Articles, Blog

Breast Cancer and the 5-Year Survival Rate Myth

August 25, 2019

“Breast Cancer and the
5-Year Survival Rate Myth” While running for president
of the United States, former New York
Mayor Rudy Giuliani ran a campaign ad
contrasting his chance of surviving prostate
cancer in the US—82%— with the same chance of surviving
prostate cancer in England, only 44% under socialized medicine, where they don’t do routine
PSA testing for prostate cancer. To Giuliani, this meant
that he was lucky to be living in New York
rather than old York, because his chances of
surviving prostate cancer seemed to be twice as
high here in the U.S. Yet, despite this
impressive difference in this five-year survival rate,
the mortality rate— the rate at which men were
dying of prostate cancer— was about the same in
the U.S. and the U.K. Wait, what? PSA testing increased survival
from 44 to 82% – how is that not evidence that screening saves lives? For two reasons: lead time bias and
over-diagnosis bias. I’ve talked about over-diagnosis, where a cancer is picked up
that would have otherwise never caused a problem. Without screening, let’s say
out of a thousand people with progressive cancer, only 400 are alive 5 years later; so, without screening 5-year
survival – only 40%. But, let’s say with screening, an additional 2000 cancers
are over-diagnosed, meaning you picked up cancers
that would have never caused a problem or even would have
disappeared on their own. Since the cancer was harmless, five years later, of course,
they’re all still alive, assuming their unnecessary
cancer treatment didn’t kill them, and, all of a sudden,
you just doubled the 5-year survival rate even though in either case,
the same number of people died from cancer. That’s one way how
changes in survival rates with screening may not correlate with changes in actual
cancer death rates. The other is lead time bias. This is how it works. Imagine a group of patients
in whom cancer was diagnosed because of symptoms
at age 67 years, all of whom die at age 70. Each patient survives
only 3 years; so, 5-year survival
for this group is 0%. Now, imagine that same group undergoes screening. Screening tests by definition
lead to earlier diagnosis. Suppose that with screening, cancer is diagnosed in all
patients at age 60 years, but imagine in this case they, nevertheless, all still
die at age 70 years. In this scenario, each
patient survives 10 years; so, the 5-year survival
for this group is 100%. Survival just went
from zero to 100%. Call the newspapers! With this new screening test, now cancer patients are
living 3 times longer — 10 years instead of 3—
it’s a miracle! Whereas all that really
happened in this case was that the person was
treated as a cancer patient for an additional 7 years, which, if anything, probably just diminished their
quality of life. So, that’s the second way
how changes in survival rates with screening may
not correlate with changes in actual
cancer death rates. And, in fact, the
correlation is zero. There is no correlation at all between increases
in survival rates and decreases in
mortality rates. That’s why “if there
were an Oscar for misleading statistics,
using survival statistics to judge the benefit
of screening would win a lifetime
achievement award hands down.” There is no way to disentangle
the lead time bias and the over-diagnosis bias
from screening survival data. That’s why these statistics
are meaningless when it comes to screening. Yet, that’s what you
see in the ads and the leaflets from most
of the cancer charities. That’s what you hear
coming from the government. Even prestigious cancer centers, like M.D. Anderson, have tried to hoodwink the
public like that. If you’ve never heard
of lead time bias, don’t worry –
you’re not alone. Your doctor may not have either. Fifty-four of 65 physicians
surveyed said they did not know what lead-time bias was. And then, when they asked
the remaining 11, “OK, what is it?”,
only 2 were actually correct. So, at this point
in the video, already, you may know more about this than 97% of doctors. To be fair, though, maybe they
don’t recognize the term, but understand the concept? Nope… “The majority of primary
care physicians did not know which screening statistics
provide reliable evidence on whether screening works.” They were 3 times
more likely to say they would “definitely recommend”
a cancer screening test based on irrelevant evidence, compared to a test that
actually decreased cancer mortality by 20%. If physicians don’t even
understand key cancer statistics, how are they going to effectively
counsel their patients? “Statistically illiterate physicians are doomed to rely on their
statistically illiterate conclusions”, or on local customs, or on industry
representatives and their information.


  • Reply Bhuvan Kalra March 5, 2018 at 12:59 pm

    FIRST! 🌱

  • Reply Hiddden Hedge March 5, 2018 at 1:00 pm


  • Reply Eelke Aptroot March 5, 2018 at 1:05 pm

    Killing more than a million people is just a statistic. -J. Stalin.

  • Reply Tactical Nuke March 5, 2018 at 1:10 pm


  • Reply MrJoeSwallow March 5, 2018 at 1:12 pm

    Im just reading the How not to die book. Its nice to have some break with a video.

  • Reply Chris Homer March 5, 2018 at 1:18 pm

    Another great video. Will you EVER run out of video ideas?

  • Reply Fart Farmer 2.0 March 5, 2018 at 1:19 pm


  • Reply SulforaphaneMeUp March 5, 2018 at 1:41 pm

    How about early detection and replacing chemo with diet and exercise? Maybe the scare of cancer can change people's lifestyle to make them serious about their health. Also, are these stats you used in this video up to date with the latest cancer treatments?

  • Reply Initial commit! March 5, 2018 at 1:50 pm

    your daily reminder ;^)

  • Reply Shari T March 5, 2018 at 1:52 pm

    Thanks for posting! Wow! Sobering info!

  • Reply Maple Flavor March 5, 2018 at 1:53 pm


  • Reply T C March 5, 2018 at 2:11 pm

    Excellent. Should be understood by every physician and customer.

  • Reply neil thompson March 5, 2018 at 2:19 pm

    It would be good to see more concrete evidence of diet and lifestyle reversing cancer. Videos like this are good, but essentially is just saying if you are at risk then it's hopeless.

  • Reply oskar tang March 5, 2018 at 2:31 pm

    I watched a video by Dr. McDougall talking about this long time ago.

  • Reply A Happy Broccoli March 5, 2018 at 3:20 pm

    The system is so fucked up… Im glad I know about all this. Thanks for these videos, Doc., changed my life forever 🙂

  • Reply Luminous Views Gallery March 5, 2018 at 3:46 pm

    There is no bigger hero alive today than you Dr. Greger. Thank you so much.

  • Reply Doug bananaboy March 5, 2018 at 3:46 pm


  • Reply MIKEDIDDY March 5, 2018 at 4:24 pm

    This video is about prostate cancer. Why is the title breast cancer? The video makes the same difference but draw in different crowds

  • Reply Alliyance March 5, 2018 at 4:26 pm

    So in a other word, more people dies from cancer treatments. The treatments will only make them think they will prolong their life but in reality, if they wouldn’t not known in the first place, they would have live a better life without treatments.

  • Reply sporto100 March 5, 2018 at 4:36 pm

    PSA tests are a scam

  • Reply Flower Bin March 5, 2018 at 4:45 pm

    I feel like i never want to get screened. Why should I ruin whatever years I have left? Perhaps ignorance is bliss after all.

  • Reply Dylan Watson March 5, 2018 at 5:00 pm

    Hey Dr. Gregor, Loving the content, Any chance you could do some videos about how to protect tooth enamel, remineralizing/restoring it if there is such a thing?

  • Reply Crystal Saling March 5, 2018 at 5:10 pm

    This is such a great video!

  • Reply Scott Tyssen March 5, 2018 at 5:27 pm

    Great video I would have never thought of cancer screening like this.

  • Reply Jeena Bittenbender March 5, 2018 at 6:45 pm


  • Reply Qwazier3 March 5, 2018 at 10:01 pm

    I have never gotten a mammogram because of what you explained here. I already knew all this but not in the terms you used. I've watched cancer diagnosis and cancer deaths explode since I graduated from high school in 1980. I've noted all the charity events funneling money into the hands of those SUPPOSEDLY finding a cure but cutting out, radiating and chemo are STILL the norm for treatment. WHY!?!?! And where is the accountability? Where is the report on where we are in new treatments? We're giving them multi million dollars in charity donations for that cure and all we get is cut, radiated and poisoned to death in return. Stop feeding the monster and cancer will all but disappear.

  • Reply Hulagu Kahn March 5, 2018 at 10:15 pm

    Thanks, Dr. Gregger for exposing the health industry's swamp every day.

  • Reply tbradtbrad March 5, 2018 at 10:38 pm

    Of your many GREAT videos, this is one of the best! Thank you

  • Reply DANG JOS March 6, 2018 at 2:18 am

    I recall Ben Shapiro implying that Canadian healthcare wasn't as good as the US's because the five-year survival rate was higher in the US. I wonder if he was actually wrong there

  • Reply Karen McCann March 6, 2018 at 2:18 am

    Thanks Dr. Gregor for this video and another one you did about overdiagnos breast cancer. I went vegan almost a year ago and I'm glad I did but these studies about cancer really opens a person's eyes to what you die from the actual cancer or the treatment that virtually destroys a person's immune system.

  • Reply Alec Rodriguez March 6, 2018 at 2:23 am

    I’ve been vegan for ten months have hypo thyroid. Can I fix it just by eating enough iodine and is synthroid safe.

  • Reply Vedic S March 6, 2018 at 3:12 am

    isnt the title supposed to be prostate cancer and the 5 year survival myth!?!

  • Reply 5ko March 6, 2018 at 11:11 am

    Please Dr. Greger reply to my question:
    My nephew is 15 and has type.1 diabetes. My question is… theoretically if he stops consuming milk protein for ever. the autoimmune reaction which kills beta cells will never occur again? since he is only 15 he can still grow some beta cells and theoretically not inject any insulin in the future?

  • Reply sqwilliam97 March 6, 2018 at 4:04 pm

    Breast cancer or prostate cancer?

  • Reply itay mitra March 6, 2018 at 7:03 pm

    This is the best video i saw from u,,thank u

  • Reply Beth black March 7, 2018 at 2:49 am

    Most Cancers are notoriously deadly. Regardless of anything. This is something that people ''need to accept''.

  • Reply Raw Recovery March 7, 2018 at 11:51 am

    Anyone heard of SugaVida?? From the palmara tree, apparently a plant source of B-12?? Anyone know if it’s healthy?? Cheers

  • Reply A J March 9, 2018 at 10:52 am

    Yep. Giuliani is a fuckin' prick.

  • Reply Dana M. McIntosh March 13, 2018 at 10:03 pm

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  • Reply Col83 March 22, 2018 at 12:22 pm

    So this is why they constantly hammer home early detection is KEY to survival. No, it's key to their stats being able to be misrepresented on the 5 year survival rates. So it's all about money in not survival. Cancer is a total scam.

  • Reply anarky4321 June 22, 2018 at 4:43 am

    you go through the slides a bit fast sometimes…and im a fast reader

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