[Lani]

Breast cancer is felt to have metastasized long before it is diagnosable. The micrometastases are too small to be detected by PET or MRI OR CT. A safe-havene where they sleep like sleeping beauties awaiting being "kissed" and woken by my angiogenic factors is the bone marrow.

I have opined endlessly on this forum about testing bone marrow for micrometastasis before and after treatments and continue testing (and adding/changing treatments until they dissappear). They appear to be cancer stem cells waiting to cause metametastases. They evade chemotherapy by being dormant (non dividing) just like mold in your shower evades the bleach and comes back when the moisture returns.

Those treatments that kill "sleeping" cancer stem cells as well as primary tumor cells and or active macrometastases should eliminate the cancer ie, 'cure' it

US oncologists tend not to be hematologists and often rarely perform bone marrow aspirations/biopsies and rationalize that "patients do not like them"
--well patients do not like receiving chemo other, but that doesn't stop them from recommending it.

A well planned trial is necessary to prove this once and for all. I tried to convince the head of the I-SPY trial to add it to their tests, then tried to get
Susan Love involved. In the meantime, she (Dr. Love) developed leukemia and
had bone marrow tests herself and I understand she will now will be recommending bone marrow testing be added to the I-spy trials.

TRIALS with bone marrow testing for DTCs (disseminated tumor cells) has long been done in Germany and indicate those with micromets in the bone marrow are at much higher risk of becoming Stage IV (macrometastasis)

I recommmend the articles of Klaus Pantel for those interested

In the US we have been trying to get the same info from circulating tumor cells--those may or may not represent cells which might "cause trouble" as they are not "sleeping" in a niche and are reachable by conventional "systemic" treatments and may not survive if they don't settle down into the right microrenvironment.

so "forher' your brain micromets might have been there for years before you were diagnosed and treated and/or hiding in your bone marrow, then awakened and traveled to your brain where the chemo and herceptin could not get to.

Off to ASCO for me now--will fill you in on latest and greatest later...