  To explain a bimodal pattern of hazard of relapse among early stage breast
cancer patients identified in multiple databases, we proposed that late
relapses result from steady stochastic progressions from single dormant
malignant cells to avascular micrometastases and then on to growing deposits.
However in order to explain early relapses, we had to postulate that something
happens at about the time of surgery to provoke sudden exits from dormant
phases to active growth and then to detection. Most relapses in breast cancer
are in the early category. Recent data from Forget et al suggests an unexpected
mechanism. They retrospectively studied results from 327 consecutive breast
cancer patients comparing various perioperative analgesics and anesthetics in
one Belgian hospital and one surgeon. Patients were treated with mastectomy and
conventional adjuvant therapy. Relapse hazard updated Sept 2011 are presented.
A common Non-Steroidal Anti-Inflammatory Drug (NSAID) analgesic used in surgery
produced far superior disease-free survival in the first 5 years after surgery.
The expected prominent early relapse events in months 9-18 are reduced 5-fold.
If this observation holds up to further scrutiny, it could mean that the simple
use of this safe, inexpensive and effective anti-inflammatory agent at surgery
might eliminate early relapses. Transient systemic inflammation accompanying
surgery could facilitate angiogenesis of dormant micrometastases, proliferation
of dormant single cells, and seeding of circulating cancer stem cells (perhaps
in part released from bone marrow) resulting in early relapse and could have
been effectively blocked by the perioperative anti-inflammatory agent.
