Recent news reports have published that Elle Macpherson has revealed that she refused medical treatment following a cancer diagnosis.
After undergoing a lumpectomy to remove cancerous tissues, Elle was diagnosed with HER2-positive oestrogen-receptive intraductal carcinoma – a type of breast cancer and was subsequently advised by doctors to undergo a mastectomy with radiation, chemotherapy, hormone therapy and a breast reconstruction for treatment. However, in February 2017, the supermodel mum of two decided to refuse medical treatment and chose a holistic approach to cancer therapy.
After her diagnosis, Elle spent eight months in Phoenix, Arizona, where she was supported by her personal doctor, holistic dentist, osteopath, chiropractor, naturopath and two therapists. During this time, she focused on “addressing emotional as well as physical factors associated with breast cancer”.
Elle has since reported that at 60 years of age, she is now in “clinical remission” after being diagnosed seven years ago.
Following this news, we asked Professor Zoe Winters, Professor of Breast Cancer Surgery at University College London Hospital and New Victoria Hospital in a Q&A to provide insight on the diagnosis and highlight the impact of medical intervention vs alternative holistic therapy.
Read the detailed Q&A below…
1. Ms Macpherson was diagnosed with HER2-positive oestrogen-receptive intraductal carcinoma – a type of breast cancer – after undergoing a lumpectomy to remove cancerous tissues. Can you explain this type of cancer?
Intraductal cancer is defined as Clinical stage 0 breast cancer, which is mostly referred to as Ductal Cancer in Situ or DCIS. The generalised term “cancer” is vague as DCIS by definition comprises microscopic breast cancer cells that are contained within a microscopic breast duct.
DCIS is a predictor of bilateral increased breast cancer risks, however, this refers to high risk within the average population and is not equivalent to very high risks that relate to an inheritable gene mutation such as the well-known BRCA genes.
HER2-positive DCIS does not equate to the poorer prognostic impact of HER2-positive invasive ductal cancer where breast cancer cells have invaded outside a microscopic duct and therefore may have spread to axillary lymph nodes.
However, it is important to note that the information shared in news reports on the case of Elle MacPherson is vague, with few clinical details that help clinicians or patients to interpret their possible risk.
2. In light of this diagnosis, what options would a patient be offered for treatment?
As a way of assessing risk, population risks are not an indication that bilateral risk-reducing mastectomies are required or beneficial, however, oncologists offer women the opportunity to consider chemo-prevention (medical risk-reducing) treatments using drugs like Tamoxifen or aromatase inhibitors for 5 years, based on international randomised (studies designed to reduce bias) clinical trials based on 10 of thousands of women. This is called level 1 or the highest quality of clinical evidence that allows clinicians to recommend a particular treatment.
3. What factors influence the risk of Elle Macpherson’s cancer?
Several factors influence the future risks of DCIS such as young age of onset or less than and equal to 50 years, large size of the DCIS, whether the DCIS presents as a lump, and whether a wide local excision or surgery lumpectomy has clear microscopic margins that should measure at least 1-2 mm away from the edges of the excised surgery specimen or wide local excision.
4. What do you advise patients who decide not to go ahead with any medical treatment and what is the potential outcome for those who refuse treatment?
HER2-positive DCIS has been studied in a large UK/ANZ DCIS trial in over 700 women where HER2 expression predicts a significantly increased risk of DCIS recurrence, and also strongly predicts radiotherapy benefit after wide local excision, with a greater reduction in DCIS recurring in the same breast.
5. Do you have any other advice for women considering alternative routes to cancer therapy?
Modern medicine is constantly evolving where clinical evidence is strengthened by designing studies that limit bias, that may exist by treating clinicians and patients. Bias is a perception not based on the body or strength of existing evidence.
Lifestyle factors are important in improving overall health but are not considered clinically equivalent to proven treatments based on studies that are numerically powered to show a difference in clinical outcomes when a particular treatment is used.
Evidence-based studies account for random and placebo effects in medicine on both sides of the consulting desk.
About New Victoria Hospital
New Victoria Hospital is a private, charity-owned hospital based in Kingston upon Thames, Surrey and is one of the few remaining independent hospitals in the country.
It has provided a high level of service to the local community for over sixty years and is frequently ranked by patients as one of the top private hospitals in London. The Hospital is registered with and regulated by the Care Quality Commission (CQC) and is fully compliant with their standards. The current CQC rating for the Hospital is “Good”. The. The hospital was proud to achieve this rating across all five categories–safe, effective, caring, responsive and well-led. It is owned by parent charity The Victoria Foundation. This charity helps to transform lives where there is an opportunity to do so either through medical provision or by ensuring that young people destined to become future generations of doctors are not prevented from doing so through lack of finances.
