The efficacy of surgical treatment of cancer-20 years later

Introduction: Cancer treatment will be effective only if it is be based on a valid paradigm of what cancer is and therefore capable of affecting the course of the disease. A review in 1993 found no evidence that surgery affected the course of the disease and an alternative paradigm was proposed. A review of mammography screening trials in 1996 found no benefits from breast cancer screening. This was predicted by this alternative paradigm. This review updates the evidence twenty years later. Aim: To identify evidence that the primary treatment of cancer, surgery, has been shown to affect the course of the disease. If there is no such evidence, then to identify the correct paradigm of what cancer is from other cancer treatments that have been shown to be effective. Method: Because surgery has never been shown in a randomised controlled trial to affect the course of cancer seven other indirect methods were used to evaluate its efficacy. Results: None of the seven indirect methods used showed that surgery clearly affects the course of the disease for any type of cancer. The lack of benefits from cancer screening now includes not only from breast cancer but also from bowel, lung, prostate and ovarian cancer screening. This confirms that cancer surgery is based on an invalid paradigm of what cancer is. Survival figures following treatments based on an alternative paradigm that assumes cancer is a systemic disease were found to be superior to those following surgery, reinforcing the conclusion that cancer is a systemic disease and that cancer surgery is unlikely to be of benefit in most cases. Conclusion: No benefits can be expected to be achieved from using cancer surgery except in a few immediately life-threatening situations. Surgery appears to be based on an invalid paradigm of what cancer is. Cancer appears to be a systemic disease and therefore standard treatments need to be reassessed in this light. (C) 2014 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).