NEW YORK--There is sufficient evidence that the timing of breast
cancer surgery affects outcome to warrant further inquiry, William
J. Hrushesky, MD, said at the 14th Chemotherapy Foundation Symposium.
It is known that tumor growth rates wax and wane during the female
menstrual cycle, but many questions remain that can be answered
only by rigorously designed studies, said Dr. Hrushesky, senior
attending oncologist, Stratton VA Medical Center, and professor
of medicine, Albany Medical College.
In his research in both mice and women, Dr. Hrushesky has found
that cellular immune function and/or host resistance to cancer
growth and spread vary with the reproductive cycle stage. Tumor
growth rate is slowest during the early luteal stage, which typically
occurs in the first quarter of the cycle after ovulation, a time
when the immune response is most robust. It is this stage that
appears to be optimal for resection, he said.
"In our own initial clinical series, women resected during
the middle of the menstrual cycle proved to have a fourfold better
chance of surviving 10 years than those whose breast cancers were
resected during or nearer to menses," he said. Ten other
retrospective studies have confirmed this finding, and multivariate
analyses demonstrate that timing is an independent predictor of
both breast cancer recurrence and death, he added.
Does that mean that all breast cancer surgery should be scheduled
for the early luteal phase? Not at this time, Dr. Hrushesky said.
"Many meaningful uncertainties remain, and only rigorous
study can answer them. We need to clarify the impact of resection
timing and the size of the window of opportunity--when it opens
He added that we further need to understand the underlying biology
"because a full understanding of the mechanisms may lead
to neoadjuvant hormonal strategies to enhance the control of this
and other cancers"