not to anger or scare anyone--just food for thought

[Lani]

Int J Surg. 2005;3(3):179-87. Epub 2005 Sep 12.
Does surgery induce angiogenesis in breast cancer? Indirect evidence from relapse pattern and mammography paradox.

Retsky M,
Demicheli R,
Hrushesky WJ.
Children's Hospital/Harvard Medical School, Department of Vascular Biology, Karp Family Laboratories, 1 Blackfan Circle, Boston, MA 02115, United States.
A significant bimodal relapse hazard pattern has been observed in two independent databases for patients untreated with adjuvant chemotherapy. This implies there is more than one mode of relapse. The earliest and most closely grouped relapses occur 8-10 months after surgery for young women with node-positive disease. Analysis of these data using computer simulation suggested that surgery probably instigated angiogenesis in dormant distant disease in approximately 20% of cases for premenopausal node-positive patients. We explore if this could explain the mammography paradox for women aged 40-49: an unexplained temporary excess in mortality for the screened population compared to controls. Calculations based on our data predict surgery-induced angiogenesis would accelerate disease by a median of two years and produce 0.11 early deaths per 1000 screened young women in the third year of screening. The predicted timing as well as the magnitude of excess mortality agree with trial data. Surgery-induced angiogenesis could account for the mammography paradox for women aged 40-49 and the bimodal relapse hazard pattern. According to the proposed biology, removing tumors could remove the source of inhibitors of angiogenesis or growth factors could appear in response to surgical wounding. While this needs confirmation, this could be considered when designing treatment protocols particularly for young women with positive nodes. It reinforces the need for close coordination between surgical resection and ensuing medical intervention. Women need to be advised of risk of accelerated tumor growth and early relapse before giving informed consent for mammography.
PMID: 17462282 [PubMed - in process]

[Mary Jo]

Is confused, as usual when reading these medical articles. Maybe someone could explain in layman's terms.

Thank you,

Mary Jo

[nancy d]

I don't understand either. Is this suggesting that surgery activates distant recurrences?

[Hopeful]

Lani,

This is another of those counter-intuitive things that makes you stop and think. I know I asked you once about laser surguery for bc, which I saw a few blurbs about that date back 3 or 4 years. I wonder if using that technology would avoid the "wound healing" signaling?

Marejo,

What I gather the article is saying is that women in their 40's who have mammos that reveal the presence of cancer are going to have surguery to remove it; however, removal of the tumor in these women may actually trigger growth factors that accelerate the relapse process as the tumor itself actually has qualities that inhibit cancer progression. From this point, they reason, it is perhaps better not to have surguery, but no one who has bc diagnosed by mammo is NOT going to have surgery, ergo, they conclude, having a mammo that results in surgery may result in a worse outcome than if the tumor had not been detected. They sugguest that women in their 40's having mammos should be advised of this risk. Circituous reasoning, to be sure. I sometimes marvel at the conclusions that are drawn from what seems to be pretty good research.

Hopeful

[Becky]

This theory has been around forever and has some merit. The primary tumor exudes chemicals that inhibit the growth of micromets that may be somewhere in the body. The primary tumor does this so it can get all the nutrients the body has to offer versus having to share with other tumors that would be rapidly growing.


HOWEVER, this is offset by getting chemotherapy. This is why the oncs want you to start chemo or radiation quickly (3-4 weeks after surgery). Also, the risk is there but small - this is even stated in the study.

[hutchibk]

Thanks for translating Hopeful and Becky!

Did you guys stay at a Holiday Inn Express last night?? LOL

[Hopeful]

Brenda,

Thanks for the laugh!

Hopeful