The phase of the menstrual cycle has no influence on the disease-free survival of patients with mammary carcinoma

Wobbes, Th.; Thomas, Chris M.G.; Segers, M. F. G.; Peer, Petronella G. M.; Bruggink, E. D. M.; Beex, L.V.A.M.

doi:10.1038/bjc.1994.110

Cited by 25 publications

(6 citation statements)

References 9 publications

(9 reference statements)

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“…Luteal phase surgery was associated with two to three times less metastatic development. Wobbes et al (26), on the other hand were not able to detect a difference in the outcome in their study. Serum concentrations of 17 β ‐estradiol and progesterone were used to divide the cycle in preovulatory, periovulatory, and postovulatory phases.…”

Section: Clinical and Laboratory Trialsmentioning

confidence: 73%

“…Small study population and small number of events restrict the power of investigations. Wobbes et al (26), who used hormonal measurements to determine the phase of the menstrual cycle, admit that they would have needed at least 200 events to detect by 80% a difference of 50% in recurrence or death rate between phases. The three studies with study population larger than 1,000 patients have presented different results.…”

Section: A Possible Explanation For the Contradictory Datamentioning

confidence: 99%

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Perioperative Endocrine Status and Prognosis in Early Breast Cancer

Kontos

Fentiman

2006

Breast Journal

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Although the relationship between breast cancer and hormones has been known for almost two centuries, it is only during the last 16 years that evidence suggesting the hormonal profile of the patient at the time of surgery can affect the outcome, came to light. A series of studies investigated the hypothesis that unopposed estrogen (observed during the follicular phase of the cycle) may adversely affect the overall and/or disease-free survival of women operated on at that time. The findings have been, at times, contradictory. The retrospective nature of the studies, poor recording of last menstrual period, small study size, and the possible effect of the timing of the diagnostic procedures (cytology or core biopsy) on the outcome may be responsible for the conflicting results. Despite this, more sophisticated studies based on pathological or hormonal observations/measurements, confirmed the relation of luteal phase surgery to better outcome. Estrogen-induced increased protease activity activates a cascade of proteolysis and allows the more discohesive tumor cells to gain access to the circulation. Moreover, disseminated cells might be able to proliferate easier because of several estrogen-dependent growth factors. Diminished immune function during the follicular phase, because of natural killer cell activity and mononuclear cell phagocytic activity down-regulation may also be implicated in the dissemination of viable tumor cells. Taken together these findings provide a framework for explaining the observation that luteal phase surgery can lead to an improved outcome. By altering the perioperative hormonal milieu it may be possible to reduce deaths from breast cancer in a simple and nontoxic manner.

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Section: Clinical and Laboratory Trialsmentioning

confidence: 73%

Section: A Possible Explanation For the Contradictory Datamentioning

confidence: 99%

Perioperative Endocrine Status and Prognosis in Early Breast Cancer

Kontos

Fentiman

2006

Breast Journal

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“…The more pronounced effect may be due to lymph node positive tumours already showing the potential for metastasis, and the hormonal environment at the time of surgery may further facilitate tumour cell metastasis in lymph node positive disease. However, not all studies have found a relationship between menstrual cycle phase and outcomes in lymph node positive patients (17,42).…”

Section: Classification Of Menstrual Cycle Usingmentioning

confidence: 97%

“…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%

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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“…[150][151][152] In contrast to these disorders, myasthenia gravis generally improves premenstrually. 153,154 Although one early report 155 indicated better outcomes if breast surgery was performed in the luteal phase, but subsequent investigators 156 have been unable to confirm this finding.…”

Section: Miscellaneous Disordersmentioning

confidence: 99%

Effects of the Menstrual Cycle on Medical Disorders

Case¹,

Reid²

1998

Arch Intern Med

111

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Exacerbation of certain medical conditions at specific phases of the menstrual cycle is a well-recognized phenomenon. We review the effects of the menstrual cycle on medical conditions, including menstrual migraine, epilepsy, asthma, rheumatoid arthritis, irritable bowel syndrome, and diabetes. We discuss the role of medical suppression of ovulation using gonadotropin-releasing hormone agonists in the evaluation and treatment of these disorders. Peer-reviewed publications from English-language literature were located via MEDLINE or from bibliographies of relevant articles. We reviewed all review articles, case reports and series, and therapeutic trials. Emphasis was placed on diagnosis and therapy of menstrual cycle-related exacerbations of disease processes. Abrupt changes in the concentrations of circulating ovarian steroids at ovulation and premenstrually may account for menstrual cycle-related changes in these chronic conditions. Accurate documentation of symptoms on a menstrual calendar allows identification of women with cyclic alterations in disease activity. Medical suppression of ovulation using gonadotropin-releasing hormone agonists can be useful for both diagnosis and treatment of any severe, recurrent menstrual cycle-related disease exacerbations.

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The phase of the menstrual cycle has no influence on the disease-free survival of patients with mammary carcinoma

Cited by 25 publications

References 9 publications

Perioperative Endocrine Status and Prognosis in Early Breast Cancer

Perioperative Endocrine Status and Prognosis in Early Breast Cancer

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

Effects of the Menstrual Cycle on Medical Disorders

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