My studies on the epidemiology of breast cancer indicate that:
1. Many patients carry micrometastasis in good health.
2. The longer a patient lives the better her chances to survive.
The following study on tumor recurrence supports the notion that patients carry hidden cancer for years and remain in good health.
Freedman et al. studied tumor recurrence after conservative surgery and whole breast irradiation. (1).
They estimated long term risks of breast irradiation after breast conserving surgery. The study population consisted of 1,990 women with American Joint Committee on Cancer Stage 0, I, or II breast cancer treated by breast-conserving surgery and radiation therapy between 1970 and 1998. The median follow-up was 80 months (range, 1 to 245 months).There were 655 patients remaining at risk at 10 years and 135 patients at 15 years. The primary endpoint of the study was ipsilateral breast tumor recurrence (IBTR); this was subclassified as “true local” or confined to the original quadrant as the initial primary tumor, or “elsewhere” involving outside of the original tumor quadrant
The rate of any local recurrence for all patients was 3%, 7%, and 13% (95% confidence interval [CI], 10–16%) at 5, 10, and 15 years, respectively (Fig. 1). Recurrence elsewhere in the breast was rare for the first 10 years, but by 15 years was nearly equal to true local recurrence even after whole-breast irradiation. The 15-year rate of elsewhere recurrence was half the rate of contralateral breast cancers. The figures were copied from the original paper.
The recurrence rate in both breasts was the same (Fig. 1) indicating that irradiation of the involved (ipsilateral) breast did not suppress nor increase the recurrence rate. The true local recurrence was the same as the “elsewhere local” (Fig.2). Thus from the beginning, the entire breast contained tumor cells, and only part of them was removed by surgery. Even irradiation did not kill them.
Since the recurrence rate in both breasts was the same (Fig. 1), either the contralateral breast harbored cancer cells at the time of diagnosis, or the tumor in the ipsilateral breast seeded metastasis soon after treatment.
In 13% of the patients tumor recurred after 15 years. Obviously not all the tumor cells in the irradiated breast responded to the treatment. These patients carried an undetected tumor for 15 years! What was their secret? Elsewhere these patients who succeeded controlling their tumor for 15 years are called cancer-yogis This metaphor stands for the capability of the patient to live with cancer in peace
1. GARY M. FREEDMAN, M.D., PENNY R. ANDERSON, M.D., ALEXANDRA L. HANLON, M.S., PH.D.,DEBRA F. EISENBERG, M.S., AND NICOS NICOLAOU, M.D.
PATTERN OF LOCAL RECURRENCE AFTER CONSERVATIVE SURGERYAND WHOLE-BREAST IRRADIATION
Int. J. Radiation Oncology Biol. Phys., Vol. 61, No. 5, pp. 1328–1336, 2005