Koscielny and Tubiana (1) studied 3679 breast cancer patients. None of them displayed metastasis at the time of diagnosis, nor before being treated. None received adjuvant chemotherapy. 663 (18%) patients had a local recurrence (LR+). The following figure published by the authors (Fig. 2) depicts the monthly rate of metastasis-emergence following the initial treatment.
During the first year or so the metastatic rate rises whereupon it declines. In patients who had a local recurrence (LR+) the peak is more pronounced than in the rest without a local recurrence (LR-). Now compare this curve with the relapse rate following breast cancer surgery (1)
And the curve describing the hazard rate in breast cancer
All three are manifestation of the same phenomenon: The patient
depends somehow on her tumor and upon its removal she grows additional
tumor tissue, either in form of a local relapse or as metastasis. Please
note that the metastatic rate in patients whose tumor did not relapse
locally (LR-), is lower than that observed in patients whose tumor reappeared
locally (LR+). The first are less tumor dependent than the other.
From the third year and onward cancer proceeds through two phases: Compensated when the hazard rate declines and de-compensated when it rises. During compensation the meatstatic rate and the probability of a relapse are low.
The therapeutic implication is straight forward: As long as tumor does not impinge upon a vital function and does not cause pain or suffering it ought to be left intact. Treatment ought to preserve the tumor and alleviate its secondary manifestations.
1. Serge Koscielny and Maurice Tubiana
The link between local recurrence and distant metastases in human breast cancer
International Journal of Radiation Oncology*Biology*Physics
Volume 43, Issue 1, January 1999, Pages 11-24
2. M. Retsky, R. Demicheli and W. J.M. Hrushesky
Does surgery induce angiogenesis in breast cancer? Indirect evidence from relapse pattern and mammography paradox International Journal of Surgery Volume 3, Issue 3 , 2005, Pages 179-187