A leading breast cancer surgeon claims that many media reports claiming that supermodel Elle Macpherson has treated breast cancer with alternative therapies are missing crucial information, risking people being misinformed.
News organizations, including this publication, reported that after being diagnosed with HER2-positive estrogen-receptive intraductal carcinoma in 2017, Macpherson decided not to follow standard medical advice from doctors.
She told the Australian Women’s Weekly magazine that she instead took an “intuitive, heart-guided, holistic approach” and declined surgery, chemotherapy and radiation.
Macpherson says she did have breast-conserving surgery, an operation that removes a lump in her breast.
Breast-conserving surgery may be an appropriate, standard medical treatment for the condition in some cases, said Professor Chris Pyke, director of medical services at the Mater Hospital in Brisbane.
Pyke, a surgeon and expert in quantifying breast cancer risk, said that in many cases, HER2-positive estrogen-responsive intraductal carcinoma might be more accurately described as a type of noninvasive precancer that can become aggressive if left untreated.
“Intraductal means precancerous, which means the cancer cells have formed but are still in the ducts in the breast,” Pyke said.
“If left to its own devices, a certain percentage of these cases will turn into invasive cancer within a year. But the number is not high — about 5%. It’s quite possible that removing that lump was sufficient treatment in itself.”
Media reports, based on Women’s Weekly’s exclusive interview with Macpherson about the launch of her new bookdetails are lacking about the size of the precancerous cell or the grade of the cells, or other risk factors that Macpherson may or may not have had.
Guardian Australia has asked her book’s publisher, Penguin Random House, and Women’s Weekly whether such data was requested or provided, or whether they have specific details about her treatments, both conventional and alternative.
“In addition to removing it, sometimes in this particular type of disease, radiotherapy is added and we can help patients with that, depending on how big the area of precancerous change was, what the grade of the cells was, and sometimes gene expression profiling can be added on top of that to help with decision making and inform risk,” Pyke said.
It is unclear whether Macpherson gene expression profiles have been made.
Pyke said about a third of patients will have a mastectomy recommended at initial diagnosis, “not because it’s severe,” but because more than a quarter of the breast is affected. Removing enough tissue with a lumpectomy alone in these cases can significantly deform the breast, so mastectomy and reconstruction may be offered.
It is also unclear whether Macpherson was diagnosed because she felt a lump, or because she underwent screening and the condition was discovered through imaging. This could also affect treatment recommendations and the importance of radiation, chemotherapy and mastectomy.
“The most important thing for breast cancer, until we find the cause, is early diagnosis is the most important thing,” Pyke said. “If you find breast cancer, even invasive cancer, early before you can feel it, the chances are very small that it will shorten your life.”
He said patients with the earliest forms of breast cancer “should be offered every treatment option that has the same outcome”. That means if a patient has intraductal carcinoma, “they could be offered lumpectomy alone; lumpectomy and radiotherapy; or mastectomy as well”, Pyke said.
In an early-detected disease, ‘those three things have the same outcome, in terms of preventing that type of pre-cancer from spreading anywhere else.’
All options are offered because some patients choose mastectomy over lumpectomy due to fear of recurrence. Although lumpectomy followed by radiation offers similar long-term survival rates as mastectomy, there is a slightly higher risk of recurrence with lumpectomy alone.
There are also medications, including immune-modulating drugs, that can be tried, and Pyke said it’s important for patients to be part of those treatment decisions. Someone who opts for a more conservative treatment like lumpectomy alone may then be screened more frequently to check for any recurrence or spread, he said.
Pyke said there is growing concern about overdiagnosis and overtreatment of some forms of nonaggressive breast cancer and precancerous lesions. That’s why some experts are advocating more conservative treatment before surgery, with plenty of oversight and support from health care providers. He also stressed that it’s OK for patients to ask questions about their treatment.
“The truth is that most people diagnosed with cancer will do more than what we (doctors) recommend,” he said.
“Almost everybody meditates, or takes a vitamin, and I say if it doesn’t interfere with treatment, do it. And the second thing I say is that the only things that are proven to treat cancer are surgery, radiation, chemotherapy, and hormone treatments.”
Vicki Durston, director of policy, advocacy and support services at Breast Cancer Network Australia, said providing the right, full context about Macpherson’s treatment and her decisions was “so important to get the right message across, allay fears and cut through the noise”.
She said the media reports are “confusing for people currently in treatment” and that some are now beginning to question their own choices and approach.
“It’s important that when public figures like Elle Macpherson share their story, they realise that their story has a huge impact and reach,” she said.
Dr Brooke Nickel, an emerging leader at the National Health and Medical Research Council and based at the University of Sydney, studies media coverage of health care, including cancer. She says Macpherson also owns a wellness business and that patients should bear this in mind when considering her comments and consulting with doctors.
In general, Nickel added: “The public and patients really need to be wary of celebrities, and increasingly social media influencers, discussing these types of wellness or alternative therapies and potentially profiting from associations with brands and products.
“This wellness movement often aligns itself with the women’s health movement, which is all about autonomy, empowerment, and legitimate critique of patriarchal medical systems. This whole rise of celebrities and influencers embracing the language of women’s empowerment has taken the wellness movement to the next level, and often what they’re talking about isn’t based in evidence.”