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Half Truths

I am pleased that the senator and former Colombian presidential candidate, Gustavo Petro, disclosed his medical history in which he discloses information about the medical procedures he underwent in Cuba and their respective results.

I am even more pleased that he is in good health and that the “squamous cell carcinoma of the esophagus”, which he was initially diagnosed with at the Center for Surgical Medical Research (CIMEQ) in Cuba, does not exist.

By reading the published document and listening to the announcement made by the senator with the result of his last endoscopy, key information was provided that would have prevented the credibility scandal in which Petro has been involved since the diagnosis obtained in Cuba was made public.

Finally, it was confirmed that the endoscopic examinations and studies carried out in Colombia did not find “evidence of malignancy in the samples”. That is to say, in three Colombian clinics they determined that Gustavo Petro did not have cancer, although the senator strangely only mentions tests in two Colombian health centers.

If Petro had included this information in his initial announcement on Twitter on April 10, if he had not spoken half-truths, surely Dr. Fernando Sierra of the Santa Fe Foundation in Bogotá would not have reacted by sending an unfortunate message to another person to say “nowhere did we see cancer.”

In the audio message, which should never have been recorded and much ] shared, the Colombian doctor says that it is “all talk” and rules out the existence of malignant cells, after reviewing the diagnosis, endoscopy, biopsies and endoscopic ultrasound from Cuba, and after having taken “multiple biopsies” in Colombia.

One of Gustavo Petro’s squires, Senator Gustavo Bolívar, says that Petro wanted to keep his state of health under wraps, but was “forced” to announce his medical situation as a result of the fact that the senator’s trips to Havana and images of the place where he was staying were made public. A monitoring and espionage that must be condemned. But, why did Petro not mention, in his initial announcement on April 10, the three favorable diagnoses he obtained in Colombia?

In a tweet released on April 22, I reported that the senator did not have cancer.

Petro did not remain silent and replied through the same social network: “No, Patricia, you’re wrong. And I must say that questioning medical opinions is unethical. I know that medicine is not an exact science, but neither is it the product of political conspiracies. The diagnosis is clear and contradicts you”.

To dispel the doubts that Petro himself generated with the public announcements about his health, I consulted several doctors who do know how to interpret the results of medical examinations and evaluations. I spoke with gastrointestinal specialists from prestigious US hospitals and with a professor of Pathology from a Colombian university who analyzed the “summary of the clinical history” of Gustavo Petro issued by the Cuban CIMEQ.

According to Senator Gustavo Petro and his medical history, the second endoscopy performed in Cuba was to “eradicate the cells with carcinoma” or “to perform the excision (removal) of the described lesion.” It refers to the lesion of more than 3 centimeters that was found at the junction of the esophagus with the stomach with a histological diagnosis of “squamous cell carcinoma of the esophagus”. This is the result of a biopsy or analysis by a pathologist under a microscope of the abnormal tissue.

This lesion that was removed in the second endoscopy and which was not small in size, was submitted again to a pathology evaluation to confirm or rule out carcinoma. The result of the biopsy or the histological diagnosis came with good news: he does not have cancer and, instead, Senator Petro suffers from “chronic esophagitis with marked fibrosis down to the muscularis propria. Squamous epithelial and mucosecretory hyperplasia with low and high grade multifocal dysplasia, predominantly low grade ”.

In other words, they found chronic inflammation and scars in the tissue, typical of a recurrent reflux that generated some changes by thickening a part of the mucosa of the esophagus. They also determined a “multifocal dysplasia (…) with a low grade predominance”.

According to gastroenterologist Dr. Robert Strauss, a member of the American Gastroenterological Association, “Dysplasia is a term used to describe cells that are not normal. They are inflammatory or premalignant changes, but they are not cancer cells ”.

I also consulted with Colombian doctor Juan Sarmiento, a surgeon specializing in liver and pancreatic cancer, who works in the Department of General and Gastrointestinal Surgery at Emory University, and who saved the life of former United States President Jimmy Carter after operating on him for melanoma in the liver. In his analysis of the CIMEQ medical history, Dr. Sarmiento specifies: “If one has a mucosa that is subjected to a chronic inflammatory process, changes in the cellular architecture occur. This is called dysplasia, which is not cancer. Untreated low-grade dysplasia can increase in intensity to medium and high grade, and turn into cancer after several years ”.

Both doctors agree that if the initial diagnosis of cancer had been confirmed, the biopsy of the lesion extracted in the second endoscopy should read “squamous cell carcinoma of the esophagus”. This is not the case with Gustavo Petro. The question then arises whether the cancer existed.

Between the first diagnosis on March 2 and the removal of the suspicious lesion on April 13, 6 weeks passed. I asked the doctors: At what point, according to Gustavo Petro’s medical history, did the cancer disappear? Was the carcinoma removed in the last endoscopy, as expressed by Gustavo Petro and his closest collaborators?

Dr. Sarmiento gave me his chronological analysis. “The patient travels to Cuba where he underwent an endoscopy in which he was diagnosed with squamous cell carcinoma of the gastroesophageal junction. There is no evidence of treatment in the first procedure, only a biopsy was performed. The patient travels to Colombia where they see the lesion described in Cuba, but the biopsies do not diagnose cancer. He returns to Cuba where he undergoes another endoscopy with resection (removal) of the lesion without finding evidence of malignancy. The problem I see is that there was no treatment for the lesion, only biopsies. And cancer is not cured with reflux treatment.”

Dr. Sarmiento adds to his interpretation: “How is it explained? Either the original diagnosis is not correct, and he never had that tumor, or the initial biopsy samples were so generous that they removed cancer cells and therefore no evidence of tumor remains in the final resection specimen, which is very improbable. The answer lies in the pathologist who diagnosed the cancerous tumor in the first instance ”.

A professor of Pathology to whom I requested his opinion agrees with Dr. Sarmiento. “If it was only in situ lesion, perhaps; but a large 3-centimeter lesion that has already ruptured the basement membrane and that was already in the submucosa, it is very unlikely that an endoscopic biopsy will be removed ”. The professor adds: “No malignant tumor lesion is going to reverse itself in a month and a half, and less without chemotherapy or radiotherapy treatment. That is perfectly impossible. “

Dr. Strauss points out that the result “initially seems contradictory, and without seeing the copies of the biopsies and the complete file, doubt persists. But what could have happened is that the biopsy samples were taken before the inflammation was treated. The result is more reliable if they first resolve the inflammation and then do another procedure to determine if they have dysplasia or cancer.

Another Colombian gastroenterologist, who did not want to be identified, agreed with Dr. Strauss. “If you take samples from reflux-inflamed tissue because it has acid irritation, it’s easy for it to resemble tumor cells on biopsy, and it’s easy to mistake it for cancer. I think it was an inflamed tissue, it improved and there is still dysplasia ”.

In the end, it is the pathologist who diagnosed the carcinoma at CIMEQ in Cuba who has one of the answers that I am looking for. However, the university professor of Pathology gave me a clue: “I sometimes, with a little sarcasm, say that many of the cancers that are cured are those in which pathologists have made mistakes.”

One thing that is true without a doubt is that Senator Gustavo Petro trusts Cuban doctors much more than Colombian doctors.

* The reference to the Main (Definitive) Diagnosis located at the top of the summary of Gustavo Petro’s medical history, refers to a work diagnosis that, according to the same document, was later discarded (see document image).

** The doctors consulted indicated that, unlike the type of cancer diagnosed in Gustavo Petro in Cuba, the most common cancer of the distal third of the esophagus is adenocarcinoma.

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