Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings.
Vol 23, No 16S (June 1 Supplement), 2005: 536
© 2005 American Society of Clinical Oncology

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Abstract

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

Univ Coll London, London, United Kingdom; St James’s Univ Hosp, Leeds, United Kingdom; Univ of Leeds, Leeds, United Kingdom; Royal Marsden NHS Trust, London, United Kingdom

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.

Abstract presentation from the 2005 ASCO Annual Meeting