Review Does surgery unfavourably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases? Michael Bauma, , , Romano Demichelib, William Hrusheskyc and Michael Retskyd aEmeritus Surgery U.C.L., Consulting Rooms, Portland Hospital, 212–214 Great Portland Street, London WIW 5QN, UK bDepartment of Medical Oncology, Milan National Cancer Institute, Via Venezian 1, 20133 Milan, Italy cSchool of Medicine and Arnold School of Public Health, The University of South Carolina, Columbia, SC 29208, USA dChildren’s Hospital and Harvard Medical School, Department of Vascular Biology, 300 Longwood Avenue, Boston, MA 02115, USA Abstract This historical perspective on breast cancer tells us how and why certain therapeutic eras have reached ascendancy and then declined. Therapeutic revolutions occur after a crisis develops when there is a general recognition that clinical interventions are not producing positive results predicted by the prevailing paradigm. The attitude of pre-modern surgeons was influenced by the very real possibility of doing more harm than good by operating upon women with breast cancer. Up until Halsted, the general consensus was clearly that, unless forced by the circumstances, surgical resection should be avoided for disease much more advanced than very early stage tumours (the cacoethesis of Celsus). Twentieth century progress in antisepsis, anaesthesia, and surgery changed this point of view. The first three quarters of that century saw more and more aggressive operations performed while the last quarter century reversed this trend, with reduction of the size of breast cancer operations based largely on the teachings of Fisher. A new crisis is upon us now in that trials of early detection have resulted in unexpected disadvantages to certain subgroups and there is previously unreported structure in early hazard of relapse, clinical data that suggests the act of surgery might accelerate the appearance of distant metastases. The explanation we propose that agrees with these results, as well as physicians of antiquity, is that surgery can induce angiogenesis and proliferation of distant dormant micrometastases, especially in young patients with positive nodes. doi:10.1016/j.ejca.2004.09.031 European Journal of Cancer Volume 41, Issue 4 , March 2005, Pages 508-515 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.