Timing of surgery during menstrual cycle and survival of premenopausal women with operable breast cancer

Badwe, Rajendra; Gregory, WM; Chaudary, M. A.; Richards, MA; Bentley, Anthony; Rubens, Robert; Fentiman, IS

doi:10.1016/0140-6736(91)92927-t

Cited by 169 publications

(52 citation statements)

References 15 publications

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“…A median value of VEGF during the luteal phase of 174.7 pg ml 71 was significantly lower than a level of 206.5 pg ml 71 (P=0.03). Heer et al (1998) hypothesised that any possible survival advantage (reported by authors such as Badwe et al (1991) of patients who undergo breast cancer surgery in the luteal phase of the cycle could be due to this difference in serum levels of VEGF found in his study. However, Chung (1998), who also measured serum concentrations of VEGF in 14 healthy pre-menopausal volunteers, carried out a similar study.…”

Section: Discussionmentioning

confidence: 86%

A comparison of serum and plasma levels of vascular endothelial growth factor during the menstrual cycle in healthy female volunteers

2002

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Angiogenesis is the formation of new blood vessels from the existing vasculature, and is essential for the growth and metastasis of most solid tumours. One of the most important growth factors involved in the angiogenesis process is vascular endothelial growth factor. Vascular endothelial growth factor expression has been shown to be regulated by female hormones in breast cancer cell lines, and two previous authors have reported on cyclical variations in serum vascular endothelial growth factor concentrations with conflicting results. No work has been performed on variations in plasma levels of vascular endothelial growth factor during the menstrual cycle. We therefore conducted the first prospective trial to compare serum and plasma levels of vascular endothelial growth factor in healthy pre-menopausal volunteers. Twenty healthy pre-menopausal women were recruited and had blood samples taken over one menstrual cycle with an average of eight samples taken per patient. Plasma and serum samples were then analysed for sex hormones and vascular endothelial growth factor 165. Serum vascular endothelial growth factor levels were found to be significantly higher than plasma vascular endothelial growth factor levels (P50.005). We found no significant difference between serum and plasma vascular endothelial growth factor in the luteal and follicular phases of the cycle. The majority of the measurements for plasma levels of vascular endothelial growth factor at all phases of the cycle were under the limit of detection of the vascular endothelial growth factor ELISA kit. We found no significant correlation between plasma or serum levels of vascular endothelial growth factor and either FSH, LH, Oestradiol or Progesterone levels. This study has demonstrated no difference in serum concentrations of vascular endothelial growth factor during the different phases of the menstrual cycle in a group of healthy volunteers. We also demonstrated no obvious difference in plasma concentrations of vascular endothelial growth factor between the phases of the cycle, but most of the measurements were below the level of accuracy reported by the ELISA kit manufacturer. With the sensitivity of this ELISA test, therefore, we must still regard the question of whether there is a variation in plasma concentrations of vascular endothelial growth factor throughout the menstrual cycle as unanswered.

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Section: Discussionmentioning

confidence: 86%

A comparison of serum and plasma levels of vascular endothelial growth factor during the menstrual cycle in healthy female volunteers

2002

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“…It is possible that the observed increase in rate of vascular invasion may be due to an effect of oestrogen on the primary tumour. It has been shown previously that premenopausal women exposed to unopposed oestrogen at the time of tumour excision have a worse prognosis than that of women undergoing surgery during the luteal phase of the menstrual cycle (Badwe et al, 1991). The magnitude of the effect in premenopausal women was similar in oestrogen receptor-positive (ER+) and -negative (ER-) cases, suggesting that this might result from activation of ER+ peritumoral normal tissue.…”

Section: Discussionmentioning

confidence: 94%

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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“…In the original study from Guy's Hospital, the effect of menstrual phase was of equal magnitude in patients with both oestrogen receptor-positive and oestrogen receptor-negative tumours (Badwe et al, 1991a). Similarly, a significant effect of timing of surgery was seen in patients with both grade I/II and grade III tumours, although of lesser magnitude in the latter group.…”

Section: Resultsmentioning

confidence: 91%

“…The patients used in the present study were part of the original group in whom timing of surgery was found to be of prognostic significance (Badwe et al, 1991a). The relationship between operating time and the clinical course of the disease has proved to be very controversial with many conflicting results.…”

Section: Resultsmentioning

confidence: 99%

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Cell proliferation measured by MIB1 and timing of surgery for breast cancer

Cooper

Gillett²,

Smith³

et al. 1998

Br J Cancer

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Summary We have investigated the use of the antibody MIBl as a proliferative and prognostic marker in breast cancer and whether changes in proliferative activity could account for differences in prognosis of premenopausal women operated on during different phases of the menstrual cycle. MIBl expression was strongly correlated with S-phase fraction and histological grade. There was no difference in MIBl scores between different phases of the menstrual cycle. Both MIBl score and timing of surgery correlated significantly with duration of survival, while the two together were even stronger predictors of overall survival. Women with slowly proliferating tumours surgically removed in the luteal phase had a very good prognosis, whereas women with rapidly proliferating tumours excised at other times of the cycle had a worse prognosis.

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Timing of surgery during menstrual cycle and survival of premenopausal women with operable breast cancer

Cited by 169 publications

References 15 publications

A comparison of serum and plasma levels of vascular endothelial growth factor during the menstrual cycle in healthy female volunteers

A comparison of serum and plasma levels of vascular endothelial growth factor during the menstrual cycle in healthy female volunteers

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

Cell proliferation measured by MIB1 and timing of surgery for breast cancer

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