Dormancy and breast cancer.

A case is presented in which multiple nodules of recurrent cancer appeared about the scar 25 years after radical mastectomy. They were accompanied by an inflammatory reaction. Breast cancers may recur as long as 50 years after surgery. Such late recurrence is accomplished by the cancer cell entering a "dormant" state in which little or no de novo DNA transcription occurs and only enough RNA is translated into proteins to maintain the vegetative functions that sustain cell viability. Features favoring the evolvement of dormancy are discussed as well as the nature of the cocoon-like shell which affords such cancer cells protection from the host's cellular and serological defenses. Speculation, promoted by the new cellular biology, as to the cause of secondary inflammatory cancers, is presented. A possible mechanism for the reactivation of these quiescent cells is suggested. The altered immune reactions of host and cancer cells provide an explanation for the controversies plaguing surgeons regarding the treatment and prognosis of breast cancer.