Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 May 11;2011(5):CD003720.
doi: 10.1002/14651858.CD003720.pub2.

Timing of breast surgery in premenopausal breast cancer patients

Miny Samuel  1 , Khin Lay Wai, Victoria K Brennan, Wei Sean Yong
Affiliations

Timing of breast surgery in premenopausal breast cancer patients

Miny Samuel et al. Cochrane Database Syst Rev. .

Abstract

Background: The majority of women diagnosed with breast cancer undergo a multidisciplinary treatment with surgical intervention and radiotherapy or chemotherapy, or both. The importance of timing of tumour removal in relation to the menstrual cycle and its influence on disease-free survival and overall survival has been studied by researchers since 1989 but still remains speculative.

Objectives: To determine if surgery performed either during the follicular or luteal phase of the menstrual cycle affects the overall and disease-free survival of premenopausal breast cancer patients.

Search strategy: We searched the Cochrane Breast Cancer Group Trials Register (January 2009), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to January 2009), EMBASE (1974 to September 2006) and the WHO International Clinical Trials Registry Platform (ICTRP) search portal (July 2010). We checked references of articles and communicated with authors.

Selection criteria: Randomised controlled trials (RCTs) comparing breast surgery during the follicular phase of the menstrual cycle with the luteal phase in premenopausal women. Prospective non-RCTs or observational studies were considered if randomised studies were lacking.

Data collection and analysis: Three authors independently extracted data and assessed trial quality.

Main results: Completed randomised trials were not found. There is one trial that is currently ongoing in Italy; the results have yet to be published.Two prospective observational studies had data on recurrence-free survival. One study reported an odds ratio for recurrence rate at one year (where > 1 favours the luteal phase) of 0.86 (95% confidence interval (CI) 0.69 to 1.08); 0.87 at two years (95% CI 0.69 to 1.09); 0.95 at three years (95% CI 0.75 to 1.21); 1.12 at four years (95% CI 0.87 to 1.43); and 1.12 at five years (95% CI 0.87 to 1.43). Another study reported a hazard ratio for overall survival of 1.02 (95% CI 0.995 to 1.04, P = 0.14) and for disease-free survival of 1.00 (95% CI 0.98 to 1.02, P = 0.92) at three years based on the last and first menstrual period. The results were not significant. There was no difference in the recurrence rate whether the surgery was done during the follicular or luteal phase of the menstrual cycle.

Authors' conclusions: In the absence of RCTs, this review provides evidence from large prospective observational studies that timing of surgery does not show a significant effect on survival.

PubMed Disclaimer

Conflict of interest statement

We certify that we have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of this review (for example through employment, consultancy, stock ownership, honoraria, expert testimony).

Figures

1.1
1.1. Analysis
Comparison 1: Follicular phase versus luteal phase, Outcome 1: Recurrence
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003720

References

References to studies included in this review

Grant 2009 {published data only}
    1. Grant CS, Hartmann LC, Suman VJ, Dumesic DA, Ingle JN, Wickerham DL, et al. Menstrual cycle and surgical treatment of breast cancer: Findings from the NCCTG N9431 study. In: American Society of Clinical Oncology Annual Meeting Prceedings. 2004. - PMC - PubMed
    1. Grant CS, Ingle JN, Suman VJ, Dumesic DA, Wickerham DL, Gelber RD, et al. Menstrual cycle and surgical treatment of breast cancer: findings from the NCCTG N9431 study. Journal of Clinical Oncology 2009;27(22):3620-6. - PMC - PubMed
Pujol 2001 {published data only}
    1. Pujol P, Daures JP, Brouillet JP, Chang S, Rouanet P, Bringer J, et al. A prospective prognostic study of the hormonal milieu at the time of surgery in premenopausal breast carcinoma. Cancer 2001;15(91):1854-61. [MEDLINE: ] - PubMed
Thorpe 2008 {published data only}
    1. Sainsbury R, Perren TJ, Brown SR, Morrell VL, Dowsett M, Thorpe HC. 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. Journal of Clinical Oncology, ASCO Annual Meeting Proceedings 2005;23 Suppl(16, Part I of II):536.
    1. Thorpe H, Brown SR, Sainsbury JR, Perren TJ, Hiley V, Dowsett M, et al. Timing of breast cancer surgery in relation to menstrual cycle phase: no effect on 3-year prognosis: the ITS Study. British Journal of Cancer 2008;15(98 (1)):39-44. - PMC - PubMed

References to studies excluded from this review

Cooper 1999 {published data only}
    1. Cooper LS, Gillett CE, Patel NK, Barnes DM, Fentiman IS. Survival of premenopausal breast carcinoma patients in relation to menstrual cycle timing of surgery and estrogen receptor/progesterone receptor status of the primary tumor. Cancer 1999;86:2053-8. [MEDLINE: ] - PubMed
Fentiman 2002 {published data only}
    1. Fentiman I. Timing of surgery for breast cancer. International Journal of Clinical Practice 2002;56(3):188-90. - PubMed
Gnant 1992 {published data only}
    1. Gnant MFX, Seifert M, Jakesz R, Adler A, Mittlboeck M, Sevelda P. Breast Cancer and timing of surgery during menstrual cycle. A 5-year analysis of 385 pre-menopausal women. International Journal of Cancer 1992;52:707-12. [MEDLINE: ] - PubMed
Goldhirsch 1997 {published data only}
    1. Goldhirsch A, Gelber RD, Castiglione M, O'Neill A, Thurlimann B, Rudenstam CM, et al. Menstrual cycle and timing of breast cancer surgery in premenopausal node-positive breast cancer: results of the International Breast Cancer Study Group (IBCSG) Trial VI. Annals of Oncology 1997;8:751-6. - PubMed
Harlap 1998 {published data only}
    1. Harlap S, Zauber AG, Pollack DM, Tang J, Arena AE, Sternfels P, et al. Survival of premenopausal women with breast carcinoma - effects of menstrual timing of surgery. Cancer 1998;83(1):76-88. [MEDLINE: ] - PubMed
Jager 1995 {published data only}
    1. Jager W, Sauerbrei W. Effect of timing of surgery during the menstrual cycle of premenopausal breast cancer patients. Breast Cancer Research and Treatment 1995;34:279-87. [MEDLINE: ] - PubMed
Milella 1999 {published data only}
    1. Milella M, Nisticò C, Ferraresi V, Vaccaro A, Fabi A, D'Ottavio AM, et al. Breast cancer and timing of surgery during menstrual cycle: a 5-year analysis of 248 premenopausal women. Breast Cancer Research and Treatment 1999;55:259-66. [MEDLINE: ] - PubMed
Mondini 1997 {published data only}
    1. Mondini G, Decian F, Sorice G, Friedman D, Spirito C, Costantini M, et al. Timing of surgery related to menstrual cycle and prognosis of premenopausal women with breast cancer. Anticancer Research 1997;17:787-90. [MEDLINE: ] - PubMed
Normura 1999 {published data only}
    1. Nomura Y, Kataoka A, Tsutsui S, Murakami S, Takenaka Y. Lack of correlation between timing of surgery in relation to the menstrual cycle and prognosis of premenopausal patients with early breast cancer. European Journal of Cancer 1999;35(9):1326-30. [MEDLINE: ] - PubMed
Saad 1994 {published data only}
    1. Saad Z, Bramwell V, Duff J, Girotti M, Jory T, Heathcote G, et al. Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast cancer. The British Journal of Surgery 1994;81:217-20. [MEDLINE: ] - PubMed
Takeda 2001 {published data only}
    1. Takeda Y, Nonaka Y, Yanagie H, Yoshizaki I, Eriguchi M. Correlation between timing of surgery in relation to the menstrual cycle and prognosis of premenopausal breast cancer patients. Biomedicine & Pharmacotherapy 2001;55:133-7. [MEDLINE: ] - PubMed
Veronesi 1994 {published data only}
    1. Veronesi U, Luini A, Mariani L, Del Vecchio M, Alvez D, Andreoli C, et al. Effect of menstrual phase on surgical treatment of breast cancer. Lancet 1994;343(8912):1545-7. [MEDLINE: ] - PubMed

References to ongoing studies

Galimberti 1997 {published data only (unpublished sought but not used)}
    1. * Galimberti P, Veronesi S, Zurrida L, Bellegotti G, Andreoni P, Zucali S et al. Prognosis of breast cancer according to timing of surgery and menstrual phase. In: The Breast. Vol. 6. 1997 (October):318.
    1. Zurrida S, Galimberti V, Gibelli B, Luini A, Gianoglio S, Sandri MT et al. Timing of breast cancer surgery in relation to the menstrual cycle: an update of developments. Critical Reviews in Oncology/Haematology 2001;38:223-30. - PubMed
NCT00005079 {published and unpublished data}
    1. NCT00005079. Timing of menstrual cycle and surgery in treating premenopausal women with stage I, stage II, or stage III breast cancer. http://clinicaltrials.gov/ct2/show/NCT00005079.

Additional references

Badwe 1991
    1. Badwe RA, Gregory WM, Chaudary MA, Richards MA, Bentley AE, Rubens RD, et al. Timing of surgery during menstrual cycle and survival of premenopausal women with operable breast cancer. Lancet 1991;337:1261–4. - PubMed
Badwe 1999
    1. Badwe RA, Mittra I, Havaldar R. Timing of surgery with regard to the menstrual cycle in women with primary breast cancer. Surgical Clinics of North America 1999;79(5):1047-59. [MEDLINE: ] - PubMed
Badwe 2000
    1. Badwe RA, Mittra I, Havaldar R. Timing of surgery during the menstrual cycle and prognosis of breast cancer. Journal of Biosciences 2000;25(1):113-20. [MEDLINE: ] - PubMed
Chaudhry 2006
    1. Chaudhry A, Puntis ML, Gikas P, Mokbel K. Does the timing of breast cancer surgery in pre-menopausal women affect clinical outcome? An update. International Seminars in Surgical Oncology 2006;1(3):37. - PMC - PubMed
Ferlay 2004
    1. Ferlay J, Bray F, Pisani P, Parkin DM. Globocan 2002: Cancer Incidence, Mortality and Prevalence Worldwide. Version 2.0: Lyon, IARCPress 2004;IARC CancerBase no.5.
Fish 1998
    1. Fish EB, Chapman JA, Link MA. Competing causes of death for primary breast cancer. Annals of Surgical Oncology 1998;5(4):368-75. - PubMed
Hagen 1998
    1. Hagen AA, Hrushesky WJM. Menstrual timing of breast cancer surgery. The American Journal of Surgery 1998;104:245-61. [MEDLINE: ] - PubMed
Higgins 2008
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2008.
Hortobagi 2002
    1. Hortobagyi GN. The influence of menstrual cycle phase on surgical treatment of primary breast cancer: Have we made any progress over the past 12 years? Journal of the National Cancer Institute 2002;94(9):641-3. [MEDLINE: ] - PubMed
Hrushesky 1989
    1. Hrushesky WJ, Bluming Az, Gruber SA, Sothern RB. Menstrual influence on surgical cure of breast cancer. Lancet 1989;25(2):949-52. - PubMed
Juni 1999
    1. Juni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 1999;282:1054-60. - PubMed
Kurebayashi 1995
    1. 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. Surgery Today 1995;25(6):519-24. - PubMed
Lippman 1986
    1. Lippman ME, Dickson RB, Bates S, Knabbe C, Huff K, Swain S, et al. Autocrine and paracrine growth regulation of human breast cancer. Breast Cancer Research and Treatment 1986;7:59-70. - PubMed
Montazeri 2008
    1. Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. Journal of Experimental & Clinical Cancer Research 2008;27:32. - PMC - PubMed
Murphy 1990
    1. Murphy LJ, Ghahary A. Uterine insulin-like growth factor-1: regulation of expression and its role in estrogen-induced uterine proliferation. Endocrine Reviews 1990;11:443-53. - PubMed
Ratajczak 1988
    1. Ratajczak HV, Sothern RB, Hrushesky WJM. Estrous influence on surgical cure of mouse breast cancer. The Journal of Experimental Medicine 1988;168:88-96. - PMC - PubMed
Recht 1999
    1. Recht A. Locoregional failure rates in patients with involved axillary nodes after mastectomy and systemic therapy. Seminars in Radiation Oncology 1999;9(3):223-9. - PubMed
RevMan 2008 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan). Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
Sainsbury 1991
    1. Sainsbury R, Jones M, Parker D. Timing of surgery for breast cancer and menstrual cycle. Lancet 1991;338:391-2. - PubMed
Sasco 2001
    1. Sasco AJ. Epidemiology of breast cancer: an environmental disease? Acta Pathologica, Microbiologica, et Immunologica Scandinavica 2001;109(5):321-32. - PubMed
Senie 1991
    1. Senie R, Rosen P, Rhodes P, Lesser M. Timing of breast cancer excision during the menstrual cycle influences duration of disease-free survival. Annals of Internal Medicine 1991;115:337–42. - PubMed
Sulke 1985
    1. Sulke AN, Jones DB, Wood PJ. Variation in natural killer activity in peripheral blood during the menstrual cycle. BMJ 1985;290:884-8. - PMC - PubMed
White 1982
    1. White D, Jones DB, Cooke T, Kirkham N. Natural killer (NK) activity in peripheral blood lymphocytes of patients with benign and malignant breast disease. British Journal of Cancer 1982;46:611-6. - PMC - PubMed

References to other published versions of this review

Thorpe 2008
    1. Thorpe H, Brown SR, Sainsbury JR, Perren TJ, Hiley V, Dowsett M, et al. Timing of breast cancer surgery in relation to menstrual cycle phase: no effect on 3-year prognosis: the ITS Study. British Journal of Cancer 2008;15(98 (1)):39-44. - PMC - PubMed

Publication types