R.D. Bulbrook

RELATION BETWEEN URINARY ANDROGEN AND CORTICOID EXCRETION AND SUBSEQUENT BREAST CANCER

Abstract The excretion of androsterone and aetiocholanolone is subnormal in women who subsequently develop breast cancer. The abnormality is found at all ages between 30 and 55 years and up to 9 years before diagnosis. Measurement of androgen metabolite excretion might be considered suitable for screening a normal population for women with a high risk of breast cancer.

THE PREVENTION OF BREAST CANCER

The case for treating women at high risk of breast cancer with the anti-oestrogen tamoxifen is presented. This is a logical extension of a screening programme and is scientifically based on the effectiveness of tamoxifen in established disease, the relation between free oestradiol (and other hormone-related factors) to the risk of breast cancer, and the lack of side-effects from tamoxifen treatment. Choice of a high-risk group is critical; a specific trial protocol is outlined.

EXCRETION OF URINARY 17-HYDROXYCORTICOSTEROIDS AND 11-DEOXY-17-OXOSTEROIDS BY WOMEN USING STEROIDAL CONTRACEPTIVES

Abstract Women using oral contraceptives excrete less urinary 17-hydroxycorticosteroids and 11-deoxy-17-oxosteroids than women not using this form of contraception.

TRANSCORTIN IN THE PLASMA OF PATIENTS WITH BREAST CANCER

Abstract Plasma-levels of transcortin and the degree of binding of hydrocortisone have been determined in healthy women, women with benign breast disease, and women with early and advanced breast cancer. In a fifth of women with benign disease and about a third of women with early or advanced breast cancer the values for transcortin were below the lower 95% normal limit. When bound radioactive hydrocortisone was displaced by carrier hydrocortisone, the capacity of transcortin was subnormal in about a third of patients—and these were the patients with subnormal binding levels of transcortin. Abnormalities in carbohydrate metabolism have been noted in women with breast cancer, and the results suggest that these abnormalities may stem from excessive adrenocortical stimulus. Since it has been suggested that diabetes and impaired glucose tolerance may precede clinical cancer, it is worth considering whether abnormalities in transcortin levels may precede the appearance of breast cancer.

RELATION BETWEEN PLASMA-CORTISOL, PLASMA-ANDROGEN-SULPHATES, AND IMMUNE RESPONSE IN WOMEN WITH BREAST CANCER

Abstract Plasma-cortisol levels were lower and plasma-androgen-sulphate levels were higher in patients with breast cancer who had a positive immune response to tuberculin than in those with a negative response. This result suggests that in such patients immune responses may be as useful for prognosis as steroid assays.