An act of surgery was required.
The dismantling of a minivan early in the film resembles the ritual slaughter of a sacrificial animal, much as the removal of a steering column later looks like a grisly act of surgery.
A better explanation is that, for some mysterious and wonderful reason, Wilson finds the act of surgery irresistible, in the way that musicians find pleasure in the sounds they produce on their instruments, or in the way Tony Gwynn gets a thrill every time he strokes a ball cleanly through the infield.
Baum suggested that the act of surgery can provoke the outgrowth of dormant micrometatstasis [ 12, 13].
It is therefore an "all or nothing" event where the act of surgery itself, no matter how extensive, is the contributing factor.
The latter remain dormant until some signal; perhaps the act of surgery or other adverse life events stimulates them into fast growth.
Importantly, given the that surgery can also be potentially immunosuppressive, we note that in fact the act of surgery itself did not adversely affect the efficacy of adjuvant IMQ.
What the authors are in fact suggesting is that the act of surgery kick starts "latent" metastases of patients with "early" breast cancer into an active state of vascularization and proliferation.
This paper is written in support of the challenging article by Retsky and colleagues in this issue of Breast Cancer Research, and develops on the idea that the act of surgery can provoke the outgrowth of dormant micrometastases, which often leads to the failure of screening to deliver its promise.
It is even possible that my worst estimate is too optimistic because of two papers I overlooked in the past that describe the risk of stroke following radiotherapy to the breast (Nilsson et al, 2005; 2009) and one very recent letter to the N Engl J Med on the early risk of cardiovascular deaths from the act of surgery alone, amongst patients with cancer (Voskoboynik et al, 2012).
