The Value of Orchiectomy in the Treatment of Carcinoma of the Male Breast

Abstract

Experimental advance of the last decade resulted in the not unexpected discovery that sexual hormones play an important role in the causation of rather large groups of cancer. It was established from the earliest days of cancer investigation that one-third of all cancers occurring in the female and almost one-tenth of cancers occuring in the male originated either in the primary or secondary generative organs, but a documentary scientific explanation for this could not be furnished until recently. The progress of research has been somewhat more swift, as is readily understandable, in the field of animal cancer and, therefore, a brief consideration of the more salient conclusions may not appear out of place. Rhoads (1), in the Caldwell Lecture of 1942 before the American Roentgen Ray Society, reviewed in a comprehensive manner the wealth of experiments on the relationship of the sex hormones and certain types of cancer of the genitalia, as cancer of the breast of both sexes, cancer of the prostate, etc. In connection with cancer of the female breast in mice, he found evidence available pointing to the fact that in certain pure strains two factors are important in the causation of the neoplasm: the hereditary factor, which is transmitted by the maternal parent, and a second factor, which is contained in the milk. If high-cancer strain offspring are foster-nursed on low-cancer strain mothers within twenty-four hours after birth, cancer of the breast develops rarely, whereas if low-cancer strain offspring are foster-nursed on high-cancer mothers, the cancer incidence rises from zero or thereabouts to 15 per cent. From this evidence, Rhoads deducted that, in the presence of both the hereditary and milk factors, the secretion of the ovary by rhythmically releasing estrogenic substances into the blood stream is directly responsible for producing cancer of the breast. The anterior lobe of the pituitary gland also plays a certain role by controlling the secretion of the ovary. As a further step, Murray transplanted ovarian tissue into castrated male mice of a strain in which the females possess a high incidence of breast cancer and thus he was able to produce experimental cancer of the male breast in a similar manner. The theory of estrogenic causation of breast cancer in mice received additional support when, as a result of numerous and varied investigations, it was noted that the administration of ovarian secretion elicits in both sexes diffuse epithelial stimulation of the mammary gland which, after passing through successive stages of metaplasia, leads to malignant neoplasia. In most instances, because of the slowness of the process, on histopathologic analysis various stages of metaplasia are encountered at the same time until at one more critical point the change culminates in cancer. If this focus is removed, the next most advanced point undergoes a similar evolution, and so on until the process becomes regional or general.