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Researcher ties success of surgery to ovulation
By LINDA H. LAMB
Knight Ridder Newspapers
Posted on Wed, Feb. 23, 2005
If you are a woman, you know: Where you are in your monthly cycle can affect
everything from whether you're more prone to snap at the kids to whether you
crave M&M's.
It also should be a prime consideration in scheduling breast-cancer surgery and
mammograms, says a VA medical center researcher who has studied the issue for 17
years.
“Menstrual cycles are important for the survival of the species, and it turns
out menstrual cycles are important for the survival of the individual as well,”
said William Hrushesky, senior clinical investigator of the center in Columbia,
S.C..
Essentially, his advice to women is this:
• If you are facing surgery for breast cancer — a minor procedure such as a
biopsy or a major one such as mastectomy — schedule it close to ovulation.
• If you are planning a mammogram, schedule it at the opposite point in your
cycle, just before or about a week after your period.
Hrushesky says the best research supports his observations, including one study
finding that 10 years after having surgery for breast cancer, 25 percent more
women were alive after being operated on at the “right” time, around ovulation.
But after years of debate and scores of studies by Hrushesky and others, not
everyone shares his convictions. For example, while best-selling author and
breast-cancer specialist Susan Love posts advice on the timing of surgery on her
Web site, neither the National Cancer Institute nor the American Cancer Society
is sold on the idea — yet.
Hrushesky says if there's a possibility patients can increase their odds for
survival, why not try it? “This is something that women have complete control
over,” he said.
Of mice and women
Two things started Hrushesky, 56, thinking about menstrual cycles and breast
cancer.
First, he and his wife, fellow researcher Patricia Wood, decided to have a baby.
(They now have a 16-year-old daughter.) So on a personal level, he was pondering
the female cycle and the timing of conception.
At the same time, as a researcher in upstate New York, he was pondering various
bodily cycles and how they interact — cardiac cycles, respiration cycles and
circadian rhythms that set one's “biological clock.” He wondered how the female
cycle might affect breast cancer.
It wasn't a completely new notion. In 1836, for example, a doctor observed that
women's breast tumors varied in size during their menstrual cycles.
Hrushesky decided to work with mice, mammals whose menstrual cycles have
similarities with women's cycles. Cancerous breast tumors were grown in mice and
then surgically removed at different times during their cycles.
“We found that we could cure two to three times more of the cancers when
resection (surgery) was done right after ovulation,” Hrushesky said.
In 1989 he collaborated with a California doctor to study the idea in 44 women
who had breast-cancer surgery. The New York Times called the study, published in
the peer-reviewed medical journal The Lancet, “by far the most talked about
study in all of chronobiology” the following year. The study found that women
who had mastectomies during the “wrong” time — near their periods — were four
times more likely to die or to have their cancers recur.
Complex mechanisms
Cyclical symptoms women notice, such as weight gain, breast soreness and
emotional swings, are mirrored each month by unseen physiological changes.
Several of these complicated mechanisms could be responsible for differences in
outcomes after cancer surgery, Hrushesky said.
For instance, cells grow and reproduce rapidly before ovulation; also, blood
vessels are more permeable or “leaky.” Hrushesky said both factors could
contribute to cancer's spread, especially because surgery on a primary tumor
might stimulate growth of outlying spots of cancer that had been dormant.
Another factor might be surgery's effects on the body's NK or “natural killer”
cells, which could help fight cancer. These cells are subdued for at least a
month after surgery, Hrushesky said.
Many doctors accept that mammograms done early in the cycle, when breasts are
not tender and swollen, are more likely to yield accurate results.
But more and better studies are needed before most cancer specialists embrace
Hrushesky's ideas about surgery, said Rosemary Lambert-Falls, who treats breast
cancer patients at South Carolina Oncology Associates in Columbia. “It's very
interesting, but you can't really hang your hat on it,” she said.
Among her misgivings is that most of the studies have started with surgery
patients and looked back, rather than starting before surgery and tracking
patients forward. The latter, “prospective” method is preferred as more
accurate.
Hrushesky agrees that a major, well-designed prospective study is needed. So
does University of South Carolina breast-cancer researcher Joan Cunningham,
“especially since some breast cancers in young women are very aggressive.”
If Hrushesky's ideas are confirmed and widely adopted, they could have a
significant impact on younger patients with tougher cancers, who frequently are
African-American, she said.
There are other caveats. More than 70 percent of women who develop breast cancer
are older than age 50, and if they are past menopause, the menstrual-cycle
theory won't help them. (Although, if their cycles can be jump-started with
hormones, that might be an option, Hrushesky and Wood said.)
Also, determining the exact time of ovulation is trickier in women with
irregular cycles. But new, easy-to-use ovulation tests could solve that problem.
“It's been pretty lonely” advocating his theories at times, said Hrushesky, a
professor in University of South Carolina's medical school and Arnold School of
Public Health. But his bottom line is that lives could be saved.
“It's clear that you can diminish your risk of dying from breast cancer,” he
said. “My advice is that if your surgeon won't go along with this, find one who
will.”
Source :
http://www.kansascity.com/mld/kansascity/living/10963155.htm?1c