Kenneth L Abbott, MD, FACP  |  8/30/2022

The Air We Breathe

Cancer is a fearsome, complicated disease. Even with all our knowledge, constantly expanding, there remain many aspects we don’t understand as well as we would like. Human nature wants to fill in the gaps. We speculate. Sometimes our speculations, which may sound plausible enough to convince, become part of the “everybody knows” body of “facts” for which there is no actual proof, or we have misinterpreted our observations about the way cancer behaves and drawn incorrect conclusions. Therefore, cancer care providers frequently hear patients, family members, and friends express mistaken ideas about cancer gleaned from any number of sources. On this blog, I have previously written about some of these misconceptions, such as the interaction of sugar with cancer. Today’s post adds to that series by taking up the idea that exposure to open air makes cancer cells grow and spread.

Is this a legitimate concern? Put simply, no. It doesn’t take long to see why.

Consider skin cancers. No cancer cell is more exposed to the air than one inhabiting the skin surface. Squamous cell cancers and basal cell cancers are by far the most diagnosed cancers in the United States, affecting about 3.3 million people per year. Melanoma affects another 100,000 people. If exposure to air incites rapid cancer growth and spread, these diseases should exhibit explosive behavior and rapidly get out of hand. But they don’t. Respiratory tract cancers, including lung cancers, are naturally exposed to air all the time. Even the most aggressive of these don’t overwhelm their victims until some time has passed.

So where did this idea come from? The version I often hear has to do with surgery. The surgeon opens the skin and exposes the deeper interior regions of the body, such as the abdominal cavity, where there is no usual contact with air and light. People tell stories about persons undergoing a biopsy or planned removal of a tumor, only to have the surgeons discover upon operating the cancer cells have spread much more widely than anticipated. They close, having been powerless to accomplish much. The affected person suffers a quick demise thereafter. Exposure to air had nothing to do with it, however. In such cases, the disease was already far more extensive than scans or other studies had demonstrated before the operation; advanced cancers often behave aggressively and respond poorly to treatment, or affected persons are already so ill from their cancers they cannot withstand the side effects of attempted treatment. By contrast, there are plenty of instances of persons undergoing entirely successful cancer operations to remove malignant masses. They become long-term survivors. Exposing these tumors to air clearly had no adverse effect.

No surgical procedure is entirely risk-free. A person should always think clearly and thoroughly about a recommendation to have an operation, weighing the risks and benefits, getting more than one opinion. At least, however, no one with a possible cancer diagnosis should worry she will jeopardize her chances of survival by thereby making the cancer worse.
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