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of metastases, from 30 to 90 per cent depending on the type of tumour, can be traced back to the time of the first treatment. tumours alone. But that is not in the interests of the cancer industry, for which invasive treatment is the financial life-blood. There have always been new drugs and new ways to combine chemotherapy and radiotherapy with surgery—accompanied by claims that now a way to prolong the lives of patients has been found. By developing methods of early detection and classifying small, precancerous, non-invasive and dormant tumours as cancer—tumours that would not have become malignant if left alone—some statistics could indeed point to improved cure rates. This has now changed with a comprehensive review by a team of leading cancer researchers. Here is the Abstract of the paper, "Surgery Triggers Outgrowth of Latent Distant Disease in Breast Cancer: An Inconvenient Truth?" Here are some key observations from his article: and new ways to combine chemotherapy and radiotherapy ¢ Inflated success rates (of cancer surgery) are the result — with surgery—accompanied by claims that now a way to of either selective composition of the groups of patients prolong the lives of patients has been found. By studied or of correspondingly adapted, i.e., corrected, | developing methods of early detection and classifying statistics. small, precancerous, non-invasive and dormant tumours ¢ Cures related to the same stage and tumour size have as cancer—tumours that would not have become not improved in the last 20 to 25 years (i.e., since the — malignant if left alone—some statistics could indeed 950s). point to improved cure rates. This has now changed with ¢ Untreated postmenopausal women with breast cancer a comprehensive review by a team of leading cancer ive longer than medically treated patients. researchers. Here is the Abstract of the paper, "Surgery ¢ Metastases occur sooner in fast-growing tumours than Triggers Outgrowth of Latent Distant Disease in Breas in slow-growing tumours. This suggests that these Cancer: An Inconvenient Truth?"?’ metastases begin their development at “We review our work over the past 14 he same time as the surgery. years that began when we were firs e Present cancer surgery may be confronted with bimodal relapse regarded as a second Semmelweis Metastases . patterns in two breast cancer databases phenomenon! (Dr Ignaz Semmelweis occur sooner In from different countries. These data Liling omen durmng delivery by | FASC-GFOWING — | rrinaous tumor growth paradigm Ta washing and disinfecting their hands.) tumours than in explain these data, we proposed tha with sevete palpation and pressure as | SIOW-GrOWiNg — | oimmonly. includes periods of with a mammography procedure), tumours. temporary dormancy at both the single incense of tumour cells released into | This Suggests | micrometastasis phase. We also he blood with a higher probability that these suggested that surgery to remove of metastasis. the primary tumor often terminates ¢ The connection between surgery metastases dormancy resulting in accelerated and formation of metastases was , : relapses. These iatrogenic events particularly impressive in single begin their are apparently very common in that observed cases: ina patient with a development at over half of all metastatic relapses progress in that manner. Assuming this is true, there should be ample and clear evidence in clinical data. We review here the breast cancer paradigm from a variety of e It has long been taught in historical, clinical, and scientific medicine that a melanoma should perspectives and consider how not be injured, since lesions would cause an almost dormancy and surgery-driven escape from dormancy sarcoma, formation of metastases occurred after surgery of the primary tumour and each time after our further surgeries of locally recurrent tumours. the same time as the surgery. explosion-like growth of metastases. would be observed and what this would mean. Dormancy ¢ Not only disturbance of a tumour but also unrelated can be identified in these diverse data but most surgery at a different location can trigger metastasis. conspicuous is the sudden synchronized escape from ¢ The larger a tumour becomes, the slower its growth, | dormancy following primary surgery. On the basis of our and some observations suggest that it eventually stops _ findings, we suggest a new paradigm for early stage breast growing. cancer. We also suggest a new treatment that is meant to ¢ Radiation and chemotherapy of the tumour before _ stabilize and preserve dormancy rather than attempt to and after surgery are both unsuccessful. kill all cancer cells as is the present strategy." ¢ The chance to improve the cure quota decisively The bimodal relapse patterns referred to in this abstract occurs only once during the course of cancer: namely, at means that there are two time peaks when metastases the time of the first treatment. appear after surgery for the primary tumour. The first peak is after 18 months; then follows a dip at 50 months and a An Inconvenient Truth? broad peak at 60 months, with a long tail extending for 15 As the following review demonstrates, a steady stream to 20 years. About 50 to 80 per cent of all relapses are in of studies shows that it is better for patients to leave __ the first peak. Metastases fast-growing tumours than in tumours. This suggests that these metastases begin their development at An Inconvenient Truth? As the following review demonstrates, a steady stream of studies shows that it is better for patients to leave NEXUS ¢ 21 occur sooner in slow-growing the same time as the surgery. AUGUST - SEPTEMBER 2010 www.nexusmagazine.com