Timing Of Breast Cancer Surgery Research Articles

D101. High Deductible Health Plans Delay Surgical Management of Breast Cancer

PURPOSE: High deductible health plans (HDHPs) have been shown to delay timing of screening for breast cancer, though the relationship with timing of breast cancer surgery is unknown. The objective of this study was to characterize the association between HDHPs and the timing of surgery following routine mammogram. METHODS: Data from the IBM® MarketScan® Commercial Claims Database from 2007-2016 were queried to identify women who underwent screening mammogram with or without a subsequent breast cancer operation. The quarter of breast cancer screening and surgery were modeled with ordinal logistic regression. Time from screening to surgery (time to surgery, TTS) was evaluated using a Cox proportional hazard function. RESULTS: Among 223,964 patients who had mammograms, 0.7% underwent breast cancer surgery within the following year. For patients in HDHPs compared to low deductible health plans (LDHPs), the odds of screening (odds ratio [OR] 1.146, p<0.001) and surgery (OR 1.120, p<0.001) increased each quarter. HDHP enrollment was not associated with a difference in TTS. Screening in Q3 was associated with shorter TTS compared to screening in Q1 (hazard ratio [HR] 1.070, p<0.001). CONCLUSION: HDHPs were associated with delays in breast cancer screening and surgery, but not with delays in TTS after diagnosis. Interventions to improve breast cancer care, including breast reconstruction, in the HDHP population should concentrate on reducing barriers to timely screening.

Abstract P3-03-10: The Impact of Type 2 Diabetes on Complications after Primary Breast Cancer Surgery: a Danish population-based cohort study

Abstract Introduction Type 2 diabetes (T2D) is associated with obesity and other comorbidities involving multiple organ systems, which may increase the risk of postsurgical complications. Knowledge is sparse on the impact of T2D on the postsurgical outcome after breast cancer (BC) surgery in primary BC. Objectives To investigate the association of T2D and risk of complications after primary BC surgery, and according to neoadjuvant chemotherapy. Methods Our cohort included all Danish women diagnosed with early-stage operable BC during 1996-2018 registered in the Danish Breast Cancer Group clinical database. All patients had primary surgical treatment—mastectomy or breast conserving surgery. Information on prevalent T2D was collected from Danish medical and prescription registries, defining T2D via diagnostic codes or redemption of ≥2 prescriptions for glucose-lowering drugs. We defined postoperative complications as hospital admissions for medical or surgical complications (re-operations (excluding seromas), bleeding, infection, thrombosis, kidney or arterial cardiovascular disease) up to 30 days after primary BC surgery. We calculated the 30-day cumulative incidence function (CIF) of postoperative complications and used Cox regression to estimate hazard ratios (HR) and associated 95% confidence intervals (95% CI) overall, and stratified by the receipt of neoadjuvant chemotherapy, adjusting for potential confounders. Results Among 84,491 women with operable BC, 4,669 (5.5%) had prevalent T2D at time of BC surgery. Overall, 800 (17.1%) and 8,621 (10.8%) of BC patients with and without T2D developed postoperative complications corresponding to CIFs of 17% (95%CI: 16% - 18%) and 11% (95%CI: 10% - 11%), respectively, and a HR of 1.44 (95%CI: 1.34-1.56). 173 (3.7%) BC patients with T2D and 2,805 (3.5%) without T2D received neoadjuvant chemotherapy. Among those who did not receive neoadjuvant chemotherapy, the CIFs of postoperative complications was 17% (95% CI: 16% - 18%) and 11% (95% CI: 10% - 11%) for women with and without T2D, respectively, with a corresponding HR of 1.42 (95% CI: 1.31-1.53). For those with and without T2D who received neoadjuvant chemotherapy, the CIFs were 24% (95% CI: 18% - 30%) and 10% (95% CI: 9% - 11%), respectively, and with a corresponding HR of 2.08 (95% CI: 1.49-2.91). Conclusion Among women with BC, prevalent T2D at the time of primary BC surgery increases the risk of postoperative complications. This excess risk is particularly pronounced among patients who undergo neoadjuvant chemotherapy. Citation Format: Kasper Kjærgaard, Jannik Wheler, Looket Dihge, Peer Christiansen, Signe Borgquist, Deirdre Cronin-Fenton. The Impact of Type 2 Diabetes on Complications after Primary Breast Cancer Surgery: a Danish population-based cohort study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-10.

A case of unresectable intrahepatic cholangiocarcinoma with a germline BRCA1 mutation.

Intrahepatic cholangiocarcinoma (ICC) is a malignant liver tumor with poor prognosis. Various mutations in cancer-predisposing genes have been reported in ICC, and germline BRCA1/2 mutations, which are the causative genes for hereditary breast and ovarian cancer syndrome (HBOC), have been reported in many patients with ICC. Here, we report a case of unresectable ICC with a germline BRCA1 mutation. A 73-year-old man was found to have a mass in the left lobe of the liver on abdominal ultrasonography during a medical check-up and was referred to our institution. Contrast-enhanced computed tomography revealed a 30-mm mass with a delayed enhancement pattern, tumor invasion into the major blood vessels, and enlarged regional lymph nodes. Ultrasound-guided percutaneous tumor biopsy revealed a well-differentiated adenocarcinoma, and the patient was diagnosed with clinical Stage IIIB ICC. Systemic chemotherapy with gemcitabine and cisplatin was initiated because of the unresectable nature of the disease. Regarding family history, his eldest daughter was diagnosed with HBOC with a germline BRCA1 mutation at the time of breast cancer surgery, and she developed pancreatic cancer seven years later. The patient underwent BRCA1 single-site analysis and was diagnosed with HBOC with a germline BRCA1 mutation.

Timing of breast cancer surgery during the menstrual cycle-is there an optimal time of the month?

An intriguing relationship between menstrual cycle phase at the time of breast cancer surgery and clinical outcomes was first proposed in the late 1980s. Despite a number of clinical studies conducted to address this, as well as meta-analyses and systematic reviews, there remains significant controversy surrounding the effect of menstrual cycle phase at time of surgery on the prognosis of premenopausal breast cancer. While some studies have suggested that surgery performed during the luteal phase results in the most favourable outcome, other studies report the follicular phase is more favourable, and others show no association. Given the conflicting results, there remains insufficient evidence to determine whether there is an optimal time of the month to perform surgery. This issue has dogged breast cancer surgery for decades; knowledge of an optimal time of the month to conduct surgery would be a simple approach to improving patient outcomes. This review explores the potential biological mechanisms through which the hormonal milieu might contribute to differences in prognosis, and why clinical findings are so variable. It is concluded that a significant problem with current clinical research is the lack of insight from mechanistic studies. While there are a number of plausible biological mechanisms that could lead to altered survival, supporting evidence is limited. There are also variable approaches to defining the menstrual cycle phase and hormone receptor status of the tumour and few studies controlled for prognostic factors such as tumour size and stage, or addressed the impact of adjuvant treatments. Elucidation of the specific confounding factors, as well as biological mechanistic pathways that could explain the potential relationship between timing of surgery and survival, will greatly assist in designing robust well-controlled prospective clinical studies to evaluate this paradigm.

Does Neoadjuvant Bevacizumab Increase Surgical Complications in Breast Surgery?

Neoadjuvant chemotherapy is being increasingly used in operable breast cancer. There are limited data on the safety of bevacizumab (bev) in the neoadjuvant setting. We sought to explore the safety of neoadjuvant cisplatin/bev in a protocol for triple negative breast cancer (TNBC). A total of 51 patients with confirmed TNBC were enrolled in a single-arm trial of neoadjuvant cisplatin plus bev. Of the 51 patients, 28 with confirmed TNBC were enrolled in our trial of single-agent neoadjuvant cisplatin. Two-sided Fisher exact test were used for comparing the 2 trials. The 51 patients received neoadjuvant protocol therapy with cisplatin/bev and underwent definitive local therapy. Breast conserving therapy (BCT) was performed in 29 (57%) and mastectomy with or without reconstruction in 22 (43%). Postoperative complications were reported in 22 patients (43%); 4 (8%) required explanation of expanders. Also, 28 patients completed neoadjuvant cisplatin therapy. BCT was performed in 13 (46%) and mastectomy with or without reconstruction in 15 (54%). Postoperative complications were reported in 11 patients (39%). None of the 5 reconstructions were lost. We compared all toxicities between the two trials (P=.81 NS), and wound healing related complications between the two trials (P=.10 NS). Cisplatin/bevacizumab and cisplatin alone neoadjuvant therapy resulted in a significant number of postoperative complications. Specifically, use of expanders/implants may be problematic for patients treated with bev. However, this was a single-arm trial; randomized controlled studies will be needed to determine the optimal use of bevacizumab in the timing of breast cancer surgery.

Surgical Complications and the Use of Neoadjuvant Bevacizumab.

Abstract Introduction:Neoadjuvant chemotherapy is being increasingly used in operable breast cancer. There are limited data on the safety of bevacizumab (Bev) in combination with chemotherapy in the neoadjuvant setting. We sought to explore the safety and efficacy of neoadjuvant cisplatin/Bev in a protocol for triple negative breast cancer (TNBC), with post operative dose dense AC or AC/Taxol plus Bev. We present our operative experience, including postoperative complications. We also compared this to a smaller single arm neoadjuvant cisplatin alone study.Methods:51 patients with confirmed TNBC provided informed consent and were enrolled in a single arm phase II trial of neoadjuvant cisplatin 75 mg/m2 plus Bev15 mg/kg q 3 weeks x 3 cycles with the 4th cycle cisplatin alone prior to definitive surgery. This design allowed at least 6 weeks between the last dose of Bev and surgery. Research biopsies were obtained before treatment and at surgery. Postoperatively, patients received doxorubicin and cytoxan (AC) plus bevacizumab or AC/Taxol plus Bev. Median age was 50 yrs (range 30-65 yrs); tumors were clinical stage II 48 (94%) and stage III 3 (6%).28 patients with confirmed TNBC were enrolled in our phase II trial of neoadjuvant cisplatin. Single-agent cisplatin 75mg/m2 q3weeks x 4cycles was given prior to definitive surgery. Median age was 50 yrs (range 29-69yrs); tumors were clinical stage II (75%), stage III (25%). Postoperatively, patients received AC or AC/Taxol. Two-sided Fisher exact test were used for comparing the 2 trials.Results:Fifty-one patients received neoadjuvant protocol therapy with cisplatin/Bev (all received at least one cycle of bevacizumab, 7 did not complete all cycles of preop bevacizumab) and underwent definitive local therapy to the breast. Breast conserving therapy was performed in 29 (57%) and mastectomy with or without reconstruction in 22 (43%). Postoperative complications were reported in 22 (43%) of patients: 4 (8%) required wound debridement and explantation of expanders, 8 (16%) wound breakdowns, 5 (10%) developed hematomas requiring operative intervention and 5 (10%) seromas requiring multiple aspirations.Twenty-eight patients completed neoadjuvant cisplatin therapy and underwent definitive local therapy to the breast. Breast conserving therapy was performed in 13 (46%) and mastectomy with or without reconstruction in 16 (54%). Postoperative complications were reported in 11 (39%) of patients: 5 seromas requiring drainage (18%), 2 hematomas (7%), 2 abscesses (7%), and 2 (7%) wound breakdowns. No reconstructions were lost including the 3 expanders and 2 TRAM flaps.We compared all toxicities between the two trials, (p= 0.81 NS), and wound healing related complications between the two trials (p= 0.10 NS).Conclusions:Cisplatin/Bevacizumab and cisplatin alone neoadjuvant therapy resulted in a significant number of postoperative complications. Specifically use of expanders or implants may be problematic for patients treated with Bev with a trend towards more wound related events for this group. However, this was a single arm trial, a randomized controlled studies will be necessary in determine the optimal use of bevacizumab in the timing of breast cancer surgery. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 43.

Timing of breast cancer surgery in relation to menstrual cycle phase: no effect on 3-year prognosis: The ITS Study

The effect of breast cancer surgery timing during the menstrual cycle on prognosis remains controversial. We conducted a multicentre prospective study to establish whether timing of interventions influences prognosis. We report 3-year overall and disease-free survival (OS/DFS) results for ‘primary analysis’ patients (regular cycles, no oral contraceptives within previous 6 months). Data were collected regarding timing of interventions in relation to patients’ last menstrual period (LMP) and first menstrual period after surgery (FMP). Hormone profiles were also measured. Cox's proportional hazards model incorporated LMP in continuous form. Exploratory analyses used menstrual cycle categorisations of Senie, Badwe and Hrushesky. Hormone profiles with LMP and FMP data were also used to define menstrual cycle phase. Four hundred and twelve ‘primary analysis’ patients were recruited. Three-year OS from first surgery was 90.7, 95% confidence interval (CI) [87.9, 93.6%]. Menstrual cycle according to LMP was not statistically significant (OS: hazard ratio (HR)=1.02, 95%CI [0.995,1.042], P=0.14; DFS: HR=1.00, 95%CI [0.980,1.022], P=0.92). Timing of surgery in relation to menstrual cycle phase had no significant impact on 3-year survival. This may be due to 97% of patients receiving some form of adjuvant therapy. Survival curves to 10 years indicate results may remain true for longer-term survival.

Does the timing of breast cancer surgery in pre-menopausal women affect clinical outcome? : an update

There is some evidence that breast cancer surgery during the luteal phase in pre-menopausal women is associated with a better clinical outcome, however the evidence for this is still equivocal.In this paper, after summarizing the normal physiology of the menstrual cycle, we examine how such an association may occur and provide a comprehensive review of the literature in the area.

O-4. Does timing of breast cancer surgery in relation to the menstrual cycle phase affect prognosis? The Yorkshire Breast Cancer Group Intervention, Timing and Survival Study

O-4. Does timing of breast cancer surgery in relation to the menstrual cycle phase affect prognosis? The Yorkshire Breast Cancer Group Intervention, Timing and Survival Study

Does timing of breast cancer surgery in relation to the menstrual cycle phase affect prognosis? The Yorkshire Breast Cancer Group Intervention, Timing and Survival Study

536 Background: The effect of breast cancer surgery timing during the menstrual cycle on prognosis remains controversial. We conducted a multi-centre prospective observational study to establish whether timing of interventions influences prognosis. Here we report 3-year survival results for ’primary’ patients (regular cycles, no oral contraceptives within last 6 months). Methods: Data were collected regarding timing of interventions (first tumor handling & subsequent surgeries) in relation to patients’ last menstrual period (LMP) & first menstrual period after intervention (FMP); hormone profiles (follicle stimulating & luteinizing hormone, oestradiol, progesterone) were also measured. Overall & disease-free survival (OS, DFS) were assessed using Cox’s Proportional Hazards model adjusting for intervention type, Nottingham Prognostic Index & adjuvant therapy. Initial analysis incorporated LMP in its continuous form & subsequent exploratory analyses used categorizations of Senie, Badwe & Hrushesky. Hormone profiles with LMP & FMP data were also used to define menstrual phase. Results: 611 patients were recruited from 25 centers between ’93 & ’00. Median age was 43 (range 19–55) years. At a median follow-up of 58 (range 0–132) months there have been 115 deaths; 56 occurred within 3 years of surgery. Types of first surgery were excision biopsy (18%), lumpectomy (48%) & mastectomy (33%). 14% of tumors were grade I, 42% grade II, 40% grade III; 51% were node positive. Menstrual cycle according to LMP was not statistically significant at the 5% level for the 412 patients in the ’primary’ group (OS hazard ratio (HR)=1.02, 95% confidence interval (CI) 0.99,1.04, p=0.14; DFS HR=1.00, 95% CI 0.98,1.02, p=0.92). Exploratory analyses indicated possible increased OS when surgery occurred in the follicular phase of the menstrual cycle. Conclusions: In this analysis timing of surgery in relation to the menstrual cycle phase had no significant impact on 3-year survival. This may be explained by our lower than expected event rate. Unlike previous studies this cohort has received modern adjuvant treatments, some of which will have caused ovarian suppression. No significant financial relationships to disclose.

Lunar phases and survival of breast cancer patients--a statistical analysis of 3,757 cases.

The potential influence of lunar phases on human life has been widely discussed by the lay press. The purpose of this study was to find out whether the timing of surgery during particular lunar phases influences the survival of breast cancer patients. It has been postulated that breast cancer surgery performed during the waxing moon, or particularly at full moon, is associated with a poorer outcome. We tested this hypothesis by evaluating the overall survival for 3,757 consecutive patients with invasive breast cancer. All patients underwent either modified radical mastectomy or breast conserving surgery plus radiotherapy, followed by adjuvant cytotoxic or hormonal therapy. The date of definitive surgery was allocated to the lunar phases. 1,904 (50.7%) patients were operated on during the waxing moon and 1,853 (47.3%) during the waning moon. The median follow-up was 74 months (range 1-372 months). The mean age at primary surgery did not differ significantly in the two groups 58.39 (SD 13.14) versus 58.34 (12.75) (p >0.05, t-test). Breast cancer stages at initial diagnosis were evenly distributed according to the lunar phases (p = 0.325; chi-square). Survival curves were plotted according to the method of Kaplan-Meier. No significant differences were observed when timing of surgery was allocated to the lunar phases (p = 0.4841, log-rank). Subgroup analysis of premenopausal patients revealed similar results (p = 0.2950, log-rank; n = 1072). Using multivariate Cox modelling, we found a significant association between the patient's age, stage of disease and survival, whereas no association with survival was observed for the timing of surgery (RR= 1.062; 95% CI, 0.970-1.163; p = 0.1937). No significant differences in overall survival of breast cancer patients were observed when timing of breast cancer surgery during the lunar cycle was considered. Although this was not a prospective randomized trial, the statistical magnitude of the results do not support any recommendations for scheduling patients for surgery at any particular day of the lunar phase.

Bone marrow micrometastases in breast cancer patients

Background: The status of the axillary nodes has historically been the most important indicator of prognosis in breast cancer patients. However, approximately one third of node-negative patients recur with systemic disease. The detection of bone marrow micrometastases (BMM) may represent additional information in predicting distant recurrence and survival. Methods: Bone marrow aspiration is obtained from the patient’s anterior iliac crest at the time of breast cancer surgery. Cytospins are prepared from this aspirate and stained for polymerase chain reaction (PCR) analysis. Results: Multiple studies have evaluated the clinical implications of BMM. The majority of studies have found a significant correlation between the presence of BMM and decreased survival. The information of bone marrow status may serve as a complement to axillary lymph node status in assessing the prognosis of breast cancer patients. Conclusions: There is a strong correlation between the presence of bone marrow micrometastases and poorer survival. These results may have an impact upon therapeutic recommendations in breast cancer patients.

Menstrual timing of breast cancer surgery

International Journal of Gynecology & ObstetricsVolume 70, Issue S1 p. A84-A84 Breast Menstrual timing of breast cancer surgery A. Haeen, A. HaeenSearch for more papers by this authorW.J.M. Hrushesky, W.J.M. HrusheskySearch for more papers by this authorA. Ebert, A. EbertSearch for more papers by this authorF. Opri, F. OpriSearch for more papers by this authorH. Weitzel, H. WeitzelSearch for more papers by this author A. Haeen, A. HaeenSearch for more papers by this authorW.J.M. Hrushesky, W.J.M. HrusheskySearch for more papers by this authorA. Ebert, A. EbertSearch for more papers by this authorF. Opri, F. OpriSearch for more papers by this authorH. Weitzel, H. WeitzelSearch for more papers by this author First published: 09 December 2003 https://doi.org/10.1016/S0020-7292(00)82768-XAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS12000Pages A84-A84 RelatedInformation

Menstrual phase and timing of breast cancer surgery: Statistical aspects

Menstrual phase and timing of breast cancer surgery: Statistical aspects

Der Operationszeitpunkt beim prämenopausalen Mammakarzinom - Einfluß auf die Prognose?

Fragestellung: Hat die Wahl des Operationszeitpunktes im Menstruationszyklus einen Einfluß auf die Prognose des Mammakarzinoms? Methode: 1989 erschien die erste Studie, bei der ein Einfluß des zyklusphasenabhängigen Operationszeitpunktes auf die Prognose des Mammakarzinoms festgestellt werden konnte. Im Rahmen einer Analyse aller seitdem veröffentlichten und überwiegend retrospektiv gewonnenen Daten (31 Studien mit 8632 Patienten) werden die Arbeitsergebnisse miteinander verglichen und diskutiert. Mit einem von uns geschaffenen Punkte-Score soll möglichst objektiv die Qualität jeder einzelnen Studie bewertet werden. Er setzt sich aus den Parametern zusammen, die zur Klärung des Problems essentiell sind. Ergebnisse: Von insgesamt 31 Studien ermittelten 14 Arbeiten einen Einfluß des zyklusabhängigen Operationszeitpunktes auf die Prognose. 17 Arbeiten konnten dies nicht bestätigen. Die Studienqualität war sehr unterschiedlich. Mangelhaft oder gar fehlend waren Angaben zur Form der Einteilung des Menstruationszyklus, der primären und adjuvanten Therapieverfahren, der Tumorstadien zum Zeitpunkt der Diagnose, des Follow-up sowie der Art und Weise der Datenanalyse. Unter den acht qualitativ besten Arbeiten ermitteln sechs (75%) einen signifikanten Einfluß auf die Prognose. Schlußfolgerung: Ein Vergleich der Studienergebnisse und somit auch die Klärung der Frage nach dem Einfluß des Operationszeitpunktes auf die Prognose beim prämenopausalen Mammakarzinom ist bei sehr unterschiedlicher Studienqualität lediglich begrenzt möglich. Nur eine entsprechend vorbereitete prospektiv randomisierte Studie kann entscheiden, ob und - wennja - in welchem Umfang die Wahl eines konkreten Operationszeitpunktes die Prognose beeinflußt. Die wichtigsten Inhalte einer solchen Studie werden kurz dargelegt.

Therapeutic touch, dialogue, and women's experiences in breast cancer surgery.

The article describes the development of a nursing intervention based on the science of unitary human beings that has the potential to help women have more positive experiences during the time of breast cancer surgery. The intervention, therapeutic touch and dialogue, is expected to result in decreased state anxiety and postoperative pain and a more positive affect balance. It is recommended that nurses maintain objective anecdotal records of their experiences with therapeutic touch and dialogue and that future research include randomized controlled clinical trials as well as studies to explore therapeutic touch's mechanism of action.

Increased surgery-induced metastasis and suppressed natural killer cell activity during proestrus/estrus in rats.

We have previously reported sex- and estrous-related differences in host resistance to the metastatic development of a mammary adenocarcinoma cell line, MADB106, in the Fischer 344 (F344) rat. In other studies, we found that surgery suppressed natural killer (NK) cell activity and increased the NK-sensitive metastatic development of MADB106 tumor cells. The current study was designed to explore whether sex or estrous phase at the time of surgery impacts the degree of such deleterious effects of surgery. Such estrous effects could be related to an ongoing clinical debate regarding the importance of the timing of breast cancer surgery with the menstrual cycle in premenopausal women. Mature F344 males and cycling females underwent either experimental laparotomy with halothane anesthesia, halothane anesthesia alone, or were untreated. Five hours after surgery, animals either were injected with radiolabeled MADB106 tumor cells and assessed for lung tumor cell retention 12 hours later, or underwent blood withdrawal for in vitro assessment of NK cell activity. MADB106 tumor cells metastasize only to the lungs, and lung tumor cell retention is: a) an early indicator of the number of metastases that would develop weeks later, and b) highly sensitive to in vivo levels of NK activity. This mammary adenocarcinoma cell line is syngeneic to the inbred F344 strain of rats used in our studies, thus constituting a model for breast cancer metastasis. The results indicated that sex, estrous phase, and surgery interacted in their effects on NK cell activity and tumor metastasis. MADB106 lung tumor cell retention was increased by surgery in both sexes (2- to 3-fold) compared to the anesthesia only and control groups. This increase, however, was significantly greater in proestrus/estrus (P/E) females than in metestrus/diestrus (M/D) females. Among the control animals, females in P/E exhibited significantly less NK cytotoxic activity compared to the males, and the NK activity exhibited by females in M/D was between these two groups. Surgery suppressed NK cytotoxic activity to a similar level in all groups. Possible implications of these findings for the surgical care of women with breast cancer are discussed.

Expression of pS2, c-erbB-2, and cathepsin D during the menstrual cycle in human breast cancers.

Many studies have addressed the effect of the timing of surgery for breast cancer relative to menstrual cycle phase, with conflicting results. Explanations for the possibility that survival could be altered by the appropriate timing of breast cancer surgery in humans remain speculative. We examined the expression of three estrogen related proteins (c-erbB-2, cathepsin D, pS2) in the breast tumors from 69 premenopausal women sampled in different phases of the menstrual cycle. Data on S-phase fraction and hormone receptor expression were also analyzed. Immunohistochemical assays were used to measure the proteins of interest. S-phase fraction was determined by flow cytometry. Analyses were performed based on fraction of cells staining positive for the protein, density of stain, and a histoscore that combined both fraction of positive cells and density. We found no differences in c-erbB-2, cathepsin D, hormone receptor, or S-phase levels in tumors sampled in the follicular versus luteal phase, or perimenstrual versus periovulatory phase. The exception was pS2, which was expressed at greater levels during the luteal than during the follicular phase of the cycle (p < 0.01); but there was no difference in pS2 expression when the patients were classified as periovulatory versus perimenstrual. Our findings do not support a variation in c-erbB-2, cathepsin D, S-phase fraction, or receptor expression as an explanation for the differences in breast cancer prognosis when surgery is timed by menstrual cycle phase. The finding that pS2 (an indicator of hormone sensitivity, and possibly better prognosis) is expressed at higher levels in tumor samples during the luteal phase suggests that the biologic profile of breast tumors may vary with the menstrual cycle and that these variations deserve further study.

Timing of breast cancer surgery during menstrual cycle. A 10-year analysis of 133 premenopausal women

<h2>Abstract</h2> We have examined survival data of 133 premenopausal women operated on from 1979 to 1987. The patients were subdivided into two groups (low and high risk) according to the interval since their last menstrual period. The distribution of risk factors and the clinical and pathological characteristics of the two risk groups did not differ. Our sample is different from other studies only as to the operative technique (predominance in our study of mastectomy compared to quadrantectomy). The overall and disease-free survival show no significant difference between the two groups. A univariate analysis of 10 years overall survival estimates, subdivided into the phase of the cycle in different prognostic subgroups, showed no significant difference in any group. At present, there is no scientific evidence to justify a change of surgical timing in premenopausal women with breast cancer.

The timing of breast cancer surgery with respect to the menstrual cycle. More data which emphasize the need for a prospective study

The timing of breast cancer surgery with respect to the menstrual cycle. More data which emphasize the need for a prospective study