Overtreatment for breast cancer has been in the news a lot lately. There is a lot of evidence that people are getting treatments that don’t help them. But less well known is the idea that some of the treatments actually make cancer worse. Surgery, chemotherapy, and radiation can all spread cancer as a side effect. I only found this out after my treatment was over, and I would likely have made different choices if I had known the facts. This article will focus on the ways that surgery can cause cancer to spread, using my own surgery as an example.
Before I had the surgery in 2011, my tumor markers1 were completely normal even though the biopsy showed cancer. After the surgery, they went way up. Since that time, they have fluctuated, but they have never returned to normal for more than a brief time. Something caused them to rise.
Medical opinion about the value of tumor markers seems to vary. Some of my doctors believe that my tumor markers are one indication that I have cancer in my body that is too small to show up on scans, and that means that I am at high risk of metastasis. Others say that tumor markers that fluctuate above normal don’t necessarily mean anything; there are a variety of inflammatory and other non-cancerous conditions that could explain the unstable tumor markers. However, when my tumor markers did not go down in the expected time after surgery, my medical oncologist was worried enough to order extra scans to look for metastasis, which, fortunately, they did not find. The markers were expected to return to normal before I started chemotherapy. When that didn’t happen, it was hoped that the chemo would cause them to return to normal, but that didn’t happen either.
I wondered if my surgery had caused the tumor markers to rise. I looked on the Internet and found many sites that say that surgical removal of cancerous tissue (and even biopsies) can cause the cancer to spread. Since it is generally accepted in cancer research that about 90% of patients die from metastases or secondary tumors, and only a small minority die from a primary tumor, this information should of great interest to doctors as well as patients.
It seems that surgery can cause cancer to spread in two ways. The first way is from biopsy needles and surgical knives that can pick up cancer cells from one location and transport them to another, non-cancerous, one.2 That this happens is not disputed; what is disputed is how often it happens. The second way is more controversial, and more research is needed to bring greater clarity. It was found that the prevailing belief that tumors grow at a continuous rate is wrong. Researchers found instead that tumors can remain dormant for long periods, depending on factors in both the tumor and the patient. During the dormancy, the blood vessels that tumors need to supply them with oxygen and nutrients to feed the cancer, do not grow. However, the act of wounding the patient during surgery sets off the growth of blood vessels as part of the healing process, and that kick-starts the growth of the cancer.3
I asked both my surgeon and my integrative oncologist what they thought about this issue. My surgeon said that this subject has been debated for many years, and that it is generally thought that the benefit of surgery outweighs the possible harm. My integrative oncologist said that he realized the dangers of surgery about 15 years ago, and that the protocol he put me on was designed to antidote those issues.
Whether the benefits of surgery will outweigh the risks is a decision each individual patient should make, as each case is different. In my case, my surgery actually had no benefit, at least so far as can be determined from statistics. I had a tiny (0.5 mm) tubular cancer in my breast that was unlikely to ever grow or cause a problem of any kind. The more dangerous lobular carcinoma was found in 3 lymph nodes, and 23 nodes were removed. However, In the research study that was new and groundbreaking at the time, they found that removing cancerous lymph nodes did not improve rates of remission or survival in women who met their criteria.4 I met their criteria, but all five of the surgeons I consulted, including the lead researcher on the study, said the study did not apply to me because my cancer was diagnosed before my surgery and not during a sentinel node biopsy. I never could understand what possible difference that would make, and nobody would answer my question. Like many people confronted by cancer, my fear took over and I capitulated to the authorities. Years later, when my surgeon told me that if he were deciding now, he might not have insisted on surgery, I figured out what probably happened. The research was new, they had to draw the line somewhere, and this line became the “standard of care.” The medical establishment decided arbitrarily, without any medical reason, to draw the line between those who were diagnosed before surgery and those who were diagnosed during surgery. I imagine they wanted to err on the conservative side because it could possibly be safer. It’s conceivable that I might have even agreed with them had I been given the choice. However, not only was I not given the choice; I was actively misled. All five surgeons basically insisted that I have a surgery that they knew, or should have known, was probably unnecessary. That seems unethical to me. In view of my fluctuating tumor markers, the surgery may have done me serious harm.
Assuming a patient opts for surgery, the new tumor dormancy theory has some implications for treatment. Unlike early-stage breast cancer, metastatic breast cancer is usually considered to be incurable, so we want to do everything we can to prevent it. By the time the metastases show up clinically it may be too late. If we know that the surgery will cause the blood vessels to grow, a process called angiogenesis, then the patient should start an antiagiogenesis program before the surgery, so her system is ready to protect itself when the angiogenic signals start. Then she should be monitored very closely with tumor markers, so If the markers go up, an anti-angiogenic program could be reintroduced. So what is an anti-angiogenesis program? According to the National Cancer Institute (NCI), there are some angiogenesis inhibitor drugs that have already been approved by the FDA, and others that target angiogenesis pathways are currently being tested in clinical trials. If these angiogenesis inhibitors prove to be both safe and effective in treating human cancer, they may be approved by the FDA and made available for widespread use. I looked up the ones that have been approved on the NCI website, and none of them were recommended for breast cancer.5 However, integrative oncologists (but not mainstream oncologists) recommend foods and supplements with anti-angiogenic effects.6 The researchers also note that some of the success attributed to the anti-estrogen hormone tamoxifen and to some chemotherapy agents may actually be due to anti-angiogenic properties rather than to the way most people think they work.
In view of the research, the decision to undergo surgery for breast cancer is not simple and easy. Some people refuse treatment, but unfortunately those people do not receive any follow-up, so we have no way of knowing how they did, and we cannot ethically refuse treatment to people in order to find out. The only research I could find was done on a small group of Canadians between 1938 and 1956. They found that in patients with cancer that had not metastasized outside the breast, the 5 year survival rate was about 70%, so apparently untreated breast cancer is not always a death sentence.
- A tumor marker is a biomarker found in blood, urine, or body tissues that can be elevated by the presence of one or more types of cancer. They are used in oncology to help detect the presence of cancer.(Go back)
- Shyamala, K., Hc Girish, and Sanjay Murgod. “Risk of tumor cell seeding through biopsy and aspiration cytology.” Journal of International Society of Preventive and Community Dentistry 4, no. 1 (Spring 2014): 5-11. doi:10.4103/2231-0762.129446.(Go back)
- Retsky, Michael, Romano Demicheli, William Hrushesky, Michael Baum, and Isaac Gukas. “Surgery Triggers Outgrowth of Latent Distant Disease in Breast Cancer: An Inconvenient Truth?” Cancers 2, no. 2 (2010): 305-37.(Go back)
- Grady, Denise. “Lymph Node Study Shakes Pillar of Breast Cancer Care.” New York times, February 8, 2011.(Go back)
- “Angiogenesis Inhibitors.” National Cancer Institute. Accessed January 29, 2016. http:// www.cancer.gov/about-cancer/treatment/types/immunotherapy/angiogenesis-inhibitors-fact-sheet.(Go back)
- Block, Keith. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell, 2009. Dr. Keith Block recommends herbs and supplements that inhibit angiogenesis, pp. 459-460.(Go back)