Hypothesis: Increasingly intensive locoregional treatment of breast cancer may promote recurrence

Abstract

Evidence is presented compatible with the hypothesis that the inevitable tissue injury to the breast engendered by mastectomy or primary radiotherapy may in itself be a factor facilitating recurrence through a variety of local, regional, and systemic tumor-promoting mechanisms. The potential for tumor enhancement appears to be commensurate with the extent of injury and concerns both local and systemic recurrence. The hypothesis lends itself well to experimental testing. If confirmed, it will point to the importance of minimizing any form of tissue injury in the process of treating primary breast cancer, be it by operation or irradiation and curtailing the extent or intensity of both.

Local recurrence after mastectomy for breast cancer: analysis of clinicopathological, biological and prognostic characteristics

“…There are two main hypotheses on the origin and significance of LRs: The first one is that LR is caused by an incomplete initial removal of the tumor [27,[37][38][39]; the second one is that LR is a sign (the first one) of the disease being already disseminated [40][41][42][43][44][45]. Unfortunately, at the present time it is not possible to determine the cause of an isolated LR.…”

Expression of metalloproteases and their inhibitors in primary tumors and in local recurrences after mastectomy for breast cancer

“…There are two main hypothesis to explain the origin and signiWcance of LRs: the Wrst one states that LR is caused by an incomplete initial removal of the tumor (Donegan et al 1966;Auchincloss 1958;Scanlon 1985;Toonkel et al 1983); the second one proposes that LR is a sign (the Wrst one) of the disease being already disseminated (Crile 1972;Baral et al 1985;Fisher et al 1980;Gilliland et al 1983;Papaioannou 1985;Valagussa et al 1978). Although, at the present time, it is not possible to determine the cause of isolated LRs, our data shows a signiWcant lower MMPs proWle in the primary tumors of patients who develop LR as Wrst manifestation of tumoral progression, suggesting that an incomplete removal could be the cause behind local recurrence.…”