Breast Cancer and Anaesthesia: Genetic Influence

Abstract

Breast cancer is the leading cause of mortality in women. It is a heterogeneous disease with a high degree of inter-subject variability even in patients with the same type of tumor, with individualized medicine having acquired significant relevance in this field. The clinical and morphological heterogeneity of the different types of breast tumors has led to a diversity of staging and classification systems. Thus, these tumors show wide variability in genetic expression and prognostic biomarkers. Surgical treatment is essential in the management of these patients. However, the perioperative period has been found to significantly influence survival and cancer recurrence. There is growing interest in the pro-tumoral effect of different anaesthetic and analgesic agents used intraoperatively and their relationship with metastatic progression. There is cumulative evidence of the influence of anaesthetic techniques on the physiopathological mechanisms of survival and growth of the residual neoplastic cells released during surgery. Prospective randomized clinical trials are needed to obtain quality evidence on the relationship between cancer and anaesthesia. This document summarizes the evidence currently available about the effects of the anaesthetic agents and techniques used in primary cancer surgery and long-term oncologic outcomes, and the biomolecular mechanisms involved in their interaction.

Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane

“…Animal-, in vitro-, and retrospective clinical studies demonstrate that survival may be affected by the anaesthetic technique for many solid cancers, e.g., gastroesophageal cancer and hepatobiliary cancer. 2 , 3 Plausible biological explanations exist, e.g., opposite effects on the immune system with suppression from inhaled anaesthetics, genotoxicity from this group, and also upregulation of hypoxia-inducible factor, making cancer cells more viable, while propofol seems to have the opposite effect. 4 , 5 For breast cancer, vascular endothelial growth factor C, which promotes angiogenesis and metastasis, is increased under sevoflurane/opioid anaesthesia, but not under propofol/paravertebral anaesthesia.…”

The association between perioperative opioids and breast cancer recurrence: a narrative review of the literature

“…Since the inception of this review, several trials studying the effects of opioids on cancer recurrence are underway. While outside the scope of the present review, these studies analyze incorporate additional patient and tumor covariates that may influence the association between opioids and breast cancer recurrence and include mu-opioid receptor polymorphisms, other genetic biomarkers ( 36 , 37 ), immunological processes ( 38 ). and hormone receptor-specific responses to opioids ( 39 ).…”

Clinical Value of Total Intravenous Anesthesia with Sufentanil and Propofol in Radical Mastectomy

“…However, the efficacy of the combined drugs cannot be accurately predicted because the combination may have synergistic and additive effects as well as antagonistic effects, leading to pharmacodynamic changes. Therefore, the compound effects of different drugs need to be analyzed one by one to clarify the drug efficacy of their combination [15][16][17]. This study combined two drugs (fentanyl and sufentanil) with propofol.…”