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.
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.
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.