A Practical and Inexpensive “Screen Test” for Cancer

The early diagnosis of cancer in any of its stages is the most important factor in the fight against it. Therefore, the need for a simple, inexpensive, universally-applicable test is a desideratum.

Doctor Charles Oberling, in his excellent book, The Riddle of Cancer, succinctly states the problem:

“One of the main essentials in any effective campaign is knowledge of the enemy. In the case of cancer this is demanded first of all from the family doctor, for he is the advance guard in the battle, yet this wholly reasonable requirement is not being met. All who have taken an active part in the struggle realize that the most pressing need, if real progress is to be made, is education of the general practitioner. He must have constantly in mind the prime necessity of early diagnosis, and realize that his most sacred duty in every doubtful case is to set in motion all diagnostic means at the disposal of modern medicine: biopsy, endoscopic exploration, X-ray examination, and biochemical tests. How much time may be lost by expectant waiting and useless treatment! The golden hour passes, and with it the last chance of the patient.”¹

Unfortunately, general practitioners and interested workers in ancillary professions are handicapped in their “advance guard battle” against this disease because they lack a satisfactory, easily performed screen test, to detect cancer in its early, intermediate or late stages. It is the consensus that no laboratory test is infallible–on the other hand, a reliable screen test is a sine qua non in office procedure for the rapid detection of malignancy and other profound physio-biological disturbances.

Quoting Oberling again:

“The fight against cancerophobia is quite as important as the fight against cancer itself, for the constant dread of a disease is not salutary but may be accompanied by ill health and perhaps even by heightened susceptibility.”²

A cancerophobe should always be thoroughly examined; then the doctor can assure the patient that no sign of cancer is present. Oftentimes, however, the patient is reluctant to accept this assurance, too frequently arrived at by a superficial physical examination.

Recently, several tests have been reported which claim satisfactory percentages of reliability–the Pfeiffer crystallization test, the Fuchs reaction, the Papanicolaou test, the Huggins reaction, and the West-Hillard test. All of these procedures, however, do not lend themselves to routine office procedure for busy general practitioners. These tests require complicated and expensive laboratory equipment and skilled help which few physicians can afford.

We desire to report our experience with a test meeting these specifications which should be an integral part of routine examinations performed in offices of physicians and dentists, in hospitals, clinics and public health surveys. It requires a minimum of time and equipment and one soon acquires proficiency in the interpretation of clot retraction patterns. If, with this procedure, a suspicious or positive diagnosis is made, it may be checked in special laboratories where the more complicated tests are employed.

It is the consensus that in cancerous processes the sedimentation rate is distributed. Goldberger³ used a simple test for measuring the blood sedimentation rate at the bedside and claimed that, although it was not intended to supersede accepted sedimentation rate tests in hospitals, etc., it was of great value because it was simple, rapid and accurate. After extensive observations, he correlated certain syneretic patterns with specific clinical entities. It could be used by any physician anywhere, supplying him with a permanent record.

In 1942, Bolen,^4,5 while working with the Goldberger sedimentation test, observed that all clot retraction patterns were not identical. He encountered the most disturbing patterns in persons afflicted with cancer, leukemia, and in pregnancy. One of us (Norman) became interested in this work through a personal contact with Doctor Bolen, and this paper may be considered an extension-study of the Bolen test.

In an attempt to evaluate his work we have performed this test routinely on all patients during the last two years. During this period we tested more than 350 patients, and in each case from 8 to 10 drops were examined, giving us a total of about 4,000 drops. Comparing the results obtained from the slide technic with the available clinical data, our accuracy averaged 97%. This corroborates the findings of Bolen, Gruner⁶ and Giron.⁷

Technic: The finger or earlobe is well-cleansed with alcohol, allowed to dry, and pricked to obtain the blood drops. The drops are lightly touched with a clean glass slide, the slide righted and the drops allowed to air dry. When thoroughly dry, they are examined under the low power of a microscope. If a microscope is not available one may use a hand-magnifier. A well-trained person may hold the slide against a light to make his diagnosis, although in our opinion the use of some form of magnification is preferable. A diagnosis may be made as soon as the drops are thoroughly dry (about 5 to 10 minutes after obtaining the drops): we prefer to let the slide dry overnight before rendering a final verdict.

The technic for taking the drops is most important. If the drops are too thick, even a cancer patient’s blood may show a normal pattern; if, on the other hand, the puncture is too shallow, necessitating extreme pressure to obtain sufficient blood, an excessive amount of serum will be expressed and the pattern of a normal person may be suggestive of cancer.

Proficiency in accurate diagnosis is acquired by routinely studying clot retraction patterns obtained from patients suffering from various diseases, or, who are “apparently” in good health. In this way, one becomes familiar with normal, suspicious and positive syneretic patterns–a prerequisite for correct diagnosis. The occasional use of the test is not advisable because the resultant lack of competence in recognizing the various clot retraction patterns will be embarrassing to the examiner and disillusioning to the patient. The routine use of the test on every patient supplies a permanent record of the multiplicity of patterns which may be encountered in various clinical conditions. Its utility depends upon the correct interpretation of the syneretic pattern–developed only through constant usage.

Therefore, we cannot stress enough the importance of learning to take and interpret the blood drops correctly.

Several contrasting photo-micrographs will demonstrate the different patterns which one may encounter.

Subjects were 58% females and 42% males. Ages ranged between 12 and 89 years; 32% of the group were over 45 years of age.

Normal patterns have a uniform background with a definite fibrin network spanned across it. Few vacuoles are present and the impression is one of complete unity. Under normal conditions age and sex do not influence the configuration of the pattern. Figures 1, 2, 3.

Fig. 1. Female; 12 years; symptomless; normal clot retraction pattern.

Fig. 2. Male; 55 years; symptomless; normal clot retraction pattern.

Fig. 3. Female; 89 years; symptomless; normal clot retraction pattern.

 

In positive configurations, a broken fibrin network is observed. Large “lakes” are formed and the red cells cling together instead of being evenly distributed as in the negative pattern.

A positive pattern does not indicate “where” the cancerous growth is located; it indicates that a malignancy is present. It is the physician’s problem to locate it. The following figures 4, 5, 6, represent characteristic configurations of blood drops obtained from patients with stomach, lung and bone cancers, respectively.

Fig. 4. Male; 55 years; cancer of the stomach; typical disturbance of the clot retraction pattern.

Fig. 5. Female; 50 years; cancer of the lung; typical disturbance of the clot retraction pattern.

Fig. 6. Male; 44 years; cancer of the supermaxillary with metastasis; profound disturbance of the clot retraction pattern.

 

As previously mentioned, this test is not 100% accurate–what laboratory procedure is? Some conditions, other than cancer, show a profound disturbance of the syneretic pattern. These indeterminate, suspicious patterns occur in seriously-ill individuals. Fortunately, concomitant with clinical improvement, the pattern reverts to normal.

The first condition which gives a picture indistinguishable from cancer is leukemia. As shown in figure 7, the lakes are identical with those characteristic of the cancer pattern. This finding is understandable because cancer and leukemia are recognized as allied diseases.

Fig. 7. Male; 70 years; leukemia; disturbance of the clot retraction pattern almost identical with cancer.

 

Another, giving a similar pattern to that of cancer, is pregnancy. Figures 8, 9, 10. This phenomenon supports the theory of some who consider cancer a proliferation of “new cells”. Fortunately, in the majority of pregnancies, the proliferation of “new” cells follows a well-ordered genetic “blueprint”–it is under control and its direction is definitive. If there is a possibility of cancer complicating pregnancy, the test should then be repeated periodically for several weeks after delivery. Normally, the syneretic pattern reverts to normal shortly after parturition. Should the test, however, continue to be positive after several weeks, then the presence of cancer should be seriously considered.

Fig. 8. Female; 34 years; three months pregnant; early disturbance of the clot retraction pattern.

Fig. 9. Female; 22 years; three and one-half months pregnant; disturbance of the clot retraction pattern.

Fig. 10. Female; 34 years; (same as Fig. 8) but four months pregnant; advanced disturbance of the clot retraction pattern.

 

Tuberculosis and ulcerative colitis also show patterns similar but not identical with cancer especially when the diseases are active. Figures 11, 12, 13, 14 illustrate this. The difference between these configurations and those of cancer may be readily differentiated–the network is less chaotic than the cancer pattern, the lakes appear smaller, and more loose aggregations of red blood cells are scattered throughout the lacunar spaces. When this condition begins to improve, the pattern progressively reverts to normal; see figure 15.

   

Fig. 11. Female; 45 years; active tuberculosis.

Fig. 12. Male; 70 years; active tuberculosis.

Fig. 13. Female; 40 years; terminal ulcerative colitis with multiple polyposis; disturbed clot retraction pattern, but not typical of malignancy.

Fig. 14. Male; 41 years; ulcerative colitis for five years duration up to four years ago; moderate exacerbation due to dietary indiscretions; note disturbance of retraction pattern.

Fig. 15. Female; 28 years; three years prior in morbid phase of ulcerative colitis; constructively treated by correct nutrition; now free from symptoms; negative clot retraction pattern.

 

This test can also be used in evaluating the course of the disease. Bolen states that if a cancerous process is completely excised, the pattern should become normal in about six weeks. If the pattern does not revert to normal, one should assume that all of the cancer tissue was not removed and a recurrence impends. We concur with this observation.

We have a few cases in which a definite diagnosis of cancer was made before either operation or x-ray treatment was instituted. The patients made complete recoveries and the following figures 16, 17, 18, illustrate the reversion to a normal clot retraction pattern.

Fig. 16. Male; 57 years; biopsy diagnosis of cancer of the larynx; deep x-ray therapy; negative clot retraction pattern after four years.

Fig. 17. Female; 53 years; bilateral radical amputation of breasts for malignancy; successful; negative clot retraction pattern after five years.

Fig. 18. Female; 72 years; bilateral radical amputation of breasts for malignancy; successful; negative clot retraction pattern after twenty years.

 

Although no disturbance is found in the pattern of “oldsters”, if in perfect health, frequently configurations occur implying an aberration of the normal pattern, although one may be reasonably sure that no malignancy is present. When these patients are carefully examined, one frequently discovers a clinical condition characteristic of an advanced type of a degenerative disease. If they respond to treatment, the pattern will revert to normal. Figures 22, 23, 24, confirm these observations.

Fig. 19. Female 71 years; disseminated arteriosclerosis; disturbed clot retraction pattern; see Fig. 22.

Fig. 22. Same patient as Fig. 19; after treatment; normal clot retraction pattern.

Fig. 20. Male; 63 years; coronary artery disease and arteriosclerosis; disturbed clot retraction pattern; see Fig. 23.

Fig. 23. Same patient as Fig. 20; after treatment; normal clot retraction pattern.

Fig. 21. Female; 75 years; fulminating cerebral arteriosclerosis; (early hypertensive encephalopathy) disturbed clot retraction pattern; see Fig. 24.

Fig. 24. Same patient as Fig. 21; after treatment; normal clot retraction pattern.

 

Another slight change in pattern may occur in serious systemic infections. The following are examples: a. A severe bronchitis which disturbed the syneretic pattern, figure 25, and b. a spider bite which disrupted the normal pattern, figure 26. After the symptoms abated, the configurations of the fibrin shreds again revert to normal. See figures 27 and 28.

Fig. 25. Female; 71 years; acute bronchitis; disturbed clot retraction pattern; see Fig. 27.

Fig. 27. Same patient as Fig. 25; after recovery; normal clot retraction pattern.

Fig. 26. Male; 60 years; cellulitis of left forearm caused by spider bite; disturbed clot retraction pattern; see Fig. 28.

Fig. 28. Same patient as Fig. 26; after resolution; normal clot retraction pattern.

 

In conclusion, if an occasional wrong diagnosis is made, one cannot discredit this procedure, because when a positive pattern is present, it is an indication for painstaking clinical, x-ray and hospital laboratory investigations. The patient should then be treated and constructively supervised, with a monthly check on his clot retraction pattern. If this pattern is persistently on the indeterminate or positive side, clinical, x-ray and laboratory investigations should be repeated periodically.

We feel that this test should be known as the Bolen Test for Malignancy because of Doctor Bolen’s original investigations and observations with this simple test.

 

References Cited:

1. Oberling, C.: The Riddle of Cancer. University Press, 1944, pages 6, 7.
2. Idem: Ibid, pages 7, 8. New Haven, Yale
3. Goldberger, E.: “A Rapid Bedside Test for Measuring Sedimentation Rate.” New York State Journal of Medicine: 39: 867, 1939.
4. Bolen, H. L.: “The Blood Pattern as a Clue to the Diagnosis of Malignant Disease.” J. Lab. & Clin. Med., 27: 1522, 1942.
5. Idem: “Diagnostic Value of Blood Studies in Malignancy of the Gastrointestinal Tract.” Am. J. Surg., New Series, Vol. LXIII, No. 3, 1944, pages 316-323.
6. Gruner, O. C.: A study of the Blood in Cancer. Montreal, 1942. Renouf Publishing Company.
7. Giron, M. A.: Thesis–”La Eritrosedimentación En Gota Gruesa Como Guía En El Diagnostico Del Cáncer.” Guatemala, July, 1943.