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Menstrual Cycle Phase Important In Mastectomy Plus Oophorectomy

The factors associated with menstrual cycle phase may influence outcomes from simultaneous mastectomy and surgical oophorectomy in pre-menopausal women with breast cancer.

There is no evidence that timing of mastectomy with menstrual cycle influences outcomes in women with operable breast cancer who receive no adjuvant systemic therapy, however.

"We found that women who underwent adjuvant oophorectomy simultaneously with mastectomy surgery during the estimated luteal phase of the menstrual cycle benefited from this treatment to a statistically significantly greater extent than did women who had this surgery during the follicular phase," researchers report.

"Women undergoing mastectomy and oophorectomy and tamoxifen during the follicular phase of the menstrual cycle derived a marginal benefit from the adjuvant hormonal treatment."

United States, Vietnamese and Chinese investigators define the follicular phase of the menstrual cycle as days one to 14 from the first day of the last menstrual cycle (LMP). They define the luteal phase as days 15 to 42 from LMP.

They investigated whether the phase of the menstrual cycle in which surgical treatment occurs influences disease-free and overall survival in pre-menopausal women with breast cancer.

Participants included 662 Vietnamese and 47 Chinese pre-menopausal women with operable breast cancer treated between August 1993 and June 1999. Patients were randomised to mastectomy with adjuvant surgical oophorectomy and tamoxifen for five years or mastectomy alone.

Investigators from the University of Wisconsin in Madison, the National Cancer Institute in Hanoi and the People's Hospital of Haimen City in Jiangsu, China analysed results for 565 women who reported an LMP within 42 days before surgery. They included 289 women in the mastectomy only arm and 276 women in the adjuvant therapy arm.

Women in the adjuvant therapy arm whose surgery occurred during the luteal phase of their menstrual cycle had better disease-free and overall survival than those whose surgery fell in the follicular phase.

"Moreover, women whose surgery occurred during the luteal phase and who received adjuvant therapy had better five-year, disease-free survival (84 percent) than did women whose surgery occurred during the follicular phase (67 percent)," the researchers concluded.

Women with surgery occurring during the luteal phase of the cycle also had better overall survival: 85 percent compared to 75 percent for those with surgery occurring during the follicular phase.
Journal of the National Cancer Institute, 2002; 94: 662-669. "Mastectomy and Oophorectomy by Menstrual Cycle Phase in Women With Operable Breast Cancer"

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