Cancer spreads when exposed to air. Underwire bras cause breast cancer. Cancer is always lethal.
No. No. And no, again.
These are but a few of the myths and misconceptions that patients bring to the doctor’s office, according to four of the region’s top cancer specialists.
“There is no evidence that cancer will spread during routine cancer surgery when it is exposed to air,” said Alexander Kutikov, chief of the division of urology and urologic oncology at Fox Chase Cancer Center.
“It may be a myth propagated from the days before CAT scans when doctors would open up a patient, find cancer that they didn’t expect, and then, all of a sudden, the patient would learn that the cancer had spread,” said Jerry McCauley, chief of the division of nephrology at Thomas Jefferson University Hospitals.
“But the reality is that exposing a tumor to air doesn’t change anything; tumors get plenty of their own oxygen through your bloodstream,” he said.
Other myths can be based on questionable or erroneous information passed along by family or friends. Or the internet.
According to a 2018 study of 150 videos about prostate cancer on YouTube (drawn from a pool of 600,000), 115 videos (77 percent) “contained biased or poor-quality information.” Despite this, these videos were viewed by more than six million people.
Below are a few common cancer myths, debunked:
Cancer is a lethal disease that must be treated immediately. The word “cancer” carries such a stigma, Kutikov said, that many patients believe this is true. But while certain cancers remain life-threatening, others do not.
“With a lot of prostate cancers, we now know they don’t actually need to be treated, and the safest thing is to monitor and treat them only as things progress,” he said. “I often see low-risk prostate cancers where the chances of dying from the disease over the next 15 years are lower than 1 percent, lower than the risk of getting into a car and driving to an appointment.”
He also notes that there are lots of cancers for which it’s known that the cure can be worse than monitoring.
“If a treatment’s side effects are going to be life-changing for folks, there’s sometimes a big deliverable in delaying it.”
Mammograms cause cancer. While important to discuss, this isn’t true, said Emily Conant, chief of the division of breast imaging at the Hospital of University of Pennsylvania.
“Women need to know that mammograms use a special kind of low-dose X-ray that has never been shown to cause cancer,” she said.
Compression during a mammogram can injure breast tissue. Few women enjoy a mammogram screening, which can be particularly uncomfortable for premenopausal women and those expecting a period. But “breast compression actually decreases the number of X-rays that we need to get through the breast tissue to see everything and to find out if there is anything of concern,” Conant said. “And it does not injure breast tissue.”
Women without a family history of breast cancer rarely get the disease. “Over the years, we’ve greatly improved our understanding of family history, risk assessment, and how to personalize screening based on a woman’s individual family history and risk,” Conant said. “But it remains true that most women who get breast cancer have no family history or no genetic reason that we can determine right now. That’s about 75 percent of women, which means that because it doesn’t run in your family doesn’t mean you shouldn’t be screened.”
All men do (or don’t) require screening for prostate cancer. Prostate-specific antigen PSA screening "is a complex issue and many people have very strong opinions — pro-screening or anti-screening,” Kutikov said. “Patients often arrive in the office with a preconceived notion about what is better or worse.”
The truth is that screening is a very individualized decision based on the patient’s profile. “There is no blanket decision,” he said. “But sometimes it requires a bit of a discussion with a patient who comes in with their mind made up.”
When it comes to prostate cancer, one kind of treatment is best. Once again, the truth is more nuanced. “Radiation or surgery can have success, but sometimes a patient’s experience has given them a very strong reaction against that modality.” For example, some people may insist that they will “never have radiation,” based on outdated notions of what radiation requires, while both radiation and surgical techniques have undergone vast improvement over the years.
Low back or flank pain or blood in the urine always means kidney cancer. “Aches or pains can be kidney cancer,” McCauley said. “But more often it stems from muscular or skeletal pain.” As for blood in the urine, it may signal kidney problems, “but can also be a sign of a urinary tract infection or even a patient who is taking blood thinners.” An ultrasound can determine a diagnosis.
Special diets or herbal treatments can cure cancer. Because being overweight or being a smoker can contribute to a number of different cancers, McCauley urges all patients to pursue healthy, active lifestyles. But as yet, he doesn’t know of any particular diet that will cure cancer.
“Avoiding processed foods can help,” he said. “But some specialized exotic diet is not going to work.”
While most doctors probably won’t object to herbal or nutritional supplements, McCauley recommends that patients try standard cancer treatments first.
“Work with your doctor,” he suggested. He points to Steve Jobs and Bob Marley as examples of people who might have been helped by standard treatments, but went with alternative treatments first. “By the time they found out that their choices didn’t work, it was too late for standard care.”
Artificial sweeteners cause cancer. One common misconception around kidney and bladder cancer is that artificial sweeteners can promote cancer, a theory that was disproved years ago, McCauley said. Studies showing this were limited to animals, and as far as he knows, there is no proof of risk in humans.
Breast lumps must be removed to diagnose breast cancer. “This is less a myth and more like outdated information,” said Richard Bleicher, leader of the breast cancer program at Fox Chase. “It used to be that if a woman had a breast lump, she would have it cut out during a biopsy to diagnose the disease.” But doctors now more often perform core needle biopsies, where a small amount of suspicious tissue is removed from the breast with a hollow needle, then studied to make a diagnosis.
“A core needle biopsy gives us sufficient information for a diagnosis, and it allows us to plan an operation without having to undergo a full-fledged surgery just to make the diagnosis,” he says. “Although people may feel that they should have any lump removed, it’s very accurate to make the diagnosis with the needle biopsy.”
The human papillomavirus (HPV) vaccine is only for “tweens.” In 2018, the FDA approved the use of the Gardasil vaccine — which protects against nine strains of HPV that cause most cervical, oral, and anal cancers — for people up to age 45. But although the vaccine is safe for this older group, “it is unlikely to provide much, if any, benefit as people get older,” according to the American Cancer Society. The ACS recommends that older patients interested in receiving the shot talk to their health-care provider.
The Advisory Committee on Immunization Practices is expected to weigh in later this year on Gardasil use up to age 45 — which would encourage insurance coverage — or leave the choice to doctors and patients.
Deodorants cause or worsen breast cancer. A study conducted by the National Cancer Institute that examined this issue found that antiperspirants do not change a woman’s risk for breast cancer. “Women who either have cancer or are concerned about developing cancer need not worry about using antiperspirants in their daily routine,” Bleicher said.
Underwire bras promote breast cancer. “A study that was not published in a peer-reviewed journal claimed that underwire bras prevent drainage from the breast, which is anatomically false,” Bleicher said. “There is no biological basis for assuming that underwire bras impede drainage from the breast or cause toxins to build up in any way.” Women who have a family history of cancer or have cancer can use underwire bras without concern.
In the end, the only way to combat cancer myths is with education. All of the doctors recommended the American Cancer Society as a trusted resource, as well as information found on hospital or professional society websites.
“If you have questions or concerns," Kutikov said, "your surgeon or oncologist is the best person to ask.”