Billions of Cells Before Detection
Today I went in for diagnostic imaging. I told the techs I was writing this article about early detection. After explaining Dr. Gullino's presentation at the conference on Breast Cancer: A Report to the Profession, their response was: "Well, don't tell anybody."
Informed consent means really having a sense of what you're up against. And all the "Looking for a cure", "working for the cure", or even "fighting for the cure", is kind of a joke to me these days. I wish that I can say that I am on the road to "finding" a cure but, alas the truth is that before my MRI screening lit up and showed a 0.8 cm bright spot, I had already been a cancer patient for years though I didn't know it. The trick for me today is living a long and healthy life with the cancer.
(Parts of this article was taken from an article written by Otis Brawley, MD, Chief Medical Officer of the American Cancer Society.)
In 1976 Pietro M. Gullino presented his findings on the natural history of cancer, showing early detection is really late detection, at the Conference on Breast Cancer: A Report to the Profession, sponsored by the White House, the National Cancer Institute, and the American Cancer Society. He explained: "If the time required for a tumor to double its diameter during a known period of time is taken as a measure of growth rate, one can calculate by extrapolation that two-thirds of the duration of a breast cancer remains undetectable by the patient or physician or diagnostic technology. After about ten years of growth, the average cancerous mass inside the breast or prostate is about one centimeter in diameter, or about the size of an eraser on the end of a pencil, and consists of about one billion cells. This is the earliest stage at which a tumor can be found. As you can see, early detection is a misnomer."
Long before a breast carcinoma can be detected by present technology, the tumor can shed cells and metastatic spread may occur. This report was subsequently published in the journal representing the American Cancer Society. According to this chart, my 0.8mm breast tumor made up of DCIS Estrogen/Progesterone positive (grade 2) and Invasive Estrogen/Progesterone positive Her2/neu (grade 2), that was missed by the mammogram and detected by MRI took 9 to 10 years to make, is estimated to be over a billion cells large and has also spent all that time becoming undetectable to my immune system (so much for early detection).
Normal, healthy cells multiply only when necessary, such as during childhood growth and development, or to repair damaged tissues after an injury. Cancer cells, however, divide at their own free will at the site of origin, and spread to other parts of the body where they continue this uncontrolled growth without respect for the surrounding healthy tissues. Like most other cancers, breast and prostate cancers begin with the mutation of a single healthy cell into a malignant one. Once this transformation occurs, the single cell begins to replicate, or divide. The time it takes one cell to divide and become two cells is called the doubling time. The average doubling time is approximately 100 days. This means that in 100 days, a single cancer cell will have become two cancer cells. In 200 days, that one cell will have become four cells in a breast or prostate gland. By one year there are eight to twelve cancer cells lurking undetectable. Consider that one breast or the entire prostate gland consists of about 100 billion cells, and then you know why the cancer is impossible to find.
At this doubling rate, it takes about six years for the single cancer cell to become one million malignant cells, which together form a tiny tumor that is about the size of the tip of a lead pencil. A mass of this size is less than one millimeter in diameter, and is undetectable by breast self-examination or mammography (or any other presently-known technology) in the female breast, and by digital rectal examination (DRE) or by PSA (prostate-specific antigen blood test.) in the male prostate.
Even though the cancer is so tiny that it cannot be detected, it nevertheless has the possibility of shedding cells and spreading (metastasizing) to other parts of the body. It is the cancer cells that have spread to, say, the liver, lungs, bones or brain, that can kill the patient and not the cancer cells confined to the breast or prostate.