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To explain a bimodal pattern of hazard of relapse among early stage breastcancer patients identified in multiple databases, we proposed that laterelapses result from steady stochastic progressions from single dormantmalignant cells to avascular micrometastases and then on to growing deposits.However in order to explain early relapses, we had to postulate that somethinghappens at about the time of surgery to provoke sudden exits from dormantphases to active growth and then to detection. Most relapses in breast cancerare in the early category. Recent data from Forget et al suggests an unexpectedmechanism. They retrospectively studied results from 327 consecutive breastcancer patients comparing various perioperative analgesics and anesthetics inone Belgian hospital and one surgeon. Patients were treated with mastectomy andconventional adjuvant therapy. Relapse hazard updated Sept 2011 are presented.A common Non-Steroidal Anti-Inflammatory Drug (NSAID) analgesic used in surgeryproduced far superior disease-free survival in the first 5 years after surgery.The expected prominent early relapse events in months 9-18 are reduced 5-fold.If this observation holds up to further scrutiny, it could mean that the simpleuse of this safe, inexpensive and effective anti-inflammatory agent at surgerymight eliminate early relapses. Transient systemic inflammation accompanyingsurgery could facilitate angiogenesis of dormant micrometastases, proliferationof dormant single cells, and seeding of circulating cancer stem cells (perhapsin part released from bone marrow) resulting in early relapse and could havebeen effectively blocked by the perioperative anti-inflammatory agent.

Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs: new findings and a review