A recent article in the International Journal of Surgery has rekindled interest in the myth that surgery itself may have an adverse effect on cancer survival.
In this report, the "target" population is premenopausal African-American women with breast cancer.
The authors write that they have a theory that might provide a scientific basis for the myth.
It's not bad to have a theory. But when the theory regarding a myth becomes interpreted as a fact, the risk of harm to people at risk is substantially increased.
That could happen in this particular circumstance.
Examining the Myth
This myth was present back when I started my oncology practice over 30 years ago.
Back then, we didn't find cancer early. We didn't have mammograms. We didn't have CT scans, and we didn't have MRI machines.
If a patient had an abdominal mass, we frequently had to do an operation called an exploratory laparotomy to make the diagnosis. Not infrequently, these cancers were advanced at the time of surgery. The outlook was poor. This led to a myth that just opening up cancer patients could make the cancer worse.
The sad reality was that African-Americans were often impoverished. To a significant degree, this remains the situation today.
It has been well documented in study after study that treatment for many diseases, including cancer, has been unequal for many African-Americans.
The result was that African-Americans did -- and too frequently today, still do -- get diagnosed later in the course of the disease. That means they are not going to do as well as someone who has access to screening, has access to medical care and gets early treatment.
Yet, more recent research articles have confirmed that the "air makes cancer worse" myth persists, and in fact is more common that some might realize.
The Theory Resurfaces
In 2005, in the International Journal of Surgery, researchers published a paper where they noted that premenopausal women, based on historical information, have a slight increase in mortality within several years after they are treated for breast cancer.
To support their thesis that this increased mortality was due to the fact that surgical removal of the cancer itself, they turned to a database of women in Italy who had been diagnosed and treated for breast cancer from 1964 to 1980.
None of these women had mammograms. None of these women received adjuvant chemotherapy. All of these women had mastectomy surgery as the only treatment for their breast cancer. And none of them were screened or treated according to current medical standards.
The authors reported that in premenopausal women who had lymph nodes involved with cancer, 20 percent developed a recurrence within 10 months after surgery. This rate of relapse was five times greater than those without lymph node involvement. Most of this was confined to premenopausal women.
One of the explanations for this observation, they concluded, was that there were already tumor cells that had spread from the primary cancer to other parts of the body, lying dormant because they had no blood supply.
The surgery and the removal of the cancer, they said, resulted in a stimulation of the cancer's blood supply leading to detectable cancer recurrence.
There is nothing wrong with making a suggestion or proposing a theory. To me, however, at the time I read this article it seemed like a very large step from theory to conclusion, without much supporting evidence.
That certainly didn't stop the media from spreading the news around the world that surgery could make cancer survival worse.
But this doesn't mean the underlying concept is incorrect.
After all, one of the authors of these reports is affiliated with one of the leading cancer vascular research labs in the country, if not the world. The investigators in this lab are noted for their innovative ideas, which, when first conceived, were considered radical and outside the mainstream.
Ultimately, their idea about blocking the development of blood vessels that enable certain cancers to grow led to the discovery of one of the most successful drugs used today to treat cancer and macular degeneration. That drug is bevacizumab, better known by its trade name, Avastin.
Deadly Disparities in Treatment
Now, however, we come to the current paper, published in a recent issue of the same journal.
The title of the article suggested that this theory is a possible explanation for some of the increased mortality of breast cancer in premenopausal African-American women.
African-American women disproportionately continue to suffer the burden of unequal access to medical care and insurance. Their rates for mammography are lower than they should be.
Almost all experts agree that these are the most significant factors which explain the poorer outcomes for African-American women with breast cancer in this country.
Now, the authors of this paper are saying the theory they proposed in 2005 may be part of the explanation.
In other words, if you are African-American and premenopausal, then -- according to their theory -- the removal of the primary cancer may stimulate the growth of otherwise dormant cancer cells elsewhere in the body, leading to a pattern of early recurrence.
What they ignore is that the reason for the increasing survival gap between African-American and Caucasian breast cancer patients may be due to the fact that African-American women are not receiving the same screening and treatment opportunities as others.
In other words, they suggest, if you are African-American and premenopausal and you get screened for breast cancer, you may do worse than if you left the cancer alone and found it on your own at some later point in time.
But it is important to note that in press interviews, one of the authors has made it very clear they are not recommending that African-American women skip screening for breast cancer or in any other way not follow the current recommendations for breast cancer treatment.
Conclusions Could Be Dangerously Misleading
There is no research done specifically for this paper and reported in this paper that supports this conclusion. It is a theory, plain and simple. Not a research paper supporting a theory -- just a theory.
In my opinion what they should be saying is that we need to do everything in our power to reduce the real disparities in health care.
We need to be certain that every woman in this country has access to state-of-the-art cancer screening and cancer treatment in this country. That is the most "curable" way to close the survival gap for breast cancer between African-American and white women in this country.
We have learned from experience that it is okay to have theories, and it is okay to do research in the laboratory and perhaps in the clinic to support your theory if your basic science research confirms your hypothesis. The world of science is built on that sequence.
My fear and concern is that the theory proposed in this paper will be picked up by the press and held forth as fact when there are other very creditable explanations for some of the observations.
My fear is that there are women who will read the news and say, "I don't need to be screened. It will increase my chances of dying from my breast cancer."
My fear is that we could take another giant step backward.
Researchers (and others) need to be very aware that that their well-intentioned thoughts and observations may end up being misinterpreted and promoted elsewhere devoid of their original good intent and stripped of their explanatory and clarifying notes and comments.
In this case, some of the headlines may lead African-American women to conclude that mammography in their premenopausal years is harmful to their health.
If that happens, the unintended consequences could be very, very unfortunate.