Journal of Clinical & Experimental Pathology
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Metastatic relapse after diagnosis of early stage breast cancer is the common pathway leading to mortality
from the disease. How to prevent relapses remains perhaps the most important unsolved problem in
oncology. We need to learn more about mechanisms of metastases seeding and progression for a variety of
clinical and scientific reasons.
As my colleagues and I recently reported, analysis of clinical breast cancer relapse data after mastectomy
suggests most distant relapses occur within 4 years of surgery and are precipitated or accelerated by something
that happens around the time of surgery. Sudden growth from single cells and angiogenesis of avascular
micrometastases are indicated. Late relapses are not accelerated by surgery. Many clinical characteristics of breast
cancer can be explained with this hypothesis. Recent retrospective analysis of clinical data from one Brussels
hospital indicates early relapse events were reduced 5-fold when NSAID ketorolac was used as perioperative
analgesic. Combining the surgery induced metastatic activity hypothesis with these data suggests transient
systemic inflammation following primary tumor removal may facilitate most metastatic activity and was
effectively blocked by the perioperative NSAID. Post surgical systemic inflammation has been independently
verified by inflammatory marker IL-6 presence in serum. While breast cancer is known as a disease that runs its
course in over a decade, most of the damage seems to occur in the week or two after surgery. This suggests new
mechanisms for metastatic initiation and progression and possibly an effective nontoxic, low cost intervention
that may significantly reduce mortality from breast cancer.
Michael Retsky pursued his Ph.D. in Physics from University of Chicago and made a career change from physics to cancer
research. He is Editor-in-Chief of Journal of Bioavailability and Bioequivalence, on staff at Harvard School of Public Health,
honorary faculty at University College London, and Prof. Adj. at UANL, Monterrey, Mexico. He was on Judah Folkman?s staff at
Harvard Medical School for 12 years. He is on the board of directors of the Colon Cancer Alliance and has published more than
60 papers in physics and cancer. He has a patent pending for treatment of early stage cancer.
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