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PAPERS: Gianni Bonadonna, Angela Moliterni, Milvia Zambetti, Maria Grazia Daidone, Silvana Pilotti, Luca Gianni, and Pinuccia Valagussa 30 years' follow up of randomised studies of adjuvant CMF in operable breast cancer: cohort study BMJ 2005; 330: 217 [Abstract] [Full text]

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Humiliating effect of biological predeterminism

Srinivasan Ravi   (3 February 2005)

Re: Humiliating effect of biological predeterminism

Francis Lopez   (24 February 2005)

Humiliating effect of biological predeterminism 3 February 2005
Srinivasan Ravi, Consultant Surgeon Blackpool Send response to journal: Re: Humiliating effect of biological predeterminism	I am sure you will turn round and say it is a surgeon talking - but the graphs for surgery and surgery with chemotherapy both show a downward trend from the word go. Long ago, I ceased to take credit for the five year results of patients operated by me. This was when I 'matured' and became wise. The wisdom struck in the form of the concept of 'biological predeterminism' of cancers. The realisation, that cancers with different cell populations and genetic structure will grow or slow down for reasons that are not yet clear; that different people die at different times despite our best efforts; that doubling time and dormancy are determinants of life expectancy dawned on me and I became a 'humble' surgeon. Prevention rather than subsequent treatment; identification of cause/s rather than even screening should be our goal for the future. We NEED to find the SWITCH that turns it on. Competing interests: None declared
Re: Humiliating effect of biological predeterminism 24 February 2005
Francis Lopez, Clinical oncologist Assunta Hospital, Selangor, Malaysia Send response to journal: Re: Re: Humiliating effect of biological predeterminism	Two factors determine the outcome in breast cancers, one is the biological factor which is predetermined and the other is the chronological factor. For every degree of aggressiveness inherent in a tumour, delayed treatment allows the tumour to spread more extensively. I suspect we sometimes take too much credit for controlling what is essentially less aggressive disease. This issue will multiply many fold when credit is claimed for early detection and cure of "tumours" that would probably never have become clinical cancers. Dr Francis Lopez Competing interests: None declared