Cultural fears of early mortality already exist.

a stimulation of angiogenesis by surgery. However, even if surgery does lead to an induction of angiogenesis, it is unlikely that this would translate into a worsening of mortality in such a short time period. Also, it is quite possible that age is an independent prognostic factor in breast cancer, as is the case in prostate cancer where generally younger men have more aggressive disease even if their grade, stage, and PSA put them in a low risk category. However, there is an increasing evidence base that surgery-induced angiogenesis is a real effect. A study by Wu et al. 4 in colorectal cancer patients found that levels of endostatin (an anti-angiogenic factor) fell in the immediate postoperative period, and this was also accompanied by a transient rise in vascular endothelial growth factor (VEGF; the most potent pro-angiogenic factor known). Also, growth factors released in the immune response to surgery may also stimulate angiogenesis. A paper by Brivio et al. 5 found that pre-surgical IL-2 immunotherapy for colorectal cancer patients reduced the postop-erative increase in VEGF. These authors also found that IL-12 (a known anti-angiogenic cytokine) levels decreased after surgery, and that IL-2 therapy abrogated this decline, further suggesting that the immune response after surgery might be responsible for accelerating angiogenesis. I am myself planning a study of neo-adjuvant anti-angiogenic therapy in prostate cancer patients to assess the effect this has on plasma angiogenic biomarkers measured by ELISA. Following the data presented by Retsky et al. (2005) a similar study is therefore now warranted in breast cancer. References 1. Retsky M, Demicheli R, Hrushesky JM. Does surgery induce angiogenesis in Breast Cancer? Indirect evidence from relapse pattern and mammography paradox. de Waal RW, et al. The effects of surgery, with or without rhGM-CSF, on the angiogenic profile of patients treated for colorectal carcinoma. et al. Effects of IL-2 preoperative immunotherapy on surgery-induced changes in angiogenic regulation and its prevention of VEGF increase and IL-12 decline. Hepatogastroen-terology 2002;49:385e7. Dear Editor The phenomena documented by Retsky 1 is apparently something that may have been long recognized by some AfricaneAmerican women who attributed it to reasons that were never medically validated. As a child overhearing conversations about this dreadful health condition, there was always the warning to ''avoid surgery because exposing the cancer to air would make it grow stronger or in other places in the body.'' Of course, that was a mere suspicion …