Serum progesterone and prognosis in operable breast cancer

Abstract

S_mmary Several studies have now shown that women with operable breast cancer undergoing tumour excision during the luteal phase of the menstrual cycle have a better prognosis than those having surgery during the follicular phase. As part of a prospective study of prognostic factors in breast cancer, blood was taken at the time of surgery. Between 1975 and1992 this was available from 289 premenopausal women within 3 days of tumour excision. All were treated by either modified radical mastectomy or breast conservation including axillary ckarance and the date of last menstrual period (LMP) was known in 239 (80%) cases. Blood samples were assayed for both oestradiol (E2) and progesterone (P). Because of the wide inter-individual variation in E2 levels there was no clear relationship between E2 and LMP. However, using a running mean smoothing technique the expected cyclical variation could be discemed. There was no significant association between E2 and survivaL Smoothing of the P data yielded a pattern similar to the normal hormone profile. Those cases with a progesterone level of 4 ng ml-I or more had a significantly better survival than those with a level <4 ng ml-'. This was especially clear in node-positive patients (P<0.01). The possibility of misclassification of menstrual cycle status, because of misreported LMP, has been minimised by applying an independent hormonal measurement (P) of cycle activity. This parameter will also identify women who may be undergoing anovular cycles. 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. Despite this, a recent meta-analysis demonstrated that overall there is a significant effect of timing of surgery on prognosis .Because all the studies were based upon retrospective data, Badwe et al. (1994) attempted to overcome these problems by measuring oestradiol (E2) and progesterone (P) on stored serum from 271 premenopausal patients operated upon between 1975 and 1985. Taking a cut-off of > 1.5 ng ml-' of P there was a significantly better prognosis in nodepositive cases with higher P levels. Further blood samples were available from 200 other patients operated on between 1979 and 1992, and concentrations of both E2 and P were assayed in these and combined with the previous results. This report describes the influence of menstrual cycle on the prognosis of an enlarged cohort of 471 premenopausal cases of operable breast cancer. Material and metKods PatientsBetween 1975 and 1992 a total of 1271 premenopausal patients presented to Guy's Hospit...

Systemic chemokine levels in breast cancer patients and their relationship with circulating menstrual hormones

“…The controversy of timing of surgical intervention in premenopausal breast cancer patients was initiated by Hrushesky et al [34] and has since been supported by 4 major studies, all favouring the second half of the menstrual cycle as optimal for surgery [35][36][37][38]. Our findings indicate that Oestradiol may cause down-regulation of SDF-1a in this phase.…”

Hormone Replacement Therapy in the Geriatric Patient: Current State of the Evidence and Questions for the Future. Estrogen, Progesterone, Testosterone, and Thyroid Hormone Augmentation in Geriatric Clinical Practice: Part 1

“…Large-scale studies 26,89,121,122 have been conducted in Europe, where bioidentical HRT is the main type of hormone therapy in menopausal women. The most significant study is the E3N or Epic cohort study that followed 80,000 postmenopausal women on various types of hormones including bioidentical hormones for more than 8 years, with 56,666 having used some form of HRT and 23,723 having never used any form of HRT.…”

“…2,3,5,25,27,55,61-63,89 -111 In contrast, the use of bioidentical progesterone has shown no association with increased risk of breast cancer; in fact, it repeatedly has been proven to decrease its risk. 45,57,76,[112][113][114][115][116][117][118][119][120][121] However, until recently, no large-scale randomized trials had been conducted with bioidentical hormones establishing beyond doubt that bioidenticals posed no increased risk of cancer.…”

Perioperative Progesterone for Obese Women with Breast Cancer May Improve Survival

“…Studies in premenopausal women with breast cancer had shown that surgery in the luteal phase of the cycle was associated with better outcome [46][47][48]. Furthermore, higher blood levels of progesterone were also predictive of improved prognosis [49]. This being so, it was reasoned that progesterone treatment could be used in the postmenopausal to try and simulate the endocrine status in the luteal phase of the cycle of the premenopausal.…”