Timing breast cancer surgery

Low, S. C.; Galea, M.H.; Blamey, R.W.; Goldhirsch, Aron; Gelber, R.D.; Forbes, John F.; Price, Karen N.; Castiglione, M.; Rudenstam, Carl Magnus; Lindtner, Jurij; Hacking, A.; Senn, Hans-Jörg; Cohen, Philip

doi:10.1016/0140-6736(91)91265-v

Cited by 37 publications

(6 citation statements)

References 5 publications

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“…There is still no uniformity concerning these findings, which have been confirmed by some (Hrushesky et al, 1989;Senie et al, 1991b;Ville et al, 1991) but not by others (Goldhirsch et al, 1991;Low et al, 1991;Powles et al, 1991). However meta-analysis of published studies has shown an overall significant effect of timing of surgery on both relapse-free and overall survival (Fentiman et al, 1994).…”

Section: Discussionmentioning

confidence: 88%

Body weight and vascular invasion in post-menopausal women with breast cancer

Fentiman¹,

Millis²,

Gregory³

1997

Br J Cancer

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Summary To examine the relationship between body weight and vascular invasion (VI) around tumours in post-menopausal women with operable breast cancer, a retrospective study was conducted of 393 patients treated in a breast unit between 1987 and 1991. Weight was measured at the time of diagnosis. Vascular invasion was recorded as being present or absent. Vascular invasion was seen in slightly more of the 50 perimenopausal patients than in the 343 post-menopausal women (44% vs 36%). In the tumour specimens from post-menopausal patients weighing <50 kg, VI was observed in 11% compared with 45% of those weighing more than 80 kg (P = 0.02). Furthermore, the 5-year survival of those with VI was 74% compared with 91% for those without (P < 0.0001). Menopausal status and body weight may influence survival in patients with breast cancer, possibly as a result of the presence of unopposed circulating oestrogens at the time of surgery. Oestrogens may alter cohesiveness of breast cancer cells and modulate secretion of proteases, thereby influencing invasive potential.Excision of tumours in such an environment may have a deleterious impact on survival.Keywords: breast cancer; prognosis; weight; post-menopausal women; vascular invasionThe prognosis of women with operable breast cancer depends upon tumour type, axillary nodal involvement and also menopausal status (Adami et al, 1986;Caleffi et al, 1989). Premenopausal cases have the lowest hazard rates for relapse and death. Rates are intermediate in post-menopausal women and the highest rates are found in perimenopausal women, that is those within 5 years of last menstrual period (Langlands et al, 1989). The observed differences may be due to the different hormonal environment to which tumours are exposed in these three groups of women.Survival has been shown to be inversely related to body weight in the majority of studies (Boyd et al, 1981; Tartter et al, 1981;Newman et al, 1986;Tretli et al, 1990; Senie et al, 199 la;Vatten et al, 1991), but such a relationship is less obvious in premenopausal women (Greenberg et al, 1985). Although there is a relation between body weight and other prognostic factors, such as tumour size and axillary lymph node involvement, the effect of obesity remains an independent factor in multivariate analysis (Tarttar et al, 1981;Vatten et al, 1991). The mechanism through which menopausal status and body weight influence survival is uncertain, although it is known that most circulating oestrogens in postmenopausal women are derived from peripheral aromatization of adrenal androgens in subcutaneous fat. Thus, more obese women have higher plasma levels of oestrogens (Grodin et al, 1973).Additionally, the impact of obesity on survival is more pronounced among those women with oestrogen receptor-positive breast cancers (Verreault et al, 1989).The risk of relapse and death also depends upon the metastatic potential of the tumour as manifested by the presence of malignant Correspondence to: IS Fentiman cells in lymphatic channels and blood vessels (vascu...

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Section: Discussionmentioning

confidence: 88%

Body weight and vascular invasion in post-menopausal women with breast cancer

Fentiman¹,

Millis²,

Gregory³

1997

Br J Cancer

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“…Although the three studies have compared different divisions of the menstrual cycle all agree that patients with surgery in early luteal phase have a longer survival. However, in contrast with these results other groups have not found any differences in outcome due to timing of surgery, (Gelber & Goldhirsch, 1989;Goldhirsch et al, 1991;Low et al, 1991;Powles et al, 1989Powles et al, , 1991Villeetal., 1990).…”

Section: Introductionmentioning

confidence: 81%

The seasonal variation in breast cancer detection: Its significance and possible mechanisms

Mason¹,

Holdaway

1994

Journal of the Royal Society of New Zealand

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We have demonstrated a number of temporal patterns in subjects with breast cancer including (a) an annual rhythm in the month of first sign or symptom of breast cancer (b) an increased frequency of tumour recurrence one year from diagnosis, and (c) abnormal annual and daily hormonal rhythms in breast cancer patients. Increased detection of breast cancer in spring-summer appears to be influenced by hormonal parameters, as it was more pronounced in premenopausal women with progesterone receptor (PR) positive tumours. Also, oestrogen receptor (ER) positive and PR negative primary tumours recurred significantly more frequently in the same season that their primary cancer was initially detected. 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, especially postmenopausal women with ER+ve and PR+ve tumours. Season of tumour detection also appeared to influence the predictive value of a number of prognostic factors for breast cancer, including ER and PR status, parity, lactational history and body mass index. Several possible mechanisms for seasonal effects in breast cancer were investigated. There was a significant circannual variation in the mean monthly PR concentration in parallel with changes in detection, with peak PR levels in April and nadir values in August/September. Women with previous breast cancer also showed an abnormal melatonin rhythm, with a paradoxical reduction of serum melatonin in wintertime in those who were winter detectors of breast cancer. Serum oestradiol levels measured in summertime were significantly higher in summer detectors than winter detectors of breast cancer. Serum insulin-like growth factor-I (IGF-I) did not increase in summer in breast cancer cases as it did in controls. There was no increase in cortisol production in winter in breast cancer cases, but there was in control women; the normal nocturnal TSH peak was reduced in breast cancer cases compared with controls. Women with breast cancer thus have blunted seasonal hormone changes which may contribute to their tumour growth patterns. Unravelling the hormonal interactions between tumour and host in breast cancer patients will have to take into account daily, annual, and monthly rhythms in hormonal parameters.

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“…In order to investigate the biometric validity of the "negative" results of our study, we have calculated the possibility of a (Low et al, 1991;Goldhirsch et al, 1991;Powles et al, 1991;Ville et al, 1991;Gelber and Goldhirsch, 1989) were also unable to confirm any effect of LMP on outcome after breast-cancer surgery. In their reports a total of 828 pre-menopausal breast-cancer patients have been investigated, without any impact of timing of surgery within the menstrual cycle.…”

Section: Discussionmentioning

confidence: 98%

“…These findings have led to remarkable confusion among breast-cancer patients and surgeons. Some controversial short reports have been published, some of them including small numbers of patients and/or short follow-up period (Low et al, 1991; Goldhirsch er al., 1991; Powles et al, 1991;Ville et al, 1991;Senie et al, 1991).The aim of our study was to evaluate a large number of pre-menopausal breast-cancer patients to investigate the validity of these suggestions. We therefore pooled the data from all pre-menopausal women who were operated on for breast cancer in the 2 major breast cancer treatment and research units of Vienna.…”

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confidence: 99%

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Breast cancer and timing of surgery during menstrual cycle. A 5‐year analysis of 385 pre‐menopausal women

Gnant

Seifert

Jakesz

et al. 1992

Intl Journal of Cancer

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It has been proposed that the timing of breast-cancer surgery in relation to menstrual phase has a prognostic impact on outcome. We carefully evaluated a combined 2-center series of 385 pre-menopausal women operated on for stage-I and stage-II breast cancer with a median follow-up of 5 years for a possible impact on outcome of the date of their last menstrual period (LMP) before surgery. The distribution of risk factors of the study cohort as well as prognostic indicators corresponded to previously published results. Nodal status, grading, and (in part) hormone-receptor status differentiate well between patient subgroups with high and low risk of relapse and death after breast-cancer surgery. In neither univariate nor multivariate analysis was any impact of the so-called "unopposed" estrogen secretion detected. We did not observe any effect of LMP on long-term survival in any of several prognostic subgroups, in particular in hormone-receptor-positive patients. From our results and from the literature, we conclude that LMP does not provide any prognostic information for outcome after breast-cancer surgery and therefore the proposed modification of scheduling of breast-cancer operations is not justified.

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Timing breast cancer surgery

Cited by 37 publications

References 5 publications

Body weight and vascular invasion in post-menopausal women with breast cancer

Body weight and vascular invasion in post-menopausal women with breast cancer

The seasonal variation in breast cancer detection: Its significance and possible mechanisms

Breast cancer and timing of surgery during menstrual cycle. A 5‐year analysis of 385 pre‐menopausal women

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