Some scientists believe that surgery to remove a breast tumor may actually help the cancer spread and have recently reported that this same belief may be the exact reason black women are more likely to die of breast cancer.There is apparently a widespread belief in parts of Africa and the United States that removing a tumor hastens death.
"I must say that I am sure there is more to this than just a myth," said Michael Retsky of Children's Hospital and Harvard Medical School in Boston, who shares his opinions in the International Journal of Surgery.
Retsky still urges any woman with breast cancer to have her tumor removed. And he says chemotherapy is such standard practice for any cancer threatening to spread. It's a safety net of sorts to catch the cells that get away. So if surgery causes cancer to spread, then in theory, chemotherapy should stop the spread.
Retsky, who is not suggesting any change in clinical practice, thinks the subject needs far more research. American Cancer Society experts, who tend to question this theory, agree.
"Whether or not the theory is correct, I have difficulty with the logic that they employed to get there," said oncologist Dr. Len Lichtenfeld of the American Cancer Society who says women should never delay treatment for breast cancer.
Retsky believes that perhaps surgery, by wounding the body, causes it to produce growth factors that fuel the growth of other, tiny tumors. Or maybe a primary tumor secretes some sort of factor that holds the other tumors in check. When the main tumor is removed, the smaller tumors grow.
But it could be that surgery does not cause a spread at all – and that any belief of this nature has no connection with breast cancer tendencies in black women. It may be that black women just have a genetic predisposition for more aggressive forms of the disease.
1. Surgical skill, both the technical aspect and the intellectual aspect, are critically important.
Even when the best of surgeons can do a complete and thorough dissection, sometimes the tumor still comes back, or occurs distally. There is so much of the disease that is not understood.
A complete resection may be done, even with poor surgical technique, and the patient does well.
This is the complex interaction between the tumor, its stage, its location, size, biochemical/genetic makeup, and the surgeon actually has little to do with it.
Sometimes it is a relatively benign lesion, peripherally located, small, no lymph node mets, and a superb surgeon, and the same outcome.
Sometimes there is a complex tumor, centrally located, relatively large, a superb surgeon, and with luck (besides the tremendous skill), a cure occurs.
Either way, one would prefer the good surgeon and hope for characteristics that allow for a truly complete resection.
Posted at 1:56PM on Feb 26th 2007 by Gregory D. Pawelski