The risks of refusing chemo, according to a breast cancer surgeon

Supermodel Elle Macpherson refused conventional treatment, taking a ‘holistic approach’, but what does a breast surgeon and survivor advise?

When breast surgeon Dr Liz O’Riordan was diagnosed with cancer at just 40 years old, the option to refuse chemotherapy was one that never crossed her mind – though she knew the toll it takes better than most. 
“I was a consultant when I was diagnosed and I knew I’d need chemotherapy when I saw my scan,” Dr O’Riordan says. 
“I was scared,” she recalls. “I didn’t want to lose my hair, and I didn’t want to lose my job, but I knew it was the best chance that I had to survive. The idea of not doing everything I could to save my life never occurred to me, because my life is precious.” 
The desperate instinct to fight a tumour is one common to most cancer patients, Dr O’Riordan says, but their reactions do not always look so conventional. 
Rather than following the treatments laid out by a doctor, some turn to “juice cleanses, alkaline diets and having their fillings removed,” she says. “Every day, I get sent videos from Instagram and TikTok where people claim that these things can cure cancer.” 
Among those opting for alternative treatments over chemotherapy and surgery is Australian supermodel Elle Macpherson, 60, who recently revealed that she had been diagnosed with breast cancer in 2017. 
Macpherson turned down a mastectomy, followed by a gruelling course of radiotherapy, chemotherapy and hormone therapy, after a surgery to remove a lump from her breast. 
It was a decision she made despite the advice of 32 separate experts, in the belief that this course of action was too “extreme”. 
Instead, the supermodel opted for “an intuitive, heart-led holistic approach” to treating her cancer, under the direction of her own primary doctor, who specialises in “integrative medicine”, a combination of therapies and lifestyle changes. 
While figures are hard to come by – one study suggests that the rate of chemotherapy refusal in cancer patients could be anywhere between 3 and 19 per cent – Dr O’Riordan says that a growing number of people are casting aside conventional cancer interventions in this way. 
Many seek “treatment” abroad, at wellness clinics and retreats. Macpherson herself spent eight months in a rented house in Phoenix, Arizona, where she was treated by a naturopath – a kind of alternative doctor promoting “natural” or “non-invasive treatments” – as well as a holistic dentist, an osteopath, a chiropractor and two therapists, in order to battle her cancer. 
Away from her two sons, who had mixed reactions to her choice of treatment, the model had lived alone, spending her days “focusing and devoting every single minute to healing myself”. 
Macpherson also claims to have sought advice from British-Australian actress Olivia Newton-John, who underwent acupuncture and massage therapy and adopted a vegan diet alongside chemotherapy for breast cancer, and who later died in 2022. 
“We spoke a few times when I was diagnosed and also through
both of our healing journeys,” Macpherson told Women’s Weekly. “We did things differently, but we did share experiences with each other and how we [felt in 2017] and how we approach things.” 
Since then, Macpherson has been in remission – or, as she puts it, is living a life of “utter wellness”. 
But that remission could be short-lived, says Dr O’Riordan. “Research shows that women with breast cancer who refuse mainstream treatments are six times more likely to die,” she explains. 
That’s because “chemotherapy is done to reduce the chances of cancer coming back”. Though the side effects can be extremely difficult to bear, chemotherapy is offered to patients when doctors believe that there is a chance greater than 5 per cent that the treatment will work, she explains. 
But “most people with breast cancer will have surgery, which has the greatest chance of curing you, because it involves removing the cancer,” Dr O’Riordan says. At times, a lumpectomy, such as Macpherson underwent, “does not get all of the cells, which is probably why she was offered a mastectomy”. 
Some women with breast cancer are offered chemotherapy before surgery, but many are offered it afterwards, to increase their chances of remaining in remission. Sometimes this can be slim. 
“I was given chemotherapy with a 20 per cent chance of survival, and I didn’t know whether I’d be in the 20 per cent who would benefit, or the 80 per cent who wouldn’t,” says Dr O’Riordan.
“That’s my worry with alternative medicine. People are being told that this will save their life, without being told about any of the side effects” or that it might not work.
“Meanwhile, doctors have to tell patients all the side effects of chemotherapy, and that it still might not work, and they don’t get the opportunity to tell them that an extra million women are alive today because of these drugs.” 
Macpherson’s particular kind of breast cancer “is aggressive and can go to the brain,” says Dr O’Riordan. It is also hormone receptor-positive, like 80 per cent of breast cancers diagnosed, “and we know that this kind of cancer can come back 20, 30 years down the line”.
This is one reason why Dr O’Riordan is concerned about a rise in chemotherapy refusals. Those most likely to turn down mainstream treatments are “well-educated, well-off women,” Dr O’Riordan says. “I think that, generally, men are less likely to be looking for information on social media, and more likely to trust a doctor.” 
The “online cancer space” is huge as a result, she says, and is largely made up of women searching for an alternative to brutal and bewildering cancer treatments. 
“Nothing about cancer is rational or logical,” she says, so “common sense goes out the window. You’re scared of dying, of treatments, of the future”.
On top of that, “doctors only have a limited amount of time to tell someone what’s happening. I used to have 10-minute slots to tell people that they had breast cancer.” 
Other patients hear about alternative cures from family and friends. At the time of Macpherson’s diagnosis in 2017, she was in a relationship with anti-vaccine campaigner Andrew Wakefield. 
In anti-vaccine circles, a worldwide rise in cancer cases has been pinned on a wide range of jabs, most recently the Covid vaccine, which conspiracy theorists have said is responsible for a 20-fold increase in certain types of cancer.
Macpherson’s own dive into wellness, however, seems to have been prompted by a separate breast cancer scare in 2013, after which she was reportedly told by a nutritionist to start following an alkaline diet. 
The alkaline diet involves avoiding acid-promoting foods such as eggs, dairy and lentils, to improve health and lose weight. It is also commonly claimed in alternative medicine circles that the diet helps fight cancer.
It is true that some of Macpherson’s lifestyle choices leave her at a lower risk of developing cancer again, Dr O’Riordan says: “She’s not overweight, and probably eats a good diet and probably exercises” – but this is simply not enough to keep her in the clear.
“Maybe for her it was never going to come back, so she didn’t need to bother [with chemotherapy and surgery],” she says. “But by turning down chemotherapy, she has reduced her chances of making it.” 
The doctor is clear: “I’d urge anyone not to make a decision like this without speaking to an oncologist and understanding what the real risks and benefits of chemotherapy are. Don’t think that because this has worked for Elle Macpherson – so far – that this will work for you.”