The Menopausal Age in Women with Cancer of the Breast

Abstract

The following report is presented as an addition to our gradually increasing knowledge of the evident relationship between ovarian activity and carcinoma of the breast. The conception of such an association is by no means recent and can, indeed, be divided into three periods. First, were those observations made about forty years ago by Beatson (1), Schinzinger (2), Lett (3), and others, who noted the apparent effect of oophorectomy on the clinical course of mammary cancer. This work was largely applied to inoperable cases or postoperative recurrences and, when such a surgical procedure was advocated as a part of the treatment in an operable case, it was often considered so radical that it was not accepted as a standard procedure. The idea was based upon the clinical observation that cancer of the breast ran a slower or comparatively less malignant course in women who had passed through the menopause.About the time that these results were published, the radical surgical removal of cancer of the breast, as advocated by Willy Meyer and Halsted, was becoming popular, and, as the percentage of postoperative survivals increased the secondary measure of oophorectomy seemed to be forgotten. There was some renewed interest in this connection when sterilization by means of x-ray was advised, and it was at about this time that we entered the second phase of our knowledge of this relationship. This was in 1916, when Loeb and Lathrop (4) produced the first definite experimental evidence of the influence of sex hormones on the development of cancer in mice. Theirs was more or less negative evidence: the failure of cancer of the breast to develop in females of a strain of mice of a high known cancer incidence, castrated while young or immature. They felt that there was an ovarian hormone that regulated the tissue changes leading to the development of the tumors and that there was a quantitative relation between this hormone and the tissue response. This work was subsequently corroborated by Cori (5). Nevertheless, little, if any, clinical application was made of this fact and only occasionally was an artificial menopause advocated as an accessory to the surgical treatment of mammary cancer.