Sex Hormones and Castration in Advanced Breast Cancer

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Abstract
The past decade has ushered in new concepts of the etiologic and therapeutic aspects of neoplastic diseases. Chemotherapeutic technics have received particular attention. Notable among the strides that have been made is the concrete demonstration that certain hormones may significantly influence the course of mammary and prostatic cancer and possibly also of neoplasms arising in other organs subjected to endocrine influences (1–6). The implications are of paramount importance and have served to stimulate intensive investigations into the possible mechanisms involved. Of practical consideration is the application of this new information in the management of potentially “hormone-susceptible” cancers. This discussion will consider specifically hormones in the therapy of breast cancer. I. Indications For Hormonal Therapy of Breast Cancer Surgery and irradiation remain the optimum methods available for permanent or palliative control of localized and accessible manifestations of breast cancer. The potentialities of hormonal therapy, however, are becoming increasingly obvious and better defined. As a result, hormones can now be considered as a third method of attack, but only from the standpoint of palliation. Hormone therapy may be utilized as (a) an initial therapeutic measure for selected advanced primary lesions beyond the scope of effective surgical or radiological attack, (b) an adjunct to the established methods, or in combination with them, particularly when the manifestations are disseminated and beyond the practicability of locally directed treatment, (c) a secondary procedure for cancer initially treated to the fullest extent by surgery or radiation but no longer amenable to either method. II. Methods and Effects of Hormonal Therapy (A) Castration: Although there is still disagreement concerning the role of castration in the management of breast cancer, and the optimum time for its performance, a practical working plan has emerged. The beneficial effects are essentially confined to premenopausal women, though occasionally castration appears to be of value a few years after spontaneous cessation of the menses if there is evidence of residual ovarian activity. In the male, by contrast, orchiectomy seems to be more efficacious in older individuals with advanced breast cancer (7, 8). Castration is primarily of value as a palliative procedure (9, 10). Present data do not indicate that it is significantly advantageous as a prophylactic measure in conjunction with radical mastectomy if the latter is performed with the expectancy of control of the disease. Beneficial effects of castration, whenever instituted, are of limited duration. Thus, the trend is to withhold the procedure for treatment of manifestations beyond effective control by the usual methods. In this way, further benefit may be obtained and the life expectancy of the patient may possibly Be prolonged.