New Findings In Debate Over Timing Of Breast Cancer Surgery In Relation To Phase of Menstrual Cycle

May 13, 1998

Doctors working in the Imperial Cancer Research Fund's Clinical Oncology Group at Guy's Hospital in London have come up with new findings* which, they say, support suggestions that the success of surgery for breast tumours in premenopausal women is influenced by the phase of the menstrual cycle during which the operation is performed.

The 'timing of surgery hypothesis' holds that women who have breast tumours removed during the follicular phase of the menstrual cycle (days 3-12) have a poorer prognosis than those operated on during the luteal phase (days 0-2 and 13-32). The first observations on this issue were made almost ten years ago, and surgeons have been debating the link ever since.

One of the earliest studies to demonstrate the time of surgery effect was published in 1991 by Professor Ian Fentiman, deputy head of the ICRF Group. Using a new laboratory staining technique for assessing the rate at which cells in a tissue are proliferating, Professor Fentiman and his colleagues have now studied preserved tissue from some of the women who took part in that original study.

They have found that after ten years of follow up, 80 per cent of patients with slowly proliferating tumours were still alive, but fewer than 50 per cent of those with rapidly proliferating tumours. The study shows that measurements of cell proliferation provide information on prognosis additional to that which comes from knowing the timing of the surgery in the menstrual cycle.

"What we've shown is that the group of women who had the best prognosis were those with slowly proliferating tumours who were operated on in the luteal phase," says Professor Fentiman. "The worst outcome was in the group who had their surgery in the follicular phase of the cycle, and had rapidly proliferating tumours. But it's clear that the effect of the timing of surgery applies in all tumours, whether of the rapidly or the slowly proliferating type."

He adds: "I think this is yet another piece of evidence showing that the timing of surgery for breast cancer has a real effect. We already know that women with rapidly proliferating tumours have a poorer outlook. This study shows that we may be able to improve the prognosis if we choose the optimum time at which to remove the tumour."

Professor Fentiman concedes that the debate among surgeons will probably continue until they have the results of a prospective trial to add to the findings of retrospective studies of the kind which have so far been carried out.

*Cell proliferation measured by MIB1 and timing of surgery for breast cancer. British Journal of Cancer (1998), vol 77(9), pp1502-150

Notes for editors:
The laboratory technique used in the study relies on a tissue staining chemical combined with an antibody called MIB 1. This antibody attaches itself specifically to the nuclei of cells which are actively proliferating, so enabling their presence to be detected under the microscope. It works with preserved as well as with fresh tissue.

Imperial Cancer Research Fund - Background Brief

The Imperial Cancer Research Fund is dedicated to the understanding, prevention, treatment and cure of all forms of cancer. Its scientists and doctors are at the forefront of the worldwide effort to defeat the disease. The charity relies almost totally on voluntary funding to carry out its vital work.

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Imperial Cancer Research Fund

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