Summary The month of initial detection of tumour was recorded in 2,245 patients with breast cancer and correlated with survival over a follow-up period of 1.5-10 years. Women who initially detected their breast cancer in spring/summer had a significantly longer survival than those detecting their tumour at other times of the year. Overall, this relationship was independent of nodal status, tumour size and hormone receptor status. However, when patients were divided into groups the survival advantage was significantly associated with receptor status and age. Women aged > 50 years with ER-positive and PR-positive tumours who discovered their initial tumour in spring/summer had significantly better survival than those detecting their tumours at other times of the year. Survival was also longer in women aged < 50 years with receptor-negative tumours who initially found their tumours in spring/summer compared with the rest of the year. This study suggests that the season of first detection of a breast cancer relates significantly to the later behaviour of the tumour, and may reflect seasonal changes in hormone dependent growth.
Summary A seasonal variation in the month of initial detection of breast cancer has been previously observed in pre-menopausal women, and it has been proposed that this may be due to
Summary Hormone measurements during the menstrual cycle were assessed in six premenopausal women undergoing breast cancer surgery and ten controls to determine whether the stress of diagnosis and surgery influenced cycle characteristics. There was hormonal evidence for normal ovulation in all cancer and control women, although the length of the luteal phase of the cycle was prolonged because of a delay in menstruation in two cancer patients. The timing of surgery in the cycle did not influence the hormonal data. The hormonal characteristics of the menstrual cycle thus appear to be normally preserved in women during the month in which breast cancer surgery is performed.Keywords: breast cancer; menstrual cycle; timing of surgery When breast cancer is detected, women usually experience considerable stress as investigation and surgical treatment proceeds. Surprisingly little is known of the effect of diagnosis and surgery for breast cancer on the characteristics of the menstrual cycle in affected women, although it is clear that subsequent adjuvant chemotherapy (Samaan et al, 1978) or endocrine therapy (Ravdin et al, 1988; Yasumura et al, 1990) influence ovarian hormonal secretion. There is currently considerable interest in the timing of breast cancer surgery according to the phase of the menstrual cycle, with the suggestion that overall survival is improved for those having surgery in the luteal phase of the cycle (Badwe et al, 1991; Senie et al, 1991;Veronesi et al, 1994). Central to these observations is the assumption that the characteristics of the cycle remain normal at the time of diagnosis and surgery of a breast tumour. The present study investigates the features of the menstrual cycle in premenopausal women undergoing breast cancer surgery.
MATERIALS AND METHODSBlood samples were obtained from six women on days 5, 10, 12, 14, 16, 18, 20, 22, 24, 26 and 28 of the menstrual cycle in the month in which surgery for primary breast cancer was performed, defining day 1 as the first day of their menstrual period before surgery. The timing of surgery was at the discretion of the patient and surgeon and was carried out at various times during the cycle. The mean time from first sign or symptom of breast cancer to date of surgery was 28 days (range 13-86 days). Ten control women were recruited by newspaper advertisement. In both groups, blood sampling continued to day 28 or to the beginning of the next period.
Serum hormone assaysOestradiol was determined by radioimmunoassay with sensitivity S 19 pmol 1-', intra-assay coefficient of variation (CV) of 6% and interassay CV of 9%. Progesterone was measured by radioimmunoassay with sensitivity of 0.25 nmol l-', intra-assay CV of 3.6% and interassay CV of 8.5%. Plasma levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were determined by enzyme immunoassay with assay sensitivity of 0.8 IU 1-', intra-assay CV of 6% and interassay CV of 8.5% (LH) and assay sensitivity of 0.8 IU 1-', intra-assay CV of 4.5% and interassay CV of 5% (FSH).Ovulation w...
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