Analysis of breast cancer relapse patterns from two independent databases suggests that surgery initiates angiogenesis (new blood supply) in dormant distant micrometastases in approximately 20% of cases for premenopausal node-positive patients.
The study published online by the INTERNATIONAL JOURNAL OF SURGERY may help to explain the mammography paradox for women aged 40 - 49: a counterintuitive temporary excess in mortality for the screened population compared to controls. Calculations predict that 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 and relapse patterns.
Dr Michael Retsky, lead author of the study comments: "Cancer outgrowth after surgery has been observed for over 100 years, and the mechanisms have not been fully identified. As we show in this paper, biology may be the underlying cause rather than something going wrong during surgery. Our results suggest most young women benefit from early detection of breast cancer, but a small percentage will relapse and die early of metastatic disease. The paper suggests remedial steps that might prevent the sudden growth from occurring. The results of this study could also be considered when designing treatment protocols for young women with positive nodes, since it may not be a coincidence that adjuvant chemotherapy works best for those patients. Importantly, young women need to be advised of the risk of accelerated tumor growth and early relapse before giving informed consent for mammography." Coauthors include Dr. Romano Demicheli and Dr. William Hrushesky.
International Journal of Surgery
You can read its full text at journal-surgery
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