentinel lymph node dissection.”   Biopsy techniques were fine-needle aspiration (FNA), large-gauge needle core, and excisional (surgery).

One of the conclusions drawn by this study:  “The incidence of SN metastases was 47% in the FNA group, 45% in the large-gauge needle core group, and 32% in the excisional group. ”   This is likely where Wark got his “50% increase in metastases” statistic despite the fact the study authors never use that percentage nor make that conclusion.  Instead the study authors had an explanation for the difference in metastases incidents among the type of biopsies:   “This was not surprising because the size of the primary tumor was larger in the FNA group than in the excisional group.”    In fact, the data shows the size of tumor biopsied to be relevant, in Table 1 the mean tumor size was largest in the FNA group (2.08 cm) and smallest in the excisional group (1.63 cm).  In other words, the tumors in the FNA group were 28% larger than those in the excision group. The larger the tumor the greater the risk it has metastisized regardless of biopsy type.  The study authors also admitted that while patients with tumors larger than 5 cm were initially excluded from the study, upon further diagnosis “some patients did have pathologic tumors larger than 5 cm that had been underestimated by physical examination or radiologic workup. These patients were included in the study.”

The study’s lead author, Dr. Nora Hansen, came to several different conclusion than Chris Wark did .

A suspicious mass identified during physical examination or by mammography or ultrasonography should be biopsied to determine whether it is cancerous. Large-gauge needle core, FNA, and excisional breast biopsies are safe and reliable diagnostic tools.

None of these studies documented a survival disadvantage with FNA.

Diagnostic large-gauge needle core biopsy is a safe and effective alternative to FNA or excisional biopsy.

I think the findings of this study are interesting, but currently have not changed our management. We still perform fine-needle aspirations and core biopsies to diagnose cancer. Until I have a good explanation as to why this is happening, we will continue our current practice because it does afford the patient the opportunity to make treatment decisions prior to surgical therapy.

In the Discussion Section of the published study, which is where other researchers discuss potential flaws of the study, Dr. Leigh Anne Neumayer of Salt Lake City, Utah makes a common sense observation:

“This is really an interesting study, but as a clinical trialist, I want people to be certain to not jump from association to cause, and I think by your comments you now realize that for those of us who believe that breast cancer doesn’t happen overnight and that metastases don’t happen overnight that your time from biopsy or FNA to sentinel lymph node dissection of around 9 or 10 days really isn’t long enough to cause 60% of the patients to have macrometastases. It seems to me that you must be pushing whole tumor boluses, and they are able to set up housekeeping and replace the lymph node within hours or days rather than a month or 2. I really want to make sure that people don’t take your findings and make them mean a lot more than what they really do, which is just an association.”

Dr. Nora Hansen, the senior study author replied Dr. Neumeyer,

“We have no definitive proof that the type of biopsy actually leads to the metastasis.”

And there’s more good news!   A 2013 Mayo Clinic study [6] of more than 2,000 patients has dispelled the myth that cancer biopsies cause cancer to spread. The researchers show that patients who received a biopsy had a better outcome and longer survival than patients who did not have a biopsy.

“This study shows that physicians and patients should feel reassured that a biopsy is very safe,” he says. “We do millions of biopsies of cancer a year in the U.S., but one or two case studies have led to this common myth that biopsies spread cancer.”

Biopsies offer “very valuable information that allow us to tailor treatment. In some cases, we can offer chemotherapy and radiation before surgery for a better outcome, and in other cases, we can avoid surgery and other therapy altogether,” Dr. Wallace says.

Yet despite all the good news, Chris clings to his belief that surgery does not play a crucial role in the treatment, even curing of cancer.

5:10 If you want to have surgery, if it makes you feel better psychologically and emotionally to get a big lump out of your body then go ahead and do it but do not make any mistake or don’t kid yourself and think that it’s not going to come back….surgery can be helpful but you cannot rely on it.  Knowing what I know now would I have surgery again? Probably not.”

He makes a foolish declaration that, should he get cancer again, he would likely honor his beliefs and decline even life-saving surgery. It is one thing to choose for yourself how you wish to management your care but to extrapolate to others borders on the unethical.  Alarmingly, at 7:10 Wark advises postponing or even declining surgery citing that “cancer has been growing a long time…waiting a month to 3 months won’t make a difference”.  Chris Wark is in no way credible in medical science to be advising anyone to delay surgery. Ten years post cancer diagnosis “researching” via the University of Google does not accredit a person as being an authority qualified to be suggesting a delayed course of action.

The last few minutes of the video go into theological issues that will be discussed at a later date.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590963/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390783/
[3] https://www.ncbi.nlm.nih.gov/pubmed/13160971
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620435/
[5]  https://www.aad.org/media/stats/conditions/skin-cancer
[6] https://www.sciencedaily.com/releases/2015/01/150109093717.htm

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