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Bernhardt SM, Dasari P, Walsh D, et al. Timing of breast cancer surgery during the menstrual cycle-is there an optimal time of the month?. Oncol Lett. 2020;20(3):2045-2057doi: 10.3892/ol.2020.11771.
Bernhardt, S. M., Dasari, P., Walsh, D., Townsend, A. R., Price, T. J., & Ingman, W. V. (2020). Timing of breast cancer surgery during the menstrual cycle-is there an optimal time of the month?. Oncology letters, 20(3), 2045-2057. https://doi.org/10.3892/ol.2020.11771
Bernhardt, Sarah M, et al. "Timing of breast cancer surgery during the menstrual cycle-is there an optimal time of the month?." Oncology letters vol. 20,3 (2020): 2045-2057. doi: https://doi.org/10.3892/ol.2020.11771
Bernhardt SM, Dasari P, Walsh D, Townsend AR, Price TJ, Ingman WV. Timing of breast cancer surgery during the menstrual cycle-is there an optimal time of the month?. Oncol Lett. 2020 Sep;20(3):2045-2057. doi: 10.3892/ol.2020.11771. Epub 2020 Jun 24. PMID: 32782523; PMCID: PMC7400969.
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Oncol Lett. 2020 Sep;20(3):2045-2057. doi: 10.3892/ol.2020.11771. Epub 2020 Jun 24.

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

Oncology letters

Sarah M Bernhardt, Pallave Dasari, David Walsh, Amanda R Townsend, Timothy J Price, Wendy V Ingman

Affiliations

  1. Discipline of Surgery, Adelaide Medical School, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia 5011, Australia.
  2. The Robinson Research Institute, University of Adelaide, Adelaide, South Australia 5005, Australia.
  3. Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia.

PMID: 32782523 PMCID: PMC7400969 DOI: 10.3892/ol.2020.11771

Abstract

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.

Copyright: © Bernhardt et al.

Keywords: breast cancer; estrogen; menstrual cycle; progesterone; tumour biology

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