Abstract
Several studies have now shown that women with operable breast cancer undergoing tumour excision during the luteal phase of the menstrual cycle have a better prognosis than those having surgery during the follicular phase. As part of a prospective study of prognostic factors in breast cancer, blood was taken at the time of surgery. Between 1975 and 1992 this was available from 289 premenopausal women within 3 days of tumour excision. All were treated by either modified radical mastectomy or breast conservation including axillary clearance and the date of last menstrual period (LMP) was known in 239 (80%) cases. Blood samples were assayed for both oestradiol (E2) and progesterone (P). Because of the wide inter-individual variation in E2 levels there was no clear relationship between E2 and LMP. However, using a running mean smoothing technique the expected cyclical variation could be discerned. There was no significant association between E2 and survival. Smoothing of the P data yielded a pattern similar to the normal hormone profile. Those cases with a progesterone level of 4 ng ml-1 or more had a significantly better survival than those with a level < 4 ng ml-1. This was especially clear in node-positive patients (P < 0.01). The possibility of misclassification of menstrual cycle status, because of misreported LMP, has been minimised by applying an independent hormonal measurement (P) of cycle activity. This parameter will also identify women who may be undergoing anovular cycles. Thus this study has confirmed that a raised level of progesterone at the time of tumour excision is associated with an improvement in prognosis for women with operable breast cancer.
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Selected References
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- Alexander I. E., Shine J., Sutherland R. L. Progestin regulation of estrogen receptor messenger RNA in human breast cancer cells. Mol Endocrinol. 1990 Jun;4(6):821–828. doi: 10.1210/mend-4-6-821. [DOI] [PubMed] [Google Scholar]
- Anderson T. J., Ferguson D. J., Raab G. M. Cell turnover in the "resting" human breast: influence of parity, contraceptive pill, age and laterality. Br J Cancer. 1982 Sep;46(3):376–382. doi: 10.1038/bjc.1982.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Badwe R. A., Gregory W. M., Chaudary M. A., Richards M. A., Bentley A. E., Rubens R. D., Fentiman I. S. Timing of surgery during menstrual cycle and survival of premenopausal women with operable breast cancer. Lancet. 1991 May 25;337(8752):1261–1264. doi: 10.1016/0140-6736(91)92927-t. [DOI] [PubMed] [Google Scholar]
- Badwe R. A., Wang D. Y., Gregory W. M., Fentiman I. S., Chaudary M. A., Smith P., Richards M. A., Rubens R. D. Serum progesterone at the time of surgery and survival in women with premenopausal operable breast cancer. Eur J Cancer. 1994;30A(4):445–448. doi: 10.1016/0959-8049(94)90415-4. [DOI] [PubMed] [Google Scholar]
- Fentiman I. S., Gregory W. M., Richards M. A. Effect of menstrual phase on surgical treatment of breast cancer. Lancet. 1994 Aug 6;344(8919):402–402. [PubMed] [Google Scholar]
- Fentiman I. S., Gregory W. M. The hormonal milieu and prognosis in operable breast cancer. Cancer Surv. 1993;18:149–163. [PubMed] [Google Scholar]
- Masters J. R., Drife J. O., Scarisbrick J. J. Cyclic Variation of DNA synthesis in human breast epithelium. J Natl Cancer Inst. 1977 May;58(5):1263–1265. doi: 10.1093/jnci/58.5.1263. [DOI] [PubMed] [Google Scholar]
- Maudelonde T., Lavaud P., Salazar G., Laffargue F., Rochefort H. Progestin treatment depresses estrogen receptor but not cathepsin D levels in needle aspirates of benign breast disease. Breast Cancer Res Treat. 1991 Oct;19(2):95–102. doi: 10.1007/BF01980939. [DOI] [PubMed] [Google Scholar]
- Papa V., Hartmann K. K., Rosenthal S. M., Maddux B. A., Siiteri P. K., Goldfine I. D. Progestins induce down-regulation of insulin-like growth factor-I (IGF-I) receptors in human breast cancer cells: potential autocrine role of IGF-II. Mol Endocrinol. 1991 May;5(5):709–717. doi: 10.1210/mend-5-5-709. [DOI] [PubMed] [Google Scholar]
- Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Saad Z., Bramwell V., Duff J., Girotti M., Jory T., Heathcote G., Turnbull I., Garcia B., Stitt L. Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast cancer. Br J Surg. 1994 Feb;81(2):217–220. doi: 10.1002/bjs.1800810219. [DOI] [PubMed] [Google Scholar]
- Senie R. T., Rosen P. P., Rhodes P., Lesser M. L. Timing of breast cancer excision during the menstrual cycle influences duration of disease-free survival. Ann Intern Med. 1991 Sep 1;115(5):337–342. doi: 10.7326/0003-4819-115-5-337. [DOI] [PubMed] [Google Scholar]
