Importance of physical trauma on recurrence of breast cancer : Can tissue trauma synchronize growth of dormant micrometastases?

Abstract

Background Surgical excision of the primary tumor is an essential part of breast cancer treatment. While breast cancer prognosis has improved dramatically over the past decades, late relapses after apparently successful primary treatment are still an unresolved clinical issue. Locoregional recurrences can be challenging and there is no cure in the case of distant metastases. Purpose and aims The general aim of the project was to evaluate the influence of tissue trauma and wound healing on metastatic relapse of breast cancer. Methods Detailed studies of relapse patterns and dynamics in several retrospective breast cancer patients’ series were evaluated and related to surgical interventions as well as patients’ factors like body mass index and perioperative events. Results A relapse pattern with multiple metastases of similar size was discovered in subgroups of patients, suggestive of a growth synchronizing event on dormant micrometastases. A peak in early relapses after delayed reconstructions supported the hypothesis that tissue trauma and wound healing may stimulate pre-existing occult tumor deposits. The effect seems to be different if surgery involves the removal of a tumor in the breast or not. Patients factors and perioperative events can modulate this effect. Conclusions This work demonstrates that tissue trauma and wound healing can have an impact on distant relapse dynamics in breast cancer. The mechanisms of this link remain to be fully elucidated in order to become targets for intervention.