Breast Cancer Surgery May Do Harm

Primum non nocere, or “first do no harm,” is an oft-repeated maxim of western medicine. But a paper by a Harvard Medical School (HMS) researcher presents new support for the possibility that breast cancer surgeons may be unintentionally doing just that.

The paper, published in the International Journal of Surgery, hypothesizes that African-American women are more likely to die of breast cancer because they are more likely to undergo surgery at a young age to remove cancerous tumors. That surgery may in fact exacerbate the cancer by unleashing agents into the body, inflaming previously dormant tumors elsewhere.

“Sometimes surgery to remove a primary tumor can kick-start a dormant disease,” said Lecturer on Surgery Michael W. Retsky, the paper’s chief author.

Doctors have long observed an increased likelihood of relapse among breast cancer patients in the two years after a tumor is surgically removed. In a 2005 paper, Retsky and his fellow researchers first proposed that surgery itself might be a cause of the relapse.

In that paper, Retsky found that age was the decisive factor: pre-menopausal women were significantly more likely to experience relapses after surgery than post-menopausal women were. His new paper applies this theory to another apparent trend—the high mortality rates among African-American women afflicted with breast cancer.

African-American women, Retsky found, tend to get breast cancer at a younger age than their Caucasian counterparts, exposing them to the negative effects of breast cancer surgery that he has theorized.

Retsky’s controversial hypothesis linking breast cancer relapses to surgery caused a moderate stir in the scientific community at the time of its publication in the International Journal of Surgery, drawing letters to the editor which ultimately put Retsky on his present course,

One of the letters, from a lawyer in Tennessee, reported a common belief among the African-American community that tumors should be left alone lest surgery “provoke” them.

The correspondence sparked Retsky’s interest in a racial angle to his theory.

“Myths seldom lack any connection with reality,” his new paper reads. “Could it be that [African-Americans] believe in the myth twice as frequently as [European-Americans] because they observe it twice as often?”

Retsky’s research is again raising eyebrows. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said he was skeptical.

“The problem here is, there is little evidence provided to back up the claim. It is a theory, not a study supporting the theory, but simply a theory,” he wrote in an e-mailed statement.

Lichtenfeld expressed his worry that Retsky’s findings may reinforce African-American fears about cancer surgery and deter patients from seeking treatment.

“Unfortunately, by the time mainstream media reports arrive to consumers, all they hear is that the myth may be true, a claim that is as potentially dangerous as it is unsupportable with the current state of knowledge,” the statement read.

Lichtenfeld could not be reached for a telephone interview.

Retsky stressed that his study is merely a hypothesis and not a prescription for change.

“We are definitely not recommending any change in clinical practice,” he said. “Far more research needs to be done.”