Abstract
Although considerable progress has been achieved in breast cancer diagnosis and treatment, the live-saving effect of mammography has hardly been measurable and the benefit of taxanes regarded as highly active is still a matter of debate, possibly because treatment effects have hitherto been mainly determined from the solid part of the tumor, due to lack of measurability of the systemic part of the disease. Here, we have quantified the influence on the systemic disease, cells mobilized from the solid tumor. Increased numbers of circulating epithelial cells were observed in screened individuals and still higher numbers in breast cancer patients with repeated mammograms as compared to mammogram naïve individuals. Taxanes as part of the subsequent systemic treatment led to mobilization of tumor suspect cells in up to 78% cases and the majority of relapses have occurred in these patients. Surgery-induced activation of disseminated cells may additionally contribute to metastasis formation.
Highlights
In most cancers it is not the primary tumor but the metastases which are responsible for fatal outcome
Mammography is the first diagnostic step taken in breast cancer screening and detection
The fatal event in most solid cancers is metastasis formation for which a prerequisite is that cells leave the primary tumor and become adherent at distant sites before they grow and form metastases
Summary
In most cancers it is not the primary tumor but the metastases which are responsible for fatal outcome. It would be most promising to aim at detecting the tumor before it has been able to form metastases. At least in breast cancer most tumors are detected when no measurable metastases are, yet, We added the highlighted part to the second address. A considerable proportion of patients during the further course of disease develop lifethreatening metastases. Screening mammography, aiming at detecting early tumors has not yet shown convincing results [1, 2] and may even rather extend the period of disease than extending life time [3]
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