Skip to main content
SpringerLink
Log in

Timing of surgery for primary breast cancer with regard to the menstrual phase and prognosis

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The hormonal milieu of the patient at the time of surgery may influence the prognosis of patients with primary breast cancer. Circulating unopposed estrogen is perhaps detrimental, while circulating progesterone may confer a survival advantage. This hypothesis has particular relevance to the timing of surgery in relation to the menstrual cycle. After all, the first 14 days of the menstrual cycle (follicular phase) are characterized by high levels of circulating unopposed estrogen, while circulating progesterone is present during the second 14 days of the cycle (luteal phase). Several retrospective studies have shown that surgery during the follicular phase of the menstrual cycle results in a worse disease- free and overall survival. Randomized controlled trials addressing the effect of timing of surgery or neoadjuvant hormonal therapy on breast cancer mortality are urgently needed to confirm or refute the unopposed estrogen hypothesis. Such trials may provide important insights into the natural history of breast cancer, and a basis for significantly reducing breast cancer mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jatoi I: Breast cancer: a systemic or local disease? Am J Clin Oncol 20:536-539, 1997

    Google Scholar 

  2. Wood WC: Progress from clinical trials on breast cancer. Cancer 74:2606-2609, 1994

    Google Scholar 

  3. Halsted WS: A clinical and histological study of certain adenocarcinomas of the breast: and a brief consideration of the supraclavicular operation and of the results of operation for cancer of the breast from 1889 to 1898 at the Johns Hopkins Hospital. Ann Surg 28:557-576, 1898

    Google Scholar 

  4. Halsted WS: The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to January 1894. Ann Surg 20:497-555, 1894

    Google Scholar 

  5. Urban JA: Is there a rationale for an extended radical procedure? Int J Rad Oncol Biol Phys 2:985-988, 1977

    Google Scholar 

  6. Fisher B, Anderson S, Redmond CK, et al: Ten year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312:674-681, 1985

    Google Scholar 

  7. Bonadonna G, Valagussa P: The contribution of medicine to the primary treatment of breast cancer. Cancer Res 48:2314-2324, 1988

    Google Scholar 

  8. Early Breast Cancer Trialists Collaborative Group: Systemic treatment of early breast cancer by hormonal cytotoxic or immune therapy. Lancet 339:1-15, 71–86, 1992

    Google Scholar 

  9. Margolese RE: 1994 Roussel Lecture: A biological basis for changes in breast cancer management. Can J Surg 38:402-408, 1995

    Google Scholar 

  10. Baum M, Badwe RA: Does surgery influence the natural history of breast cancer? In: Wise L, Johnson H Jr (eds) Breast Cancer: Controversies in Management. Futuras Publishing, Armonk NY, 1994, pp 61-69

    Google Scholar 

  11. Badwe RA: Timing of surgery during the menstrual cycle for operable breast cancer. Cancer Topics 9:42-43, 1993

    Google Scholar 

  12. Mueller CB, Ames F, Anderson GD: Breast cancer in 3558 women: Age as a significant prognostic determinant in the rate of dying and causes of death. Surgery 83:123-132, 1978

    Google Scholar 

  13. Vyas JJ, Desai PB, Sampat MB, et al: Observation on Indian node-negative breast cancer patients: A multivariate analysis. J Surg Oncol 42:256-263, 1989

    Google Scholar 

  14. Boyd NF, Campbell JE, Germanson T, et al: Body weight and prognosis in breast cancer. J Natl Cancer Inst 67:785-789, 1981

    Google Scholar 

  15. Tretli S: Height and weight in relation to breast cancer morbidity and mortality. A prospective study of 570,000 women in Norway. Int J Cancer 44:23-30, 1989

    Google Scholar 

  16. Grodin JM, Siiteri PK, MacDonald PC: Source of estrogen production in postmenopausal women. J Clin Endocrinol Metab 36:207-214, 1973

    Google Scholar 

  17. Hrushesky WJM, Bluming AZ, Gruber SA, Sothern RB: Menstrual influence on surgical cure of breast cancer. Lancet ii:949-952, 1989

    Google Scholar 

  18. Ratajczak HV, Sothern RB, Hrushesky WJM: Estrous influence on surgical cure of a mouse breast cancer. J Exp Med 168:73-83, 1988

    Google Scholar 

  19. Badwe RA, Gregory WM, Chaudry MA, et al: Timing of surgery during the menstrual cycle and survival of premenopausal women with operable breast cancer. Lancet 337:1261-1264, 1991

    Google Scholar 

  20. Senie RT, Rosen PP, Rhodes PR, Lesser ML: Timing of breast cancer excision during the menstrual cycle influences duration of disease-free survival. Ann Intern Med 115:337-342, 1991

    Google Scholar 

  21. Veronesi U, Luini A, Mariani L, et al: Effect of menstrual phase on surgical treatment of breast cancer. Lancet 343:1545-1547, 1994

    Google Scholar 

  22. Saad Z, Branwell V, Duff J, et al. Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast cancer. Br J Surg 81:217-220, 1994

    Google Scholar 

  23. Kurebayashi J, Sonoo H, Shimozuma K: Timing of surgery in relation to the menstrual cycle and its influence on the survival of Japanese women with operable breast cancer. Jpn J Surg 25:519-524, 1995

    Google Scholar 

  24. Donegan WL, Shah D: Prognosis of patients with breast cancer related to the timing of operation. Arch Surg 128:309-313, 1993

    Google Scholar 

  25. Kroman N, Hojgaard A, Anderson KW, et al: Timing of surgery in relation to menstrual cycle does not predict prognosis in primary breast cancer. Eur J Surg Oncol 20:430-435, 1994

    Google Scholar 

  26. Sainsbury R, Jones M, Parker D, et al: Timing of surgery for breast cancer and menstrual cycle. Lancet 338:391-392, 1991

    Google Scholar 

  27. Davidson NE, Abeloff MD: Menstrual effects on surgical treatment of breast cancer. Cancer Treat Rev 19:105-112, 1993

    Google Scholar 

  28. Forbes JF: Timing of breast cancer surgery in the menstrual cycle and outcome. Ann Oncol 2:243, 1991

    Google Scholar 

  29. Wobbes T, Thomas CMG, Segers MFG, et al: The phase of the menstrual cycle has no influence on the disease-free survival of patients with mammary carcinoma. Br J Cancer 69:599-600, 1994

    Google Scholar 

  30. Ville Y, Briere M, Lasry S, et al: Timing of surgery in breast cancer. Lancet 337:1604-1605, 1991

    Google Scholar 

  31. Badwe RA, Wang DY, Gregory WM, et al: Serum progesterone at the time of surgery and survival in women with premenopausal operable breast cancer. Eur J Cancer 30A(4):445-448, 1994

    Google Scholar 

  32. Mohr PE, Wang DY, Gregory WM, et al: Serum progesterone and prognosis in operable breast cancer. Br J Cancer 73:1552-1555, 1996

    Google Scholar 

  33. McGuire WL, Hilsenbeck S, Clark GM: Optimal mastectomy timing. J Natl Cancer Inst 84:346-348, 1992

    Google Scholar 

  34. Wood WC: Prognosis of patients with breast cancer related to the timing of operation (invited commentary). Arch Surg 128:313, 1993

    Google Scholar 

  35. Badwe RA, Fentiman IS, Richards MA, et al: Surgical procedures, menstrual cycle phase and prognosis in operable breast cancer. Lancet 338:815-816, 1991

    Google Scholar 

  36. Badwe RA, Juvekar RR: Timing of breast cancer surgery during the menstrual cycle. Ann Oncol 5:29-31, 1994

    Google Scholar 

  37. Fentiman IS, Gregory WM, Richards MA: Effect of menstrual phase on surgical treatment of breast cancer. Lancet 344:402, 1994

    Google Scholar 

  38. Hrushesky WJM: Breast cancer, timing of surgery and the menstrual cycle: call for a prospective trial. J Women's Health 5:555-566, 1996

    Google Scholar 

  39. Grant CS: NCCTG to test timing of breast cancer surgery relative to menstrual cycle. Mayo Cancer Center 2(5):6-7, 1997

    Google Scholar 

  40. Sainsbury R: Timing of surgery for breast cancer in relation to the menstrual cycle and survival of premenopausal women. Br J Surg 80:670, 1993

    Google Scholar 

  41. Jatoi I: Neoadjuvant progesterone therapy for primary breast cancer: rationale for a clinical trial. Clin Ther 19(1):56-61, 1997

    Google Scholar 

  42. Fentiman IS, Gregory WM: The hormonal milieu and prognosis in operable breast cancer. Cancer Surveys 18:149-163, 1993

    Google Scholar 

  43. Rochefort H, Augereau P, Briozzo P, et al: Structure, function, regulation and clinical significance of the 52K pro-cathepsin D secreted by breast cancer cells. Biochimie 70:943-949, 1988

    Google Scholar 

  44. Hissom JR, Moore MR: Progestin effects on growth in the human breast cancer cell line T-47D — possible therapeutic implications. Biochem Biophys Res Commun 145:706-711, 1987

    Google Scholar 

  45. Jatoi I, Mansi JL, Bliss JM, et al: Influence of menopause on bone marrow micrometastases in early breast cancer. Abstract book 1, Sixteenth International Cancer Congress, New Delhi, India, 1994: 160

  46. Pollack MN: Timing of surgery in breast cancer. Lancet 337:1604, 1991

    Google Scholar 

  47. Sulke AN, Jones DB, Wood PJ: Variation in natural killer cell activity in peripheral blood during the menstrual cycle. Br Med J 290:884-886, 1985

    Google Scholar 

  48. Gunduz N, Fisher B, Saffer EA: Effect of surgical removal on the growth and kinetics of residual tumor. Cancer Res 39:3861-3865, 1979

    Google Scholar 

  49. Fisher B, Gunduz N, Coyle J, et al: Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer Res 49:1996-2001, 1989

    Google Scholar 

  50. O'Reilly MS, Holmgren L, Shing Y, et al: Angiostatin: a novel angiogenesis inhibitor that mediates the suppression of metastases by a Lewis lung carcinoma. Cell 79:315-328, 1994

    Google Scholar 

  51. Pike MC, Spicer DV, Dahmoush L, Press MF: Estrogens, progestogens, normal breast cell proliferation, and breast cancer risk. Epidemiol Rev 15:17-35, 1993

    Google Scholar 

Download references

Authors
  1. Ismail Jatoi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jatoi, I. Timing of surgery for primary breast cancer with regard to the menstrual phase and prognosis. Breast Cancer Res Treat 52, 217–225 (1998). https://doi.org/10.1023/A:1006121117336

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006121117336

Search

Navigation