Surgical Pain Killers Might Influence Breast Cancer Recurrence
Posted Jun 03 2010 6:40am
There are many, many factors that influence breast cancer risk and breast cancer recurrence. Two under-studied factors that might effect the risk of breast cancer recurrence are the anesthetics and pain relief medications used during mastectomy.
New breast cancer research published in the current issue of Anesthesia & Analgesia explored the possible relationship between surgical drugs and breast cancer recurrence. In the first study, researchers conducted a retrospective study of 327 breast cancer patients who had mastectomies . Breast cancer recurrence among these patients was analyzed in respect to the different pain killers they received during surgery. Somewhat unexpectedly, analysis of the data showed that patients receiving ketorolac (a non-steroidal anti-inflammatory drug) had substantially lower rates of breast cancer recurrence. The other pain relieving drugs examined (sufentanil, ketamine, and clonidine) in this study did not reduce breast cancer recurrence.
According to a review paper published in this same issue of Anesthesia & Analgesia, these results should not be entirely surprising. According to this review and a free editorial that discusses both of these articles in more detail, preclinical research results have shown that some surgical drugs, particularly opioids, might increase the risk of breast cancer recurrence. Apparently, the manipulation of tissues during surgery can cause the release of cancer cells into the bloodstream and while this is usually kept under control by the body's immune system, many drugs like the opioids suppress the immune system thereby increasing the risk of breast cancer recurrence. These studies suggest that certain approaches can be used to possibly reduce the risk of breast cancer recurrence after surgery. These approaches include using appropriate surgical drugs when available, using regional anesthesia rather than inhaled anesthesia, and using total anesthesia with intravenously administered anesthetics.
These are eye-opening revelations and are an important part of increasing our breast cancer awareness. The majority of this research to date is in animal models with only limited human clinical trials and to date, this research appears to be inconsistent and inconclusive. Nonetheless, this is an important, potentially modifiable risk factor of which we should all be aware. Hopefully, future clinical trials will more clearly define the effect of anesthestics and pain relieving drugs on breast cancer recurrence so that surgical approaches that reduce breast cancer recurrence risk become standard of care.