In two exploratory analyses with short (median 3.5 years) and longer (median 7.0 years) follow-up of women with operable breast cancer treated with adjuvant surgical oophorectomy, the proposers found that benefit from adjuvant therapy was significantly greater in women undergoing simultaneous mastectomy and oophorectomy in the history-estimated luteal phases of their menstrual cycles. The investigators have been conducting a randomized, controlled trial to investigate the hypothesis that luteal phase oophorectomy is superior to follicular phase surgery in Filipino, Vietnamese or Moroccan premenopausal women with regular menstrual cycles and hormone receptor-positive tumors, undergoing adjuvant surgical oophorectomy followed by tamoxifen therapy. Blood samples for hormonal assays are taken on the day of oophorectomy for later analysis. As of June 1, 2008, 548 women have been enrolled in the trial. Based on recent experience, the accrual goal of 762 will be reached by June 2009. Compliance with randomized assignments for dates of surgery has been good and less than 1% of cases have been lost to follow-up. With follow-up of 3.5 years from the time of last study case entry, (to December 31, 2012), the study is expected to have at least 80% power to detect a hazard ratio for disease-free survival of 0.65 comparing mid-luteal phase scheduled and immediate ophorectomy/mastectomy surgery. Four years of support is requested to complete this novel hypothesis-testing trial.

Public Health Relevance

The goal of the study is to prove that we can improve the survival of the average (middle) woman in the trial by a year with luteal phase oophorectomy. 548 women have entered the study so far. We will also study other aspects of these treatments including how long they work in controlling the disease, and the relationships of progesterone and other hormone levels on the day of oophorectomy surgery to disease free survival. If the improvement in treatment tested works, this will have major implications for treatment of breast cancer and other solid tumors generally.

National Institute of Health (NIH)
National Cancer Institute (NCI)
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Epidemiology of Cancer Study Section (EPIC)
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Song, Min-Kyung H
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International Breast Cancer Research Fdn
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Love, Richard R; Laudico, Adriano V; Van Dinh, Nguyen et al. (2015) Timing of adjuvant surgical oophorectomy in the menstrual cycle and disease-free and overall survival in premenopausal women with operable breast cancer. J Natl Cancer Inst 107:djv064
Love, Richard R; Young, Gregory S; Laudico, Adriano V et al. (2013) Bone mineral density following surgical oophorectomy and tamoxifen adjuvant therapy for breast cancer. Cancer 119:3746-52
Love, R R; Ginsburg, O M; Coleman, C N (2012) Public health oncology: a framework for progress in low- and middle-income countries. Ann Oncol 23:3040-5
Love, Richard R; Young, Gregory S; Hade, Erinn M et al. (2011) Effects on survival of menstrual cycle phase of adjuvant surgical oophorectomy in premenopausal women with breast cancer. Breast Cancer Res Treat 126:479-85
Ginsburg, Ophira M; Love, Richard R (2011) Breast cancer: a neglected disease for the majority of affected women worldwide. Breast J 17:289-95
Hammond, M Elizabeth H; Hayes, Daniel F; Dowsett, Mitch et al. (2010) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Arch Pathol Lab Med 134:907-22
Mostafa, Mg; Larsen, Mt; Love, Rr (2010) Estrogen Receptor, Progesterone Receptor, and Her-2/neu Oncogene Expression in Breast Cancers Among Bangladeshi Women. J Bangladesh Coll Phys Surg 28:157-162
Uy, Gemma B; Laudico, Adriano V; Carnate Jr, Jose M et al. (2010) Breast cancer hormone receptor assay results of core needle biopsy and modified radical mastectomy specimens from the same patients. Clin Breast Cancer 10:154-9
Hade, Erinn M; Jarjoura, David; Lai Wei (2010) Sample size re-estimation in a breast cancer trial. Clin Trials 7:219-26
Love, Richard R (2010) Adjuvant hormonal therapy in premenopausal women with operable breast cancer: not-so-peripheral perspectives. Oncology (Williston Park) 24:322-7

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