Surgery Induced Tumorigenesis in Breast and Other Cancers: An Inconvenient Truth?

Dear Colleagues,

Bimodal relapse patterns in early stage breast cancer are observed in multiple databases. This is unexplainable with the long-accepted continuous growth model. In order to explain these data, it was proposed with the aid of computer simulations that micrometastatic tumor growth includes periods of temporary dormancy and furthermore, surgery to remove primary tumors kick-starts growth of dormant distant disease. Apparently over half of all relapses are accelerated by such means. Two previously unreported modes of relapse were proposed as the dominant paths leading to treatment failure in early stage breast cancer. Single dormant cells are induced into division by surgery, an effect that increases with primary size. Also angiogenesis is induced in dormant avascular micrometastases mainly for premenopausal patients with positive lymph nodes. This theory may provide new explanations for a wide variety of clinical breast cancer features that were previously thought to be unconnected. In addition to the relapse patterns, this is proposed to at least partly explain paradoxical mammography data for women age 40-49, that the benefit of adjuvant chemotherapy is most effective by far for premenopausal node positive patients, breast cancer in young women is often labeled “aggressive”, the overall heterogeneous nature of breast cancer, and the racial disparity in outcome. To present a forum for focused discussion, this special issue of Cancers will be devoted to papers that argue for and against this new theory.

Dr. Michael W. Retsky
Guest Editor