Is Chavez sacrificing cancer care for privacy?

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By BRADLEY BROOKS, Associated Press

SAO PAULO (AP) — As Venezuelan President Hugo Chavez flies to Cuba Friday for surgery to remove a possibly cancerous growth, top doctors say he could be taking a risk by skipping more respected cancer centers in Brazil or the U.S. if his illness proves more complicated.

What muddies that assessment is the miserly amount of detail the firebrand leftist president has revealed about his condition. Since first disclosing his cancer in June, he has only said doctors removed a baseball-sized tumor in his pelvic region last year, and that the new growth discovered this week was two centimeters (one inch) in size and found in the same area.

He had earlier said his cancer was in remission after completing weeks of chemotherapy.

But late Thursday Chavez, 57, said he's "preparing to face the worst."

Referring to the new growth, he said: "The possibility that it's malignant is greater than it not being (malignant)."

Medical experts said that if Chavez has a "standard" cancer, or one that hasn't spread or isn't a rarer and deadlier type of tumor, seeking treatment in Cuba is likely as good as anywhere else.

But if his cancer is more complex, many said he's at risk in not opting for treatment in the U.S., Europe or Brazil — which has Latin America's most advanced cancer centers with specialized radiation equipment.

"If you have a 'common' cancer, that of the breast, colon or lung ... then it's going to be easy to find standards of care that are the same in the U.S., Brazil or Cuba," said Dr. Julian Molina, an oncologist at the Mayo Clinic in Rochester, Minnesota. "The problem comes when you have a tumor that's not one of the common ones, and that's what most of us suspect Chavez has."

Latin America's top cancer doctor Paulo Hoff, who heads the cancer center at Sao Paulo's Sirio-Libanes hospital, considered the region's best, would not talk specifically about Chavez's case. But he did say that a cancerous tumor in the pelvic region would be mainly limited to four types: prostate, rectal, bladder and sarcoma, the latter being a rare and deadly form of tumor.

Mayo clinic cancer specialist Molina said the consensus among doctors in Latin America and the U.S. he's spoken with is that Chavez has a sarcoma tumor because those tend to come back in the same site where a previous tumor was removed, which appears to be the case with Chavez.

Sarcomas in the pelvic region are also associated with an increased rate of the cancer spreading, making them deadlier. Exactly how much more lethal they are and how quickly a person might die from such a tumor depend entirely upon the specific details of each individual's case, doctors say.

While addressing thousands of cheering supporters Thursday night, Chavez said he was "preparing to face the worst" as he prepares to undergo surgery early next week.

He recalled how he recently dreamed about an encounter with Jesus Christ and said, "He told me, 'Chavez, get up, it's not time to die.'"

A caravan of buses and cars fitted with red balloons and carrying Chavez supporters clogged a main artery in central Caracas heading toward the presidential palace Friday morning, honking horns and blaring music from loudspeakers in the back of pickup trucks.

Chavez planned to bid farewell to his supporters in a radio and television address, and then travel by motorcade to the airport on the outskirts of the capital.

It's not clear if Chavez would then have radiation therapy after surgery; if so, it normally begins between three and six weeks after the procedure.

Brazil's President Dilma Rousseff, who successfully underwent cancer treatment at Hoff's center in 2009, invited Chavez to seek treatment at the Sirio-Libanes hospital Sao Paulo last year when he was first diagnosed.

Hoff said the matter never went further than that and that he's not involved in Chavez's treatment. Given Chavez's position, Hoff said, "I'm sure they did due diligence on deciding where he would be treated" and decided Cuba was a safe bet.

Cuba's health system has long been one of the pillars of the 1959 revolution. Health care is free for all Cubans and generally considered good compared to what's available to most people in Latin America and the Caribbean.

There has been some decline in the level of care over the years, however, as economic difficulties make it difficult to purchase medicine and supplies. The U.S. embargo also complicates replacing outdated equipment, despite the fact that the sanctions in theory exempt medicine and most supplies.

If Chavez's cancer has spread to his liver, brain or lymphatic system, the most likely locales for a cancer coming from the pelvic region, he may need more advanced machines that can pinpoint intense bursts of radiation at tumors and not damage nearby tissue.

Dr. Demetrios Braddock, an associate professor of pathology at Yale University's School of Medicine in New Haven, Connecticut, whose research focuses in part on cancers that spread, said a two-centimeter (one-inch) lesion "isn't a small recurrence, that's a significant tumor."

"Even if it were sarcoma, the way it's typically treated it to go back in and taken it out. That's how it would probably be treated up here in the U.S.," Braddock said, underscoring that's the procedure taken if the cancer hasn't spread.

Molina, however, questioned even that surgery, noting that the pelvic region "is really fully packed with organs, nerves, blood vessels ... there is not much room to work."

He added that Chavez's previous surgery in the same area would have produced scar tissue, further complicating the procedure.

Molina said he didn't know about the specific capability of surgeons in Cuba to deal with such a tumor. But both he and several doctors interviewed in Brazil acknowledged that surgeons in the U.S. have the advantage of routinely encountering more complex cancer cases and also having a much larger pool of colleagues to consult.

"When you go to a place like Cuba or Brazil, even with all the development in Brazil, you find less people with enough knowledge to make good advice about what to do," Molina said. "That is where the concern about Chavez comes in — the concern that the knowledge is not at the same level."

Dr. Peter Bourne, chairman of the Medical Education Cooperation with Cuba, a nonprofit organization working to enhance ties between the Cuban and U.S. medical communities, said he routinely visits the island and knows its doctors are up to the challenge of treating all but the most "exotic" cancers.

"They have a very excellent cancer institute in Havana, which is the facility where he's being treated," said Bourne, a former drug czar in the Carter administration who works closely with Cuban doctors and routinely visits the island. Chavez has not publicly specified where he's being treated in Cuba.

Bourne, trained in psychiatry, acknowledged he has no inside information on the illness Chavez is facing. But based on the information that is public, it "seems certain he has cancer of the colon and that the treatment for it would be similar wherever he might seek it."

Bourne, for one, said he thought Cuban doctors would be up to the task of tackling a dangerous recurrence of sarcoma.

"They're very sophisticated in Cuba," he said, "and would be able to treat that as well as he would be treated anywhere."

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Associated Press writer Peter Orsi contributed to this story from Havana.

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