Survival of premenopausal breast carcinoma patients in relation to menstrual cycle timing of surgery and estrogen receptor/progesterone receptor status of the primary tumor

BACKGROUND. Premenopausal breast carcinoma patients who undergo tumor excis ion during the follicular phase of their menstrual cycle may have a signifi cantly worse prognosis than those whose tumors are excised in other phases of the menstrual cycle. METHODS. Outcome was determined in a series of 112 premenopausal women with operable breast carcinoma in relation to the timing of surgery within the menstrual cycle and the estrogen receptor (ER) and progesterone receptor (P R) status of their primary tumors as determined by immunohistochemistry. RESULTS. Those patients with ER positive tumors who underwent surgery in th e early and luteal phase of the cycle had a significantly better survival t han women with ER negative tumors (chi-square test = 15.56; P < 0.001). Thi s also was true for PR status (chi-square test = 18.21; P < 0.001). After f ollicular phase surgery, tumor receptor status had no effect on overall sur vival. Patients with the best prognosis had ER/PR positive tumors excised o n Days 0-2 and 13-32 but even those women with ER or PR negative tumors rem oved during the luteal phase of their menstrual cycle fared better than pat ients whose tumors were removed during the follicular phase. CONCLUSIONS. There was a better survival rate for patients with both ER/PR positive and negative tumors treated during the luteal phase of the menstru al cycle. This could be the result of progesterone acting on the surroundin g peritumoral normal tissue, thereby exerting a straitjacket effect and imp roving cohesion of the primary carcinoma. Unopposed estrogen in the follicu lar phase of the cycle may enable more tumor emboli to escape and successfu lly establish micrometastases. Cancer 1999;86:2053-8. (C) 1999 American Can cer Society.