In their recent article, Gansler et al.1 discussed various myths held by those from low sociodemographic backgrounds and cited a study by Margolis et al.2 that stated that approximately 61% of African Americans and 29% of white Americans believe that lung cancer spreads when it makes contact with air. This is given as a reason for the relatively low compliance rate in screening and the reluctance to undergo cancer surgery noted among African Americans and, to a lesser extent, other underserved communities in the U.S. One can almost hear tongues clicking by reassuring physicians at the pity of misinformed people who forgo the life-saving benefits of the early detection of cancer because of cherished but wrong information.
However, things are sometimes not as simple as they appear. As we have reported previously, surgery may induce angiogenesis of dormant or indolent distant micrometastases.3–6 This would make it appear as though cancer spreads when the air hits it. It has nothing to do with air; what is actually happening is that in certain circumstances a primary tumor can produce inhibitors of angiogenesis. When the primary tumor is removed, the inhibitors are removed also. Another possibility is that angiogenesis stimulators are produced as part of the wound-healing process. Tumor outgrowth after surgery among cancer patients has been observed for more than 100 years.
We continue to learn more about this effect and in the interim, it would be wise to refrain from any condescension before we lose all credibility regarding the early detection of cancer.