Cervical Cancer Cases
Understanding the Tumor Doubling Defense (continued)

One novel and unscientific defense advocated by Ostrum and others is to argue from the size of tumor at the time of diagnosis that the tumor at the time that the earlier diagnosis should have been made would have been of such a size as would have already metastasized. This argument depends upon the earlier false premise that growth of a given tumor is exponential and predictable. However, it is important to remember that this argument also depends upon accurate measurement of the tumor at diagnosis. The measurement of tumor size on a mammogram is often impossible. In addition, when tumors are examined carefully under the microscope there is sometimes much more inflammatory tissue than malignant cells and assessment of tumor cell density is therefore an important factor in understanding this defense. The fewer malignant cells present within the measured tumor mass the later the critical metastatic event(s).

Prolonged survival, whether or not the patient has been cured, is hardly an insignificant benefit of early diagnosis. Disease-free survival prolonged to the point of a person reaching their normal life expectancy certainly represents a cure in any layman's definition. The possibility of such survival exists for all forms of the cancer when early diagnosis is provided. The chances of prolonging survival with early diagnosis and treatment is virtually certain. Even if one assumes that metastasis has already occurred at the time that a primary tumor is removed, it cannot be seriously questioned that the primary tumor contributed to the overall tumor burden. New tumor needs time to grow sufficiently to replace the cells that have been removed. How quickly depends not only on tumor-doubling time, but also on the impact upon the residual tumor burden of the body's immune defenses and on the success of any adjuvant therapy that may be employed in the patient's care. Adjuvant chemotherapy is successful even where it only wipes out 95% to 99.9% of residual cancer cells in a patient's body. Presumably, in those patients who are not cured by adjuvant therapy, the remaining tumor cells are resistant to chemotherapy. Yet, even applying Spratt's median doubling time of 260 days where reduction of the metastatic tumor from 1,000,000 to 10,000 cells has occurred, 6-2/3 cell generations are required for the tumor to grow back to 1,000,000 cells. With a doubling time of 260 days, a patient wouldn't reach his/her lethal tumor burden for many years (lethal tumor burden of 1012 is reached after 40 to 45 tumor doublings).

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