Surgery May Spread Cancer.
Make no bones about it, breast cancer is scary. It’s the second most-common type of cancer in women, after skin cancer... it’s also the second-leading cause of cancer death in women, after lung cancer. And one in seven women will be diagnosed with the disease at some point in their lives.
But there’s good news. Thanks to earlier detection and improved treatment methods, breast cancer death rates are declining. And researchers are constantly asking important questions regarding the treatment of the disease itself in an effort to improve outcomes.
Here’s an interesting example: In an effort to explain the high rates of early post-surgery recurrence of breast cancer in premenopausal women whose cancer had spread to their lymph nodes, researchers, in a study published in the International Journal of Surgery, pointed to the surgery itself as being the cause for the recurrence.
AN UNKIND CUT
The issue in the research: Angiogenesis, the process used by the body to create new blood vessels to help heal wounds and restore blood flow to injured tissue. Simply put, the process relies on a group of “on” (stimulators) and “off” (inhibitors) growth factors in the body. When these proteins are in balance, no blood vessel growth occurs. But injured or diseased tissue produces a greater amount of “on” growth factors, spurring the development of new blood vessels to bring oxygen and nutrients to the injured tissue, helping the tissue to heal. However, the process is also intertwined with cancer development. Studies have found that tumor growth relies on the formation of new blood vessels to bring nutrients to the tumor so it can grow. Without these blood vessels, most tumors cannot grow beyond a half-centimeter to a centimeter in size.
In the study, researchers speculate that the necessary angiogenesis stimulators would appear to heal the tissue as a result of surgery, and could ultimately lead to blood vessel growth that would provide nutrients to previously undetected tumors. In addition, they say that the primary tumor also could be a source of inhibiting factors, stopping the formation of blood vessels to other tumors in the body, and that the removal of the primary tumor also would remove those inhibitors.
Notice I said, “speculate.” That’s the problem. Because the researchers were looking at an archive of information, and analyzing that information retrospectively, no further examinations or blood tests could be done on the patients to support the researchers’ theory.
SORTING OUT THE STUDY
”It’s an interesting concept, and something that’s been thought about for a while,” says Amelia C. Grover, MD, an assistant professor in the division of surgical oncology at the Virginia Commonwealth University Medical Center in Richmond. “But I don’t necessarily agree with the conclusions of this study.”
According to Dr. Grover, the population on which the study focuses its angiogenesis theory -- premenopausal women with node-positive cancer -- tends to suffer from very aggressive cancers, which could explain the early recurrence. Plus, Grover adds, “[The researchers] haven’t measured any growth factors, or even any of the inhibitory angiogenesis factors.” Without digging deeper and actually testing for the inhibitors or stimulators, the theory behind the study is just that -- a theory.
What’s more, the women highlighted in the study were not given any additional therapy, such as radiotherapy or chemotherapy. Chemotherapy was not widely used as adjuvant therapy before 1980 -- and most of the information the researchers used for their study was pre-1980. That’s not standard practice. These days, young women with breast cancer -- especially those with aggressive cancer that has spread to the lymph nodes -- are treated by chemotherapy.
JUST THE BEGINNING
Clearly, this study isn’t reason for breast cancer patients to forgo surgery, and that isn’t what the study’s authors are saying. Early detection -- and removal, if necessary -- of breast cancer is still one of the best forms of treatment of the disease.
So why even talk about a study that just scrapes the surface of a new topic? Because the theory needs to be investigated further, and not just for the sake of breast cancer patients -- treatment of other forms of cancer would benefit from the research, as well. A clinical trial that measures the angiogenic markers in the body before and after surgery, or that tests the benefits of anti-angiogenic drugs taken before surgery, could help verify (or disprove) the theory.
Stay tuned for the latest word on this theory.