Most of us accept the standard medical view that around one in three of us will develop cancer at some time in our life. The disease is also generally viewed as a pro-gressive and aggressive disease that will usually pass through four stages and will ultimately prove fatal if it's not treated successfully.
Nevertheless, there's now a growing body of evidence to suggest that cancer can just go away-or, as oncologists put it, spontaneously regress-on its own. Case studies of this puzzling phenomenon have been systematically recorded since 1918 and have been witnessed at every stage of cancer, even at the very final phases when the patient has been given only weeks to live. However, for it to be a genuine instance of spon-taneous regression, the patient must have received little or no medical treatment.
Given this as the definition of the phenomenon, it is hardly surprisingthat oncologists regard cases of spontaneous regression as rare events, as very few cases of cancer-once diagnosed-go untreated. This definition also leaves open the possibility that cases of spontaneous regression have gone unreported in patients whose immune system has actually brought about the spontane-ous regression, yet the chemotherapy or surgery was credited with the successful outcome (Cameron E, Pauling L. Cancer and Vitamin C. New York: W.W. Norton & Co, 1979).
Rates of spontaneous regression are generally believed to occur in one out of every 60,000 cancer cases, although researchers at the Institute of Noetic Sciences believe the true figure may easily be 20 times greater than that (O'Regan B, Hirshberg C. Spontaneous Remission: An Annotated Bibliography. Petaluma, CA: Institute of Noetic Sciences, 1993).
But the estimates could be even further off the mark, according to Professor Uwe Hobohm, based at the University of Applied Sciences in Giessen, Germany.
Hobohm reckons that cases of spontaneous regression could be going underreported by as much as a hundredfold-either because the patient never returns to the clinicor, more likely, because the specialist either does not believe a reversal has actually occurred or does not under-stand it, or is too lazy to report it (Br J Cancer, 2005; 92: 421-5).
Such underreporting has been recognized for nearly a century. In 1925, oncologist Hastings Gilford said: "Though cancer is so commonly regarded as inevitably fatal, many cases are recorded of its spontaneous disappearance-and nothing can be more certain than that those recorded cases are very few in comparison with those which are unrecorded" (Scott C. Victory Over Cancer. London, UK: True Health Publishing, 1925).
Hobohm also notes a reluctance by cancer specialists to acknowledge any natural healing power of the body. He quotes Professor K.H. Bauer, one of the founders of the German Cancer Research Institute in Heidelberg, who stated in 1965 that "the human body has no cancer-fighting capabilities", a view that is still prevalent today, judging by one recently published paper entitled 'The immune system: Is it relevant to cancer development, progression and treatment?' (Clin Oncol, 2008; 20: 101-12).
Cancer's natural course
What would happen if cancer were to be left untreated? A study by researchers from the Norwegian Institute of Public Health in Oslo has uncovered what the natural progression of breast cancer would be-and, to the scientists' great astonishment, they found that up to 22 per cent of cases may have spontaneously regressed (Arch Intern Med, 2008; 168: 2311-6).
They made the discovery when they tracked two groups of women with similar health profiles and backgrounds, and signs of breast cancer. However, one group was screened by mammography every two years from 1996 to 2001, while the other group was screened just once at the end of that six-year period. After taking into account factors that could distort the results-such as cases of ductal carcinoma in situ (DCIS)-the rate of breast cancer in the frequently-screened women was 22 per cent higher than in the unscreened group at the end of the six-year period, when all the women were screened together.
There were no obvious reasons to explain why the screened group should have developed more breast cancers than the unscreened group during the six years of the study.
So, where had the cancers in the 'unscreened' group gone by the time they had their final mammogram?
As lead researcher Dr Per-Henrik Zahl says: "It appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of six years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress."
Researchers recorded a similar rate of spontaneous regression in patients with non-Hodgkin's lymph-oma who had not been treated for the disease. In this study of 83 patients, they found that 19 cases (23 per cent) had undergone spon-taneous regression (N Engl J Med, 1984; 311: 1471-5).
The spontaneous regression rateis even higher for cases of neuro-blastoma, the childhood cancer that attacks the adrenal glands. Doctors at the Saitama Children's Medical Centre in Iwatsuki, Japan, adopted a 'watchful waiting' approach in the cases of 11 six-month-old infants who had neuroblastomas that were either at stage I or II (early-stage) or had tumours that were less than 5 cm in diameter.
After six months of such so-called passive observation, the tumours were reduced in every case, although none had completely disappeared by the end of the study. On the basis of these findings, the researchers concluded that "regression of screened neuroblastoma is not a rare phenomenon" (J Clin Oncol, 1998; 16: 1265-9).
Indeed, cases of spontaneous regression appear to be more frequently recorded in children than in adults. Other recent reports have included a six-month-old boy whose leukaemia regressed in 12 months with no treatment whatsoever (Int J Hematol, 2008; December 4; e-published ahead of print), a four-month-old infant with a brain tumour that threatened his sight and which regressed completely after six months (J Pediatr Hematol Oncol, 2008; 30: 712-5), and a four-year-old girl whose leukaemia also regressed without treatment (Pediatr Hematol Oncol, 2008; 25: 181-6).
Tracking the evidence
Spontaneous regression can happen in any patient of any age and withany sort of cancer. It is also a phenomenon that has occurred for as long as cancer has been recognized and diagnosed. Yet, it was not until 1918 that the first meta-analysis of spontaneous regression of cancer was first carried out by Dr G. Rohdenburg, the then medical director at Columbia University in New York, who tracked and analyzed 302 cases of spontaneous regression (J Cancer Res, 1918; 3: 193-225).
More recently, Drs Tilden C. Everson and Warren H. Cole, both from the University of Illinois College of Medicine in Chicago, rigorously reviewed cases of spontaneous regression reported in the medical literature, going back at least 65 years, and concluded that 176 of these cases were genuine-albeit inexplicable (Everson TC, Cole WH. Spontaneous Regression of Cancer. Philadelphia, PA: W.B. Saunders Co, 1968).
An even larger-scale review was carried out by researchers at the University of Calgary in Alberta, Canada, who analyzed 741 cases of spontaneous regression of cancer that had been recorded from 1900 to 1987, for which the authors of nearly half failed to speculate on or to specify any possible cause (Acta Oncol, 1990; 29: 545-50).
More recently, researchers from Odense University in Denmark reviewed 32 cases of spontaneous regression in breast cancer patients and noted that these patients lived for a further 10 to 15 years (Ugeskr Laeger, 1999; 161: 4001-4).
Spontaneous regression is also "well recognized" in cases of testicular cancer, say researchers from Stanford University Hospital, in California, who reviewed the course of the disease in 42 cases (Am J Surg Pathol, 2006; 30: 858-65).
Regression is also a well-known phenomenon in cases of colon and rectal cancers, as confirmed by surgeon Ayman S. Abdelrazeg, from the Huddersfield Royal Infirmary in the UK, who carried out an extensive review of all cases reported between 1900 and 2005 (Int J Colorectal Dis, 2007; 22: 727-36).
Researchers from Gdansk in Poland have reported that the numbers of reports of spontaneous regression have grown over the past 20 years, perhaps because of the increasing interest in the subject of late. When they compared figures from 1900 to 1987 and then from 1988 to 2006, they found that, although cases of regression had been reported with all types of cancer, it was most often seen with kidney tumours (nephroblastoma, renal cell carcinoma, malignant melanoma and lymphoma (Przegl Lek, 2007; 64: 380-2).
However, perhaps the most exhaustive research on this subject was that carried out by Brendan O'Regan and Caryle Hirshberg, based at the Institute of Noetic Sciences in Petaluma, CA, in 1993. In this review, they catalogued 1574 cases of spon-taneous regression of cancer. They also included cases of 'spontaneous remission', which was associated more with systemic cancers such as leukaemia or lymphoma. However, either term can be used to describe "when a patient shows a significantly measurable reduction in tumour size, or a reversal in the progression of the disease, and when this improvement cannot be attributed to Western allopathic medical treat-ment" (O'Regan B, Hirshberg C. Spontane-ous Remission: An Annotated Bibliography. Petaluma, CA: Institute of Noetic Sciences, 1993).
Understanding the cause
While the word 'spontaneous' often suggests something mysterious or even miraculous, researchers of regression cases have nonetheless attempted to identify a common cause. In the earliest (1918) meta-analysis of spontaneous regression, Dr Rohdenburg noted that the vast majority of cases were seen following a fever, which he described as an "acute febrile process" that appeared to take place for either no apparent reason or as a postoperative fever following failed surgery to remove the tumour. In most cases, the patient experienced a very high temperature that "continued without remission for several days" (J Cancer Res, 1918; 3: 193-225).
Erysipelas, the medical term to describe an acute streptococcal bacterial infection of the skin, was the most common condition found to induce the high body temperatures seen in cancer patients, although cases of smallpox, pneumonia, malaria and acute tuberculosis have also been observed.
This febrile phenomenon has also been noted in around 80 per cent of cases of spontaneous remission in children with leukaemia (Am J Med, 1951; 10: 238-9), while 31 per cent of regressions of advanced malignant melanoma were also preceded by febrile infections, with nearly half of these in association with erysipelas (Onkologie, 1998; 21: 14-8).
Professor Hobohm argues that an even closer association between fever and cancer regression would be seen if doctors did not immediately treat these bouts of high temperature (Br J Cancer, 2005; 92: 421-5).
In fact, the relationship between cancer regression and fever was noted as long ago as in the 1700s (Med Hypotheses, 2002; 58: 115-9), but was first tested by Professor W. Busch in 1866 when he deliberately infect-ed a cancer patient with live Streptococcus pyogenes bacteria, which led to erysipelas followed by complete cancer regression (Berl Klin Wochenschr, 1866; 3: 245-6). Such an association was also noted in 1884 by the celebrated Russian dramatist and physician Anton Chekhov (N Engl J Med, 1987; 317: 457).
The theory was then actively pursued in the first half of the 20th century by Dr William Coley (1862-1936), a bone surgeon at the New York Cancer Hospital (now the Memorial Sloan-Kettering Cancer Center), which led to a therapy that became known as 'Coley's toxins'.
Coley claimed to have become interested in the theory when he investigated a case of spontaneous regression in a patient who had advanced (phase IV) throat cancer, and whose recovery followed a bout of erysipelas (Ann Surg, 1891; 14: 199-200).
Coley's toxins comprise a com-bination of S. pyogenes and Serratia marcescens bacteria, which he used from 1893 (Am J Med Sci, 1893; 105: 487-511) until his death. Although it has been used intermittently ever since, the concoction was classified as a 'new drug' by the US Food and Drug Administration (FDA) in 1963, and is now limited to use only in clinical trials.
During his lifetime, Coley varied the dose and frequency of his 'vaccinations', and it was his daughter, Helen Coley-Nauts, who established a standard protocol for the toxins after reexamination of her father's notes (Adv Exp Med Biol, 1990; 267: 483-500).
While the use of Coley's toxins is restricted, several drug companies developed their own range of cancer-fighting agents that were also designed to induce fever. During the 1950s and 1960s, Bayer produced the MBV (mixed bacterial vaccine), S"udpharma launched Vaccineurin, and Chugai developed Picibanil and OK-432. Their products, like Coley's, have enjoyed similarly mixed success, although it was later realized that patients were also being given chemotherapy at the same time, which may have suppressed their immune system function.
Despite these variable results, further support for the fever theory comes from a study of 603 melanoma patients who were compared with 627 healthy controls. In this case, researchers discovered an inverse correlation between melanoma risk and the number of times the patient suffered an infectious illness. Indeed, melanoma risk fell by 40 per cent in those who had a history of three or more infections that had resulted in a fever above 38.5o C (Melanoma Res, 1999; 9: 511-9).
In a further meta-analysis, there was an association between the number of infections and death from cancer in Italy between 1890 and 1960. Here the authors calculated that every 2-per-cent reduction in the number of infections correlated with a 2-per-cent increase in tumours around a decade later (Eur J Epidemiol, 1999; 14: 749-54).
Why heat may kill cancer
Extreme heat, whether generated internally following an infection or externally by hyperthermia, appears to kill cancer cells and kickstart a healing process. In one laboratory experiment, cancer cells began to produce immune-building T cells when subjected to a fever-like heat of 41o C over a six-hour period. Similar results were obtained when a similar experiment was carried out using laboratory mice (Int Immunol, 2003; 15: 1053-61).
In a separate study, Newcastle-based cancer researcher J.A. Dickson discovered that tumour cells are more vulnerable to heat than are healthy cells and that they can be killed by extreme heat (42-43o C) (Lancet, 1979; 1: 202-5).
Hobohm speculates that heat generates a missing signal that is needed to activate dormant T cells, which results in full or partial regression, and can also eradicate dormant cancer cells as a preventative (Br J Cancer, 2005; 92: 421-5).
Future cancer treatment?
Although there are numerous anecdotal case reports of spontane-ous regression, it nevertheless has still not been thoroughly studied by researchers, both because drug companies do not consider it a subject worthy of proper research-nor is it in their interests to do so-and also because the funding for such studies is not available from independent (non-drug-company) sources. It is also a difficult subject to research scientifically as patients are either 'lost' to the medical system or, if in the system, because their cancer is then invariably aggressively treated.
As a result, we have an incomplete picture of regression, of the body's natural healing abilities and of the nature of cancer itself.
It's also important to stress that, while fever appears to be the most common cause of spontaneous regression, it's not the only one. In fact, the Institute of Noetic Sciences lists nine possible biological and physiological factors that may be triggers of cancer regression, together with five additional factors that could be classified as psychol-ogical or spiritual (see box on page 8 and box below) (O'Regan B, Hirshberg C. Spontaneous Remission: An Annotated Bibliography. Petaluma, CA: Institute of Noetic Sciences, 1993).
Whatever the cause, spontaneous regression may well provide us with a glimpse of how we may treat cancer in the future, and its open-minded and impartial investigation is long overdue.
How common is cancer?
While most of us can quote the oft-repeated statistic that one in three of us will develop cancer, the truth may well be that it is much more common than that.
Cervical cytology-or the Pap smear test-shows that 15 per cent of women test positive, yet only around 0.37 per cent of women die from cervical cancer. Similarly, cancers of the thyroid and pancreas may be 40 times more common than oncologists believe. These cancers are often only found at autopsy, with the patient not even aware of having had the disease (Cameron E, Pauling L. Cancer and Vitamin C. New York: W.W. Norton & Co, 1979).
As Cameron and Pauling comment: "The tumours are usually small, but when they are looked at through the microscope, they are seen to have all the characteristics of a growing, invasive cancer."
Overall, Swedish researchers estimate that as much as 15 per cent of major cancers are not diagnosed before death, and around half of these are usually considered fatal-yet the patient had died due to a completely different condition (Hum Pathol, 1994; 25: 140-5).
A similar picture emerges in cases of colorectal cancer, many of which are, again, only detected at autopsy (Gastroenterol J, 1989; 49: 26-8), while 1.3 per cent of women who died of other causes had breast cancer (Ann Intern Med, 1997; 127: 1023-8).
This suggests that cancer is a more common disease than the statistics indicate, and that it becomes apparent only when it grows out of control and is then noticed by medicine. Otherwise, it appears that the immune system alone is responsible for countless unrecognized acts of 'spontaneous regression' as it works to keep cancer cells in check.
Other causes of spontaneous regression
In their exhaustive review of spontaneous regression and remission, researchers at the Institute of Noetic Sciences (IONS) outlined nine biological and physiological factors, and five psychological or spiritual factors, that may have accounted for the 1574 cases they examined (O'Regan B, Hirshberg C. Spontaneous Remission: An Annotated Bibliography. Petaluma, CA: Institute of Noetic Sciences, 1993).
Biological and physiological factors
- Immune mediation
- Hormonal factors
- Inhibition of tumour growth by growth factors and/or cytokines
- Differentiation of tumour into a more 'normal' type of tissue
- Elimination of carcinogens
- Angiogenesis (new blood-vessel development)
- Tumour necrosis
- Programmed cell death (apoptosis)
- Genetic factors.
Psychological and spiritual factors
- The placebo effect
- Altered states (such as trance, prayer and meditation)
- Miraculous healings (defined as complete regres-sions inexplicable other than by faith and prayer, the International Medical Commission of Lourdes had, at the time that the IONS researchers were preparing their report, recognized 65 cases of healing as 'miraculous')
- Group support (such as where breast-cancer patients participating in a support group survived twice as long as women who did not join).
Mind over cancer
If we accept that the 'mind'-for want of a better term-and the body are inextricably linked, profound changes in our attitudes and outlook may also affect our physiological status.
Institute of Noetic Sciences researchers have identified the following eight changes that may play important roles in bringing about the spontaneous regression they identified (O'Regan B, Hirshberg C. Spontaneous Remission: An Annotated Bibliography. Petaluma, CA: Institute of Noetic Sciences, 1993).
1. A shift from dependency to autonomy combined with activities, attitudes and behaviours that promote increased autonomy and increased awareness of themselves, of others and their environment, and also increase love, joy, playfulness, satisfaction, laughter and humour.
2. Facing the crisis and having the power to find a new way of life that is fulfilling and meaningful.
3. Taking control of their lives, including personal, professional, emotional, spiritual and medical aspects, and reappraising old beliefs that are no longer appropriate or adequate.
4. Becoming comfortable with, and expressing, positive and negative emotions, and finding the ability to say 'no' when necessary for their wellbeing.
5. Having at least one strong loving relationship, and a connection with an organization.
6. Working in partnership with their physician.
7. Finding meaning in the experience of cancer, and finding reasons to live and accepting the diagnosis, but not the prognosis, of cancer and believing in a positive outcome.
8. Choosing activities that promote awareness and reduce stress, and showing renewed spiritual awareness that can lead to a spiritual practice such as prayer or meditation.