Hormones and Human Breast Cancer

Seventeen years ago Mr. HAYWARD came to work in the Breast Clinic at Guy's Hospital. At that time the influence of hormones on the progress of breast cancer was appreciated; the prescription of androgens and oestrogens in the treatment of the advanced case was well established, and the operations of adrenalectomy and hypo­ physectomy had recently been introduced. Nevertheless, the prevailing view of the nature of breast cancer was that it was a local malignancy which had to be eradicated before it spread too widely and only if that had occurred would the aid of hormones be enlisted. How these hormones worked was unknown, indeed, today, as Mr. HAY­ WARD points out, their mode of action is still unknown. What has happened, however, within the last seventeen years has been a change of emphasis in our views regarding the essential nature of this disease. Instead of breast cancer being considered primarily as a local fault spreading centrifugally, it is realised with increasing con­ viction that it is a generalised disease with local manifestations and that one of the principal, if not the principal, aberration from normality lies in the endocrine environ­ ment. That this philosophy is demanding increasing acceptance is due in a significant measure to Mr. HAYWARD'S own investigations. In this work he has had the devoted assistance of BRIDGET WOLFF of the Breast Clinic at Guy's Hospital and the expert collaboration of Dr. R. D. BULBROOK of the Imperial Cancer Research Fund.

Inhalt

1 Historical Developments.- Animal Studies.- Human Studies.- References.- I - Hormones in Treatment and Prophylaxis.- 2 The Ovaries.- 1. Castration in the Advanced Disease.- a) Response.- b) Prediction.- c) Adjunctive Therapy.- Castration as a Prophylactic Measure.- The Comparative Values of Therapeutic and Prophylactic Castration.- a) For Prophylactic Castration.- b) For Therapeutic Castration.- Surgical Castration Compared with Irradiation Castration.- The Physiological Significance of Castration.- Summary and Conclusions.- References.- 3 The Adrenals and the Pituitary.- 1. The Remission Rates from Adrenalectomy and Hypophysectomy.- 2. The Timing of Adrenalectomy and Hypophysectom.- 3. The Comparative Results of Hormone Therapy and Ablation.- 4. Techniques.- a) Adrenalectomy.- b) Hyphophysectomy.- 5. Endocrine Changes after Ablation.- a) Postoperative Hormone Levels and Response.- b) The Measurement of Completeness of Operation.- Summary and Conclusions.- References.- 4 Tests of Prediction.- 1. Clinical Methods.- a) The Histology of the Tumour.- b) Macroscopical Features of the Tumour.- c) Response to Previous Hormone Therapy.- d) The Response to Previous Castration.- e) The Free Period.- f) Menopausal Status.- 2. Hormone Assays.- a) Oestrogen Assays.- b) Androgens and Corticosteroids.- Summary and Conclusions.- References.- 5 Androgens and Oestrogens.- 1. Response.- a) Success Rate.- b) Survival.- c) Histological Changes.- 2. Factors Associated with Hormone Action.- a) Age.- b) The Site of Metastases.- c) Host Factors.- d) The Primary Complex.- e) The Histology of the Tumour.- 3. Choice of Compound and Dosage.- 4. Comparison of Androgens and Oestrogens.- 5. The Place of Androgens in Prophylaxis.- 6. Mode of Action.- 7. Hypercalcaemia.- a) Hypercalcaemia in Patients without Skeletal Metastases and with Depressed Levels of Serum Phosphorus.- b) Hypercalcaemia in Patients without Skeletal Metastases and with Normal Serum Phosphorus.- Summary and Conclusions.- References.- 6 Corticosteroids and Progestogens.- 1. Corticosteroids.- 2. Progestogens.- Summary and Conclusions.- References.- II - The Hormonal Environment and Hormone Assays.- 7 Antecedent and Racial Factors.- 1. Heredity.- 2. Marriage.- 3. Pregnancy and Parity.- 4. Lactation.- 5. Menstrual History and the Menopause.- 6. Bilateral Disease.- 7. Gynaecological Disease.- 8. Racial Factors.- Summary and Conclusions.- References.- 8 Oestrogens.- Exogenous Oestrogens.- 1. Males.- 2. Females.- Endogenous Oestrogens.- 1. Males.- 2. Females.- Summary and Conclusions.- References.- 9 Androgens and Corticosteroids.- The Guernsey Trial.- Plasma Studies.- Summary and Conclusions.- References.- 10 Pituitary and Thyroid Hormones.- 1. Gonadotrophins.- 2. Growth Hormone and Prolactin.- Thyroid.- 1. Thyroid Disease and the Incidence of Breast Cancer.- 2. Thyroid Factors in the Established Disease.- 3. Thyroid as Treatment.- 4. Thyroid Effects on Endocrine Metabolism.- Summary and Conclusions.- References.- 11 The Present and the Future.