Of all the animals of prey, man is the only sociable one.
Every one of us preys upon his neighbour, and yet we herd together.
The Beggar's Opera: John Gay

Thursday, 5 April 2012

Slipping through the diagnostic net

Deaths from uterine cancer have increased by a fifth in the last ten years, data from Cancer Research UK has found. It means almost 2,000 women now die annually from the condition. (Telegraph)

Since they report that the number of annual diagnoses has risen by almost half since the mid 90's, this does mean that survival rates are improving. According to Professor Jonathan Ledermann, gynaecological cancer expert at Cancer Research UK,

"the chances of surviving the disease are still better than ever. It’s clear we’re making great progress, but we don’t yet fully understand what’s driving up cases of womb cancer, so there’s still lots more to do.”

Until they solve the mystery (and I hope they are looking very carefully at HRT and synthetic hormones, which the article doesn't mention at all), researchers are falling back on that old staple of weight loss and plenty of fruit & veg, reminding us that being obese 'more than doubles' the risk of uterine cancer.

This gives us some juicy headline statistics, conveniently forgetting that, obesity increases the risk rather than creating it and that lifestyle is far from the only causal factor at work. Yes, folks, it's that old false syllogism again:

Unhealthy lifestyles cause cancer
You have cancer
ergo You have an unhealthy lifestyle

If Professor Ledermann and his team want to reduce the number of deaths, they would do well to consider the inversion of this argument, the application of which nearly cost a relative her life. As applied by her GP in the face of worsening symptoms for nearly two years, it goes roughly thus:

Obese women have uterine cancer
You are not obese
ergo You do not have uterine cancer

With a healthy diet and plenty of exercise, there was, the GP said, no need to bother with an examination. In fact, when the patient complained that she was rapidly losing weight for no obvious reason, the doctor told her she was lucky; "But that's a good thing; I wish I could lose weight like that!"

The diagnosis was finally made by a second doctor at a point urgent enough for the patient to be rushed into hospital within hours for drastic surgery, but the original GP was unrepentant to the point of defensiveness; how could she be expected to diagnose the condition, she demanded, when my 7st relative didn't fit the profile?

Survival rates decline sharply as the cancer develops; the later the diagnosis, the less your chances of recovery. Professor Ledermann doesn't say what proportion of the fatalities are not overweight; it might be well worth his while to find out.


  1. In my experience UK doctors are rubbish at diagnosis having gone through the hands of countless numbers over a 20 year period none of which could tell me what I was suffering from. Eventually I moved to France where the local GP diagnosed, treated and cured me within a space of 1 year. I had 20 years of misery due to their incompetence.

  2. Antisthenes, I wonder how much misdiagnosis is due to the 'flow-chart' approach that seems to permeate the NHS.

    If you don't fit the criteria, the process moves on to the next step and discards aproportion of the possibilities, one of which might well have been the correct diagnosis.

    The casualties of the system are those patients who don't match the general rules - and since medical training in the UK includes very little statistical analysis, these anomalies are frequently - and wrongly - dismissed as insignificant.

  3. Rule 1 in this country - don't get sick.

    Rule 2 - don't get old.