ABSTRACT
To define the prognostic significance of menstrual timing of breast cancer [BRCA] surgery, its interaction with estrogen receptor [ER] and angiogenesis. Prospective randomized involving 40 premenopausal BRCA patents with accurate triangulation of surgery [no multistage] in objectively defined menstrual cycle side [transvaginal ultrasound-serum progesterone], immunocytochemical stain for estrogen receptors and factor VIII, 5 years follow up with well proved finite end points./ /[ disease free survival [DFS]and disease free time [DFT]/ /]. Resected Tumors in the follicular phase had more angiogenic score [P, 0.001] plus higher micro vessel count [P, 0.001]. Patients who underwent surgery in the luteal phase had better [DFS] [P, 0.02]. On univariant analysis the menstrual timing [P, 0.01] and angiogenic score [P, 0.01] predicted the DFS, their bivariant analysis found luteal phase subset with low angiogenic score had the best prognosis [P, 0.04], but on multivariate analysis the menstrual timing was the discriminant factor [P, 0.04], the predictors for DFT were menstrual timing [P, 0.02], and ER status [P, 0.04] with insignificant difference on subset analysis. Menstrual timing represented grade II prognostic factor, with better DFS, DFT for patients operated in the luteal phase. It acts through angiogenesis modulation