for those weighing the risk of "stirring up their breast cancer" by having surgery

[Lani]

after taking part in a recent thread on whether to have a prophylactic mastectomy on the uninvolved breast without being a BRCA1/2 carrier, I brought up the risk of activating inflammatory cascades.

In a just released article on why african americans mortality from breast cancer is higher than european americans they postulated it was because AA bc was more often premenopausal and cited articles showing that the risk of activating dormant distal metastases is greater in premenopausal women

I cite the following from the press coverage of that article:

It has also been shown, in a study of 1173 women in Italy undergoing breast cancer surgery, that surgery to remove a primary tumor induces angiogenesis of distant dormant micrometastases in 20% of node-positive patients who are premenopausal.

Surgery-induced angiogenesis is recorded in five times as many node-positive patients than node-negative patients, and in twice as many premenopausal patients than postmenopausal patients.

This, the researchers say in the International Journal of Surgery, may help to explain the "mammography paradox" – that mammography screening has significantly less benefit in women aged 40–49 years than in those aged 50–59 years.

It might also tie-in with the belief in 69% of the AA community, versus 29% of EA communities, that "exposing a cancer to air" will cause it to spread. This has been dismissed as superstition, but may simply be due to the observation that AA women appear twice as likely to die after cancer treatment as EA women.

The team goes on to say that early detection of breast cancer with mammography began in the 1970s. Consequently, seeing as AA breast cancer is largely premenopausal and EA breast cancer is largely postmenopausal, it logically follows that, due to surgery-induced early mortality, outcomes from the 1970s would be improved in EA patients compared with their AA counterparts.

"In conclusion, we suggest that the observed race-related changes in breast cancer mortality may, in part, stem from screening and subsequent resection of poor-prognosis breast cancers among AA premenopausal women, which negatively impacts the host–cancer balance in a subset of these women."



Int J Surg 2007; Advance online publication

I hope this helps somewhat those with difficult decisions to make!

[Lauriemn]

Hi Lani, I am very interested in this, as I have my second stage of my reconstruction coming up.

I was wondering how did they find out that surgery induces angiogenesis of distant micrometastases? did they just look at how many recurred, or did they do some bone marrow/tissue sample tests?

the one thing that struck me about this study is that they are comparing premenopausal women to post menopausal women. Isn't cancer in premenopausal women more agressive, whether they have surgery or not? couldn't that explain the difference?

Laurie

[kk1]

Hi Lani;

IMHO After reading the full text of this article I don't think it offers much. Note that the title is "Might partially explain". In the full article they put forward a hypothesis and then also present a theoretical frame work to test the hypothesis. They don't actually do the experiments needed to test their hypothesis and there are other just as likely explanations for the differences between reoccurence in AA premenopausal BC and EA post menopausal BC. It's like comparing apples and oranges. I would not put much confidence in this particular paper.

kk1

title:
Enhanced surgery-induced angiogenesis among premenopausal women might partially explain excess breast cancer mortality of blacks compared to whites

Michael W. Retskya, , , Romano Demichelib, Isaac D. Gukasc and William J.M. Hrusheskyd. in press Int. J. surgery.

[Lani]

I didn't post it as explaining the difference in mortality between African and European Americans--there are MANY other factors--blacks more often get triple negative bc, they often have less access to early mammography, state-of-the-art treatment, perhaps use more creams containing estrogen-like compounds, etc...

I posted the quote regarding the activation of distant mets. I did not think this had been proven either---but it provided a reference as to the paper that put this claim forward.

There are so many factors influencing whether cancer recurs that control experiments cannot be done in humans--leaving many to hypothesize