Letters spurred theory about breast cancer deaths in blacks

It's an unusual way to conduct science, but a researcher at Children's Hospital Boston says the insights he got from two letters to the editor have led him to a provocative theory about breast cancer.

Black women, Dr. Michael Retsky hypothesizes, may be more likely to die from breast cancer because they are more likely to get it -- and therefore the surgical treatment -- before they reach menopause. The surgery itself may be the trigger.

Retsky wrote a paper in 2005 saying that surgical removal of tumors in young women seemed to kick-start tiny, dormant tumors in other parts of the body, causing potentially lethal relapses. At the time, his theory was based merely on the age of the woman getting the surgery: Premenopausal women were more likely to suffer these relapses than older ones.

But then the International Journal of Surgery, which had published his paper, ran two letters about it: one from an African surgeon who said his experience with patients in Africa supported Retsky's theory; another from an African-American lawyer in Tennessee who said many blacks are superstitious about getting their tumors operated on, believing that "cancer spreads when it hits the air."

The letters piqued his interest in applying a racial lens to his theory. His subsequent research convinced him he was onto something.

African-American women, on average, get breast cancer at age 46 compared with 57 for white women, making blacks more vulnerable to the postoperative effects he described in his original paper. He also learned that the disparity in mortality between blacks and whites began to appear in the 1970s -- around the time that early detection and therefore treatment started -- and has been on the rise ever since.

"By connecting the dots it seems to us that what we propose is a logical explanation," said Retsky, a vascular biologist who works in the lab of renowned scientist Judah Folkman. "The comments from the African physician and the African-American attorney pointed us toward reexamination of the subject. . . . It is rare that a letter to the editor can trigger research in a subject that hasn't been previously examined."

But other researchers say what is truly rare is that a journal would publish a theory that is not substantiated by laboratory research.

"It is a theory and it is speculation and it is fine for people to advance their theory -- many of us do that. What we don't do is publish them until we have research to back them up," said Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.

Lichtenfeld is concerned that the news of the study will be misinterpreted, causing African-American women to forgo mammograms -- or, worse, surgery.

Several other leading breast cancer researchers say they welcomed the thoughtful questions raised in the article but are concerned that Retsky may have been too quick to discount the leading theory on racial disparities in care and diagnosis.

Retsky cited one study showing there were still disparities even when blacks and whites had equal access to care. But Harold Freeman of the National Cancer Institute says equal access doesn't necessarily mean equal quality of treatment.

Freeman, also the director of the Ralph Lauren Center for Cancer Care and Prevention in Harlem, thinks the theory is interesting but has little promise of being more than a bit player in the ongoing drama of breast cancer in black women.

"When you correct for equal treatment and socioeconomic factors, studies show you have corrected most of the problem," he said. "That might leave you a little room for the surgery theory. You might get to a subset of the problem, but it is a relatively small one."