Brenda Denzler is a writer and editor living in North Carolina. She received her doctorate from Duke University and worked as an editor at UNC-Chapel Hill before she was diagnosed with inflammatory breast cancer in 2009. Since then, she has devoted a great deal of her time and energy to understanding and writing about cancer, cancer treatment and the impact of pre-existing PTSD on the ability of doctors to give and patients to receive medical treatment.
One breast cancer survivor's thoughts on news from a recent study about the potential risks of surgery.
Like I said in my last post here, the American public doesn't understand cancer, but we are, collectively speaking, terrified of it. In that nexus where ignorance and terror meet, all kinds of things can happen, like the recent reaction to a new study showing that surgery for cancer can actually help cancer to spread.
The study, titled, The systemic response to surgery triggers the outgrowth of distant immune-controlled tumors in mouse models of dormancy” was published this month in the journal, Science Translational Medicine.
I'm not much surprised at the hoopla. I actually heard this idea — that surgery can help spread cancer – when I was newly diagnosed and struggling mightily with the decision to use conventional treatments. Since I had inflammatory breast cancer and a mastectomy was in my future, the issue of whether or not surgery would be a good thing was big in my thinking. Given that I also have a morbid terror of being rendered senseless (and, for me, thus defenseless) via anesthesia, I had a doubly powerful reason to find an excuse not to remove my diseased breast.
Sidebar: I have found, in the almost nine years since my diagnosis, that many of the things I had heard all my life in the alt-med community often have some basis in fact. But the direction those facts tend in the alt-med community can be very different than the direction they tend in the mainstream medical community. The whole "surgery-spreads-the-cancer" idea is an excellent example of this.
It is true: surgery (specifically, in this case, mastectomy) can sometimes seem to stimulate the spread of the cancer, because metastases pop up within surprisingly short time periods (about 18 months) after a surgery is done, according to research.
The alt-med community takes this fact, elides the "sometimes" bit, and runs with it. They make it sound like a consistent, unavoidable outcome of surgery: "Ergo, surgery for cancer is bad. You'll risk spreading the cancer if you have surgery." The implicit idea is that there is something about tumor removal that scatters cancer cells around like little seeds and helps them find homes in other organs, where their growth will be lethal.
Meanwhile, the mainstream med community takes this fact and says, "Why is that? If surgery can be, but is not always, linked to the appearance of mets, what is it about the surgery that is causing that?" They wonder if it's the physical act of removing the tumor that scatters seeds (as the alt-med community imagines it does) or if it's something else - and if so, what? Notably, they don't tend to totalize — that is, they don't take an observed linkage between two events and suggest that this linkage operates every time. Instead, they investigate.
A study presented at the 2017 European Society for Medical Oncology Annual Congress discovered that it's not the removal of the tumor per se that causes the phenomenon of increased metastasis risk. It's the wound-healing response of the body after surgery that causes it because the physiological processes involved in wound-healing also stimulate cancer cell growth.
The media uproar about whether women with breast cancer should have surgery at all capitalized upon mightily by the alt-med crowd saying "I told you so!” has failed to highlight two important things.
First is the fact that this study was done in mice, not humans. As far as I'm concerned, this is a weak caveat to the uproar, but it's the one most main-med folks are turning to in an effort to reassure women made jittery by the anxious news reports. For myself, I suspect that what's true for mice is true for women (and men) with breast cancer, too.
The second caveat is, IMHO, much more important, namely, that the surgery isn't seeding new cancerous cells. The wound-healing process is simply activating cancerous cells that were already disseminated in the body before the surgery ever took place. In other words, if the tumor has already sent out its little scouts to other places in the body, the wound-healing process may (not "will," but "may") stimulate them to grow. That's metastasis, and it's deadly.
Here's where a little understanding about how cancer works could go a long way toward moderating the anxiety being stirred up by the media.
In other studies, like one published in a 2016 publication of the journal Nature, we have learned that some breast cancers develop metastatic potential very, very early in their growth, while others reach that capability much later. In other words, some breast tumors send out their little scouts very early-on, even while they are just "baby" tumors. Other tumors only send out scouts later on, when they themselves get bigger. I don't think we know why, yet. But we know that it happens.
This is why a few women with an early-stage diagnosis go on to develop mets, while most do not. Their tumor was a precocious little thing — more aggressive and active than its staging as an "early" disease process would make you think. We have no way of knowing when a tumor (early-stage or later-stage) has sent out its scouts until those scouts start producing symptoms or until they get big enough to see on an X-ray or CT scan. That can take some time. Meanwhile, the original tumor needs to be treated, on the chance that it has not yet developed metastatic potential….
This could account for why ALL cancer surgeries do not "create" mets. It takes a combination of at least two things for the linkage between surgery and mets to happen: (1) a surgery creating a wound that the body has to heal, and (2) already disseminated cancer cells that, incidentally, can get activated by the wound-healing processes.
The main-med media has been lamenting the fact that so many women with breast cancer, terrified of their disease, opt for mastectomies instead of less-invasive lumpectomies. Perhaps that trend will now change? Producing a smaller wound for the body to deal with might help limit the strength of the wound-healing response needed as well as the length of time it would be needed -- which might help diminish the risk that surgery would activate latent metastatic cancer cells.
Me? The news from this latest study doesn't make me regret my decision to ignore the dire warnings I was getting from the alt-med community and have a mastectomy. With IBC, it's the standard of care. Lumpectomy isn't even an option. I wasn't happy about it; I wasn't comfortable with it. But it had to be done. I am less sanguine about the tension between the alt-med approach to cancer and the main-med approach to cancer. I continue to struggle with what to think, sometimes. But that is fodder for a different post!