Why you need to know about this drug BEFORE breast cancer surgery

(your surgeon may not tell you about it)

The study, performed by a group of physicians at Harvard and across Europe, has shown that one dose of the common and non-addictive pain reliever ketorolac (Toradol®) is associated with a substantial decrease in risk of breast cancer recurrence. [1]

Study Synopsis: When breast cancer surgeons gave patients a dose of ketorolac at the time of surgery, specifically just before the first incision, there was a five-fold decrease in expected breast cancer recurrence events in the two-year period following surgery.

Design: Of 316 patients total, 175 received ketorolac at the time of surgery, while 141 did not.

Results: in the 9 month period immediately following surgery, there were 3 relapses in the ketorolac group compared to 15 in the no-ketorolac patients.

Why you should care: If your surgeon simply gives you an injection of 20 or 30 milligrams of ketorolac immediately before making the surgical incision, your chances of having a cancer recurrence in the first 24 months are decreased. The effect is stronger than the effect of chemotherapy.

Ketorolac is in the non-steroidal inflammatory drug (NSAID) family, along with ibuprofen (Motrin®) and aspirin. The authors of the study speculate here on the mechanisms behind the observed anticancer activity of this class of drugs.

“Transient systemic inflammation accompanying surgery could facilitate angiogenesis of dormant micrometastases, proliferation of dormant single cells, and seeding of circulating cancer stem cells (perhaps in part released from bone marrow) resulting in early relapse and could have been effectively blocked by the perioperative anti-inflammatory agent.”

What they’re saying is that the act of cutting into the body (surgery) turns on the body’s “grow” signals, in order to facilitate healing. The problem is that cancer cells also respond to the “grow” messages of surgery. NSAID drugs such as ketorolac block this message.

Herein lies the problem for patients: One of the listed side effects from this family of drugs is bleeding. Surgeons unaware of this research will make a knee-jerk demand that patients actively avoid NSAIDS like ketorolac for a week before surgery, along with a long list of other drugs, including aspirin.

Not using ketorolac in this setting is, however, dangerously backward. That is because the risk of dying of breast cancer is high (That’s why you’re having the surgery in the first place!) while the risk of life-threatening hemorrhage during or following breast cancer surgery is vanishingly small.

Solution: arrange before setting a surgery date to discuss use of this drug with your surgeon.

Action point:

Print out and deliver this article to your breast cancer surgeon.

Insist the surgeon discuss it with you before you settle on a surgery date.

If your surgeon reads the article, takes a careful history of your past medical problems, and agrees that you have no contraindications for use of ketorolac—a non-exhaustive list would include a history of bleeding problems, kidney trouble, extremely high blood pressure, or current ulcerations of the stomach or intestines—ask that ketorolac 20 or 30 milligrams, depending on your size, be injected just before the incision.

If your surgeon refuses to read and discuss the article with you, or refuses to give you the drug without explaining and documenting the specific contraindication that poses a supposed danger, you may wish to consider changing surgeons. At the very least, get a second opinion.

[1] Retsky M, Demicheli R, Hrushesky WJ., et al. Reduction of Breast Cancer Relapses with Perioperative Non-Steroidal Anti-Inflammatory Drugs: New Findings and a Review. Current Medicinal Chemistry. 2013;20(33):4163-4176. doi:10.2174/09298673113209990250.