Elle Macpherson’s Cancer Story and the Missing Tumor Info

(Title image: Photo by Pierre Bamin on Unsplash)

Following on the heels of my Elle Macpherson post last week, I wanted to fill in some missing info…

To back up, former supermodel Elle Macpherson revealed that she took the holistic route when deciding to treat her breast cancer in 2017. However, most of the news stories that reported and offered opinions on her choices left out some critical information, as noted by this article in The Guardian (“Crucial information missing in Elle Macpherson breast cancer story, experts warn“). In this case, that information makes a big difference.

While it seems that Elle’s cancer was HER2-receptor positive, which suggests a more aggressive cancer, it was considered “non-invasive”, meaning it was contained within the mammary ducts. Often, this is referred to DCIS, or Ductal Carcinoma In Situ, and at this point those of us with personal knowledge of the disease will knowingly go, “OOooooooh.”

This is basically a “precancerous” mass of cells and often the treatments are more conservative. It’s considered stage 0. Yes, it becomes more dangerous if you do nothing, but clearly Elle did something: she had it removed.

DCIS is a stage 0 cancer, which doesn’t necessitate the most aggressive treatment.
(Photo by Bernard Hermant on Unsplash)

Beyond that, there are other conventional treatments offered, depending on how aggressively you want to go. This introduces the issue of potential overtreatment, which is gaining more attention among physicians and the public. It’s easy to throw the kitchen sink at anything that looks like cancer, but that increases the chances that patients unnecessarily experience damaging side effects. Not everyone needs to be smacked that hard with treatment.

So, given that Elle’s cancer was DCIS, her holistic treatment starts looking less extreme. In perspective, for stage 0, a radical mastectomy topped off with chemotherapy and other treatments leans towards overkill with minimal benefits, potentially affecting quality of life. So this is less about the types of Elle’s holistic treatments and much more about her cancer not requiring the same level of aggressive action as stage 1+ tumors.

However, very few of the news stories mentioned this. As a matter of fact, my own blog post last week might have confused the issue—I was writing without having all the facts. This underscores the importance of learning as much about your cancer as you can and understanding that your version of the disease may be very different from that of a friend with cancer.

In light of this, the pile-on regarding Elle’s treatment seems unfair…but only as it regards her personal situation. Because all the opinion pieces that came out against her choices, including my post, did so for a critical reason: that Elle’s story (“follow your heart”) may turn a cancer patient away from much-needed and beneficial treatment that can prolong their lives.

Get the facts, talk to your team, understand what you’re up against and what your risks are—yes, meditate, pray, exercise, change your diet. But don’t try to wish your cancer away.

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To clarify, Elle did indeed decline even less radical treatments such as endocrine therapy, so one could argue that she’s still taking a risk. We don’t have a crystal ball to determine whether this was the wisest choice, Elle believed it was the right choice for her.

Balancing Side Effects vs. Quality of Life

“Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.”

I can’t tell you how many times I’ve read that statement on the informational leaflets from various bottles prescribed for me. When it comes to a disease like cancer, it might as well say, “You think these side effects are bad? Hohoho, just try not taking your meds!”

This does not give warm, fuzzy feelings of hope. Then again, there’s not much about cancer that’s warm and fuzzy.

It can feel like the treatment is as bad as the disease.

I, admittedly, am generally accepting of the advice given by knowledgeable professionals. When my oncologist laid out a treatment plan, I didn’t argue, although when offered a choice between an effective targeted therapy versus an even more effective but also more toxic one, I opted for lower toxicity.

For me, it was a quality of life issue. If I’m “cured” of cancer but end up with severe heart problems…well, I’d rather take my chances with a less damaging option.

Cancer still remains life-threatening, now as it did decades ago. The difference is that patients are living longer and some go completely into remission. Survivorship should be considered a factor when designing a treatment plan, as should long-lasting repercussions of side effects.

So if I had one request of oncological health teams, it would be that they look beyond simply bombarding the cancer and consider the physical and mental condition in which they leave the patient, being sensitive to the possibility of ‘overtreatment’ in their exuberance to squash as much of the disease as possible.

Should you use a sledgehammer when a rubber mallet might be sufficient? Is “just to be sure” a justification for side effects than can compromise your quality of life, however long that is?

It’s not always easy to find that sweet spot between acceptable risk and tolerable side effects.

There is no “right” answer to this as everyone’s situation and risk tolerances are different. So if I could have a second request of the medical community, family and friends of the patient, it would be that they respect the limits and decisions of the one who’s going through this.

To be able to weigh the risks and decide what’s acceptable and where to draw the line — that might offer at least a semblance of control in the crazy roller-coaster ride that is cancer.