Timing of breast cancer surgery within the menstrual cycle: Influence on lymph-node involvement, receptor status, postoperative metastatic spread and local recurrence

Rageth, J. C.; Wyss, P.; Unger, C.; Hochuli, E

doi:10.1093/oxfordjournals.annonc.a057935

Cited by 42 publications

(5 citation statements)

References 6 publications

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“…Our negative finding concerning the relationship between phase and survival is in agreement with two other studies in which the patients were divided into a proliferative (follicular) and a secretory (luteal) group (Rageth et al, 1991;Senie et al, 1991). It thus seems hard to defend the view that the unopposed oestrogen phase is a dangerous period during which patients with mammary carcinoma should not be subjected to surgery.…”

Section: Discussionsupporting

confidence: 78%

“…In particular, patients surgically treated in the perimenstrual period (days 0-6 and 21-36) have been reported to have a poorer prognosis Badwe et al, 1991;Gregory et al, 1992). Other groups have not been able to confirm these findings (Powles et al, 1991;Rageth et al, 1991;Gnant et al, 1992). An important drawback of these studies is their retrospective character with all its possible disadvantages (Forbes, 1991).…”

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confidence: 88%

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

Wobbes

Thomas²,

Segers³

et al. 1994

Br J Cancer

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We evaluated the outcome of treatment for mammary carcinoma in 89 premenopausal women in relation to the phase of the menstrual cycle. The phase of the cycle was determined on the basis of serum concentrations of 17 beta-oestradiol and progesterone. The serum samples were collected 1 day prior to or on the day of operation. After a median follow-up of 4.1 years no significant differences in disease-free survival were found between the preovulatory (proliferative), periovulatory and post-ovulatory (luteal) groups. No differences in survival were found in these subgroups between the N0 and N1 subgroup. On the basis of this study we cannot confirm that the phase of the menstrual cycle during surgery has any effect on the eventual outcome in mammary carcinoma patients. However larger studies of this type are required before definitive conclusions can be reached.

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Section: Discussionsupporting

confidence: 78%

mentioning

confidence: 88%

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

Wobbes

Thomas²,

Segers³

et al. 1994

Br J Cancer

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“…Several studies (Badwe et al, 1991;Senie et al, 1991;Veronesi et al, 1994) and a meta-analysis (Fentiman et al, 1994) showed an increased overall survival rate in women with breast cancer who had undergone surgery in the luteal phase. Other studies, however, failed to demonstrate such a significant effect of timing of surgery on prognosis (Powles et al, 1991;Rageth et al, 1991). Because no correlations were found between Cath D levels and the menstrual phase, it is unlikely that hormonal induction of total Cath D could explain the prognostic differences according to the time of surgery.…”

Section: Discussionmentioning

confidence: 94%

Time at surgery during menstrual cycle and menopause affects pS2 but not cathepsin D levels in breast cancer

Pujol

et al. 1999

Br J Cancer

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Many studies have addressed the clinical value of pS2 as a marker of hormone responsiveness and of cathepsin D (Cath D) as a prognostic factor in breast cancer. Because pS2 and Cath D are both oestrogen induced in human breast cancer cell lines, we studied the influence of the menstrual cycle phase and menopausal status at the time of surgery on the levels of these proteins in breast cancer. A population of 1750 patients with breast cancer, including 339 women in menstrual cycle, was analysed. Tumoral Cath D and pS2 were measured by radioimmunoassay. Serum oestradiol (E2), progesterone (Pg), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels at the day of surgery were used to define the hormonal phase in premenopausal women. There was a trend towards a higher mean pS2 level in the follicular phase compared with the luteal phase (17 ng mg −1 and 11 ng mg −1 respectively, P = 0.09). Mean pS2 was lower in menopausal patients than in women with cycle (8 ng mg −1 and 14 ng mg −1 respectively, P = 0.0001). No differences in mean Cath D level were observed between the different phases of the menstrual cycle, or between pre- and post-menopausal women. In the overall population, pS2 was slightly positively associated with E2 and Pg levels and negatively associated with FSH and LH, probably reflecting the link between pS2 and menopausal status. In premenopausal women, no association was found between pS2 and E2, Pg, FSH or LH levels. There were no correlations between Cath D level and circulating hormone levels in the overall population. However, in the subgroup of premenopausal women with ER-positive (ER+) tumours, E2 was slightly associated with both pS2 and Cath D, consistent with oestrogen induction of these proteins in ER+ breast cancer cell lines. There are changes in pS2 level in breast cancer throughout the menstrual cycle and menopause. This suggests that the choice of the pS2 cut-off level should take the hormonal status at the time of surgery into account. In contrast, the level of Cath D is unrelated to the menstrual cycle and menopausal status. 1999 Cancer Research Campaign

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“…Although this result is not statistically significant, it is in the direction of accepting the original hypothesis (15). Rageth et al (16) also reported lack of correlation between timing of surgery and survival. Nevertheless, the patients were followed for less than 5 years and an unexplained higher percentage of node‐positive tumors was observed among patients with perimenstrual surgery.…”

Section: Clinical and Laboratory Trialsmentioning

confidence: 99%

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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Timing of breast cancer surgery within the menstrual cycle: Influence on lymph-node involvement, receptor status, postoperative metastatic spread and local recurrence

Cited by 42 publications

References 6 publications

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

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

Time at surgery during menstrual cycle and menopause affects pS2 but not cathepsin D levels in breast cancer

Perioperative Endocrine Status and Prognosis in Early Breast Cancer

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