Macpherson, seen here during the January 2024 Australian Open in Melbourne Park, claims she used a holistic approach to remaining healthy seven years after her breast cancer diagnosis. — TNS
WHEN celebrities go public with their diagnoses of cancer or other diseases, they’re often lauded as courageous for raising awareness and making people who share their diagnosis feel less alone.
Other times, they’re chastised in the media for setting a bad example.
The latest famous cancer case involves supermodel Elle Macpherson, 60, whose breast cancer tale has lit up the media.
She claims she used an “intuitive, heart-led, holistic” approach to remaining healthy and glowing seven years after being diagnosed with a non-invasive breast cancer for which her doctor recommended more radical surgery, chemotherapy and radiation.
While some headlines implied Macpherson was foolish for “refusing chemotherapy,” the reality is more complicated.
Some critical factors are unknown – whether the tumour caused a lump or was asymptomatic, the size of the tumour, and whether there were cancer-free margins around the part that was removed.
All are factors that would influence the risks of recurrence.
Without more details of the tumour or the specifics of her “holistic” approach, it’s hard to know what to make of her choices.
Skipping more aggressive treatment might have been reasonable.
Doctors have increasingly come to understand that many of the small, localised, asymptomatic tumours that show up on annual mammograms aren’t necessarily the start of deadly cancers.
Some would never have caused any harm if left alone.
Others may only need to be removed, rather than attacked with a combination of major surgery, chemotherapy and radiation.
And some parts of Macpherson’s approach are backed by science – she avoids junk food, is slender and has abstained from alcohol for 21 years, all lifestyle factors many doctors would recommend to reduce the risk of recurrence.
A recent study shows that 40% of cancer cases and more than half of deaths are attributable to modifiable risk factors, including exercise, diet and avoiding alcohol and cigarettes.
But there can be a big downside to celebrity health confessions, says Timothy Caulfield, a professor of law and public health at Canada’s University of Alberta and author of Is Gwyneth Paltrow Wrong About Everything? When Popular Culture and Science Clash.
He points out that Macpherson is pushing her own wellness company.
Much of what gets sold as wellness involves supplements and alternative therapies that are expensive and sometimes harmful.
Doctors don’t always do a good job of explaining prevention or risk or respecting patients’ views, he says, “but we’re not going to fix the problems of a conventional healthcare system with pseudoscience and lies.”
Some alternative therapies have been debunked and some haven’t been studied, but that’s not how they’re sold by wellness hawkers.
“Their ad doesn’t say, ‘come to our clinic, because maybe this works. The data is really underwhelming and iffy,” says Prof Caulfield.
Misinformation aplenty
As breast cancer expert and surgeon Chris Pyke points out in The Guardian, the kind of cancer Macpherson was reported to have, ductal carcinoma in situ, “can accurately be described as a type of non-invasive precancer that has the potential to become aggressive if left untreated.”
He placed the odds of such cancers spreading at about 5% – but that can vary.
The risk would be lower after a lump was removed, and doctors often offer chemotherapy, radiation or both to further reduce the risk of recurrence.
How aggressively to proceed is partly a personal decision based on risk tolerance and quality-of-life concerns.
And some women have felt misinformed by mainstream doctors who’ve recommended mastectomies or chemotherapy without explaining it in probabilistic terms.
In 2022, the British Medical Journal profiled 12 women who had undergone aggressive treatments for asymptomatic tumours.
One, who got a mastectomy, said she commented to her surgeon several years after the fact that she’d surely be dead had she kept her breast.
She was enraged and horrified to learn that the odds were reasonably high that she’d still be very much alive had she opted for less-aggressive treatment.
When celebrities use their personal stories to raise awareness of cancer screening techniques, it’s almost always seen as an unmitigated good.
Researchers have shown that celebrities can influence cancer screening rates.
But although it sounds counterintuitive, more screening isn’t always helpful.
A few years ago, actor Ben Stiller promoted screening tests for prostate specific antigen (PSA), arguing that it saved his life, though the mainstream medical community has recognised that this test has led to many unnecessary biopsies and harmful overtreatment.
Prof Caulfield is not convinced of the overall good of Angelina Jolie’s public case for breast cancer genetic testing followed by a prophylactic double mastectomy and removal of her ovaries.
On the one hand, it might have made women in a similar situation feel less alone, but on the other, her choices might not be the best ones for everybody with a family history of cancer.
Celebrity health problems resonate with people because they come from familiar figures and tell compelling narratives.
But without data they’re just stories, and shouldn’t apply to anyone else’s health but their own. – Bloomberg/Tribune News Service
