Prognostic effect of menstrual cycle on timing of surgery in premenopausal breast cancer patients

Liu, Yu; Wang, Yaohui; Zhou, Liheng; Yin, Kun; Yin, Weiqiang; Lu, Jinsong

doi:10.1016/j.amjsurg.2015.01.025

Cited by 6 publications

(6 citation statements)

References 32 publications

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“…The mean length is approximately 14.37 days for the follicular phase and 14.26 for the luteal phase [4]. Thus, setting the first day of menstruation as day 1, the cutoff threshold for the follicular phase and the luteal phase can be defined as the 14 th day of the cycle [5]. Generally, E2 concentration is low at the beginning of the follicular phase, during which it steadily increases.…”

Section: Introductionmentioning

confidence: 99%

The Menstrual Cycle Related Hormone Variations and Breast Cancer Risk: A Novel Theory

Xiaohui¹,

Taylor²,

Fang³

et al. 2020

COR

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Background: The cumulative and excessive exposures to estrogen contributing to increased risk of breast cancer may be misleading. Methods: We proposed a novel theory to highlight that exposure to unstable estrogen levels may play a critical role in determining breast cancer risk among females as the change of endocrine environment may pose a risky environment to breast tissues for carcinogenesis. Particularly, we considered the menstrual cycle related estrogen variation (MCREV) as the primary hazard to breast cancer among females. Results: To describe MCREV, its intensity was defined as the difference between the highest and the lowest levels of estrogen within a menstrual cycle; its timing was defined as age at menarche and age at pregnancies (i.e. timing of cessation of exposure to this hazard); and its frequency and duration can both be defined as the total number of menstrual cycles, which is influenced by many factors including age of menarche, age of menopause, average length of one menstrual cycle, and durations and number of pregnancies and breastfeeding. Conclusions: The proposed MCREV theory may identify women at high-risk of breast cancer at an earlier age. The development of breast cancer might be weakened if suitable techniques to reduce the MCREV become clinically available. This novel theory opens a new door in breast cancer prevention and management.

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Section: Introductionmentioning

confidence: 99%

The Menstrual Cycle Related Hormone Variations and Breast Cancer Risk: A Novel Theory

Xiaohui¹,

Taylor²,

Fang³

et al. 2020

COR

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“…In another study, they reported that ER positivity was higher in the follicular phase and the PR was found to be independent of the menstrual cycle; and if the condition of the hormone receptor is found to be negative, it is necessary to reevaluate the phase of the menstrual cycle in which the operation is performed [24]. Liu et al [25] reported that surgery performed during the follicular phase provides a more favorable prognosis compared with the luteal phase.…”

Section: Discussionmentioning

confidence: 99%

The effect of timing of breast cancer surgery during the menstrual cycle phase on the axillary lymph node, estrogen receptor, progesterone receptor and c-erb B2

Specialist

Durmuş

Papila

et al. 2020

Preprint

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Background: Estrogen receptor (ER) and progesterone receptor (PR) positivity and c-erbB2 gene expression levels are important in determining breast cancer (BC) development and aggression. Although the importance of hormonal factors in tumor cell proliferation, migration and differentiation is increasing, it needs more evidence. The effect of BC surgery timing during the menstrual cycle on prognosis remains controversial. In order to clarify this hypothesis, we aimed to determine the importance of adjusting the timing of surgery according to the menstrual cycle by examining the relationship between ER, PR, c-erbB2 gene and the menstrual cycle phase in patients with premenopausal BC.Method: Our study was designed retrospectively. 50 patients with premenopausal BC who were operated were included in the study.Results: Our results showed that the patients in the luteal phase had higher ER positivity, PR positivity and c-erbB2 negativity, and the number of metastatic axillary lymph nodes was lower than the patients in follicular phase. Conclusion: BC surgery during the luteal phase in pre-menopausal women is associated with a better clinical outcome. Although larger-scale studies are needed, our results suggest that better results can be achieved by performing surgery in luteal phase in BC patients during premenopausal period.

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“…Differences in classification methods can introduce significant variability into results, and may provide some explanation for the differences in results between different studies (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)26,27) (Table I). Other factors include inaccuracies in menstrual cycle data, as there can be significant variability in cycle length (i.e., 22-36 days) between women (35); and other factors, such as irregular menses, use of oral contraceptives, recent pregnancies, or differing hormonal and chemotherapy treatment regimens may impact circulating ovarian hormones and menstrual cycle phase.…”

Section: Confounding Factors That Could Affect the Relationship Betwementioning

confidence: 99%

“…To date, only one study that examines the relationship between the timing of surgery and patient outcomes has assessed HER2 expression (Table IV). Liu et al (16) took into account HER2 expression, and found that HER2 expression did not fluctuate across the menstrual cycle, nor was it a prognostic factor for disease free survival. However, the authors did not consider the intensity of HER2 expression.…”

Section: Impact Of Menstrual Cycle Phase At Time Of Surgery On Adjuvamentioning

confidence: 99%

“…Mouse studies supported by small retrospective clinical studies suggested that changes in the characteristics of the tumour and tumour microenvironment across the menstrual cycle might influence the metastatic potential of tumour cells, and affect clinical outcomes in premenopausal women. However, while some studies suggest that surgery performed during the luteal phase results in favourable outcomes in terms of metastatic incidence, disease free survival, and overall survival (6)(7)(8)(9)(10)(11)(12)(13)(14), other studies report the follicular phase is more favourable (5,15,16), and other studies show no association (17)(18)(19)(20)(21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

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Timing of breast cancer surgery during the menstrual cycle‑is there an optimal time of the month? (Review)

et al. 2020

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An intriguing relationship between menstrual cycle phase at the time of breast cancer surgery and clinical outcomes was first proposed in the late 1980s. Despite a number of clinical studies conducted to address this, as well as meta-analyses and systematic reviews, there remains significant controversy surrounding the effect of menstrual cycle phase at time of surgery on the prognosis of premenopausal breast cancer. While some studies have suggested that surgery performed during the luteal phase results in the most favourable outcome, other studies report the follicular phase is more favourable, and others show no association. Given the conflicting results, there remains insufficient evidence to determine whether there is an optimal time of the month to perform surgery. This issue has dogged breast cancer surgery for decades; knowledge of an optimal time of the month to conduct surgery would be a simple approach to improving patient outcomes. This review explores the potential biological mechanisms through which the hormonal milieu might contribute to differences in prognosis, and why clinical findings are so variable. It is concluded that a significant problem with current clinical research is the lack of insight from mechanistic studies. While there are a number of plausible biological mechanisms that could lead to altered survival, supporting evidence is limited. There are also variable approaches to defining the menstrual cycle phase and hormone receptor status of the tumour and few studies controlled for prognostic factors such as tumour size and stage, or addressed the impact of adjuvant treatments. Elucidation of the specific confounding factors, as well as biological mechanistic pathways that could explain the potential relationship between timing of surgery and survival, will greatly assist in designing robust well-controlled prospective clinical studies to evaluate this paradigm.

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Prognostic effect of menstrual cycle on timing of surgery in premenopausal breast cancer patients

Cited by 6 publications

References 32 publications

The Menstrual Cycle Related Hormone Variations and Breast Cancer Risk: A Novel Theory

The Menstrual Cycle Related Hormone Variations and Breast Cancer Risk: A Novel Theory

The effect of timing of breast cancer surgery during the menstrual cycle phase on the axillary lymph node, estrogen receptor, progesterone receptor and c-erb B2

Timing of breast cancer surgery during the menstrual cycle‑is there an optimal time of the month? (Review)

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