Retsky M, Demicheli R, Hrushesky WJ.
International Journal of Surgery 2005; Vol 3 Issue 3 Pgs:179-87. Epub 2005 Sep 12.
Does surgery induce angiogenesis in breast cancer? Indirect evidence from relapse pattern and mammography paradox
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. Surgery-induced angiogenesis accelerates 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. More
See also New Concepts in Breast Cancer by Michael Retsky et al
Challenging fundamental concepts in breast cancer, which have long assumed that breast cancer growth is continuous, this group suggests tumor growth commonly includes extended periods of quasi-stable dormancy. Furthermore, surgery to remove the primary tumor often awakens distant dormant micrometastases, accellerating relapses in breast cancer. This paper describes how a numerical algorithm was used to come to these conclusions. Based on these findings, a dormancy preservation therapy is proposed.