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.

I once waited to see my oncologist -- in a room with nothing more than outdated magazines and my own wandering mind -- for four hours. I offered up 20 hours of my time for chemotherapy treatments and then spent five days -- two times, for a total of ten days -- waiting in the hospital for doctors to determine how to raise my blood counts and decrease my fever after the completion of a dose-dense chemotherapy attack. I traveled to and from radiation appointments for 35 days, spending an average of 90 minutes on each of these round-trip excursions. I reclined in an infusion chair every three weeks for 12 months so that a new breast cancer wonder drug could sail through my veins. I spent 52 hours in that chair. And I spent countless hours pouring out my emotions to a counselor, in an attempt to clear my mind of all that cancer took from me -- including my time.

These are just seven memories I have of time lost to cancer. There are others -- countless others -- but this should suffice as proof that among all the potential side effects that accompany cancer, loss of time is a guarantee.

According to the first study to put a price tag on the time patients spend battling cancer, it seems the disease steals at least $2.3 billion worth of time for patients in the first year of treatment alone.

Eleven of the most common cancers were included in the study. And it was determined that 368 hours are lost during the first year of treatment for ovarian cancer. For lung cancer, 272 hours are lost. For kidney cancer, 193 hours go down the drain. These hours don't take into account time spent in bed recovering from surgery or chemotherapy treatments. It accounts only for time engaged in actively receiving care -- it counts chemotherapy, radiation, blood tests, scans, surgery, check-ups, waiting to see doctors, and driving to and from appointments.

The study, published in the Journal of the National Cancer Institute, sheds new light on the burden of commitment -- the human cost of cancer.

"Cancer is more than the just the dollars and cents for the medicines and the treatments and the doctors. It's also the lost opportunities for the patients," said the American Cancer Society's Dr. Len Lichtenfeld, of this overlooked reality.

Lichtenfeld says this study demonstrates the need for early detection. The earlier cancer is caught, the less time patients spend in the system. It also shows the need for more targeted therapies that spare patients physical side effects and allow them opportunities for taking pills at home instead of receiving treatment in clinics.

I would love to have back the time I spent treating and recovering from cancer. But I'm not heartbroken over my lost time. Because it bought me something in the end -- more time.

There may be another explanation for the recently announced decline in breast cancer rates. And it's not nearly as promising as the first explanation may be.

A day after researchers announced that the significant drop in breast cancer cases is primarily due to fewer women using hormone replacement therapy (HRT), some experts suggest breast cancer rates are not dropping at all. Just as many women may have breast cancer, they say. They just aren't being screened for it.

"We have been aware for several years that the number of radiologists who specialize in mammography have been decreasing, and that there are places in the United States where women have difficulty getting access to mammography," Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, wrote on the society's blog just after the public announcement.

"If mammography use has reached a peak and is now decreasing, we may actually be diagnosing fewer cancers when they can be most effectively treated, Lichtenfeld said. "If you don't get a mammogram, you don't diagnose a cancer."

The research linking the decline in HRT to the drop in breast cancer came from the M.D. Anderson Cancer Center in Houston and was discussed at a breast cancer conference in San Antonio on Thursday. The research, based on a report by the National Cancer Institute, showed a seven percent drop in new breast cancer cases between July 2002 and August 2003, corresponding with the results of a 2002 Women's Health Initiative study.

With media reports citing HRT as the direct cause of the drop, some worry the public is getting the wrong message -- specifically women still taking hormones or those who have taken them in the past. While women not taking hormones are breathing a sigh of relief, others are in a panic.

Dr. Katherine Sherif, director of the Drexel Center for Women's Health at Drexel University College of Medicine in Philadelphia, has spoken already with 15 patients worried about this news.

"What I have told them is that three years is too short of a time to measure the effects of a drug on breast cancer," she said. "Cancers take decades to develop, and conversely, withdrawing hormones could not result in a decrease in breast cancer in three years -- it's actually absurdly short." There are also concerns women will experience anxiety about other therapies using estrogen, such as in vitro fertilization (IVF).

The study on HRT and breast cancer may be raising more questions than answers -- which could be a good thing. More questions prompt more investigation, more study, more research. And this will hopefully help us figure out one facet of the mystery of breast cancer.

Previous posts on the topic of HRT and breast cancer are as follows.

• HRT use drops breast cancer rates drop
• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks