Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast cancer

Abstract

Recent studies have suggested that the timing of surgery in relation to the menstrual cycle might influence survival of premenopausal women with operable breast cancer. The data of 96 premenopausal patients who underwent primary surgery for operable breast carcinoma between 1975 and 1988 were analysed. At 10 years, disease-free and overall survival rates of patients whose initial surgery was 1-12 days after the starting date of the last menstrual period (follicular phase) were significantly poorer compared with survival of those who underwent operation more than 12 days after the last menstruation (luteal phase) (disease-free survival rate 40 versus 72 per cent, P = 0.002; overall survival rate 40 versus 79 per cent, P = 0.001). These differences in survival remained significant in a second analysis based on the menstrual phase at the time of both initial and definitive operation. Menstrual phase had the greatest impact on the survival of patients with positive axillary nodes (P = 0.009). Prospective studies are required to elucidate the relationship between the timing of all surgical procedures during the menstrual cycle and survival.

Increased susceptibility to metastasis during pro-oestrus/oestrus in rats: possible role of oestradiol and natural killer cells

“…Although a topic of intense debate in the clinical literature, several studies have indicated differential rates of cancer recurrence (and different rates of long-term mortality) as a function of the menstrual phase during which mastectomy is performed (Badwe et al, 1991;Hrushesky et al, 1989;Saad et al, 1994;Senie et al, 1991;Spratt et al, 1993). Our study in rats and this clinical phenomenon have many characteristics in common.…”

“…In the mouse, spontaneous metastasis of an oestrogen-responsive tumour was reduced around ovulation (Ratajczak et al, 1988), and prolonged exposure to ,Boestradiol (more than 8 weeks) increased experimental and spontaneous tumour metastasis (Hanna and Schneider, 1982). In humans, some studies, but not others, have associated certain periods of the menstrual cycle with a better long-term survival rate following a breast cancer resection (Badwe et al, 1991;Hrushesky, 1989;Saad et al, 1994;Senie et al, 1991;Spratt et al, 1993;Veronesi et al, 1994; for review see Davidson and Abeloff, 1993). For example, studies by Badwe et al (1991) and Senie et al (1991) reported a 3-fold increase in cancer reoccurrence and mortality in patients undergoing surgery during the unopposed oestrogen synthesis phase (elevated oestradiol/low progesterone levels, days 3-12 after the last menstrual period), relative to patients undergoing surgery during the rest of the menstrual cycle (approximately 45% vs 15% mortality rate respectively).…”

“…levels and affinity of intercellular adhesion molecules, vascular permeability and immune functions). The abovementioned clinical phenomenon is reported to occur whether or not the excised breast tumours possess receptors for sex hormones (Badwe et al, 1991;Saad et al, 1994;Senie et al, 1991). Thus, it is likely that this phenomenon reflects an indirect effect of sex hormones on tumour development.…”

Serum progesterone and prognosis in operable breast cancer

“…Thus this study has confirmed that a raised level of progesterone at the time of tumour excision is associated with an improvement in prognosis for women with operable breast cancer. Although some other centres reported similar findings (Senie et al, 1991;Saad et al, 1994; Veronesi et al, 1994) there have been other negative studies (Powles et al, 1991;Sainsbury et al, 1991;Low et al, 1991). There are major difficulties in comparing these published results partly because of differences in timings used, errors in selfreporting, anovular cycles and possible variations in treatment.…”

Timing within the oestrous cycle modulates adrenergic suppression of NK activity and resistance to metastasis: possible clinical implications

“…reported an increase of up to 300% in the 10-year mortality rate of women undergoing surgery during days 2-14 of their menstrual cycle (Badwe et al, 1991;Senie et al, 1991;Saad et al, 1994). Other groups, however, have suggested that it is the perimenstrual period that is characterized by a higher mortality rate (Hrushesky et al, 1989), and several studies have failed to detect any relationship between the two variables (for review see Lemon and Rodriguez-Sierra, 1996).…”