Showing papers on "Breast cancer published in 1979"
TL;DR: Recurrence-free survival was significantly common among patients who had initially reacted to cancer by denial or who had a fighting spirit than among patientsWho had responded with stoic acceptance or feelings of helplessness and hopelessness.
749 citations
TL;DR: Cosmetic results were lessened when the biopsy procedure included a wide resection of adjacent breast tissue or when theBiopsy scar was obvious, and increasing doses of external beam radiation were associated with greater degrees of retraction and fibrosis of the treated breast.
Abstract: In 31 cases of Stages I or II carcinoma of the breast treated by primary radiation therapy, the cosmetic results were analyzed with regard to the details of treatment. Three principal treatment factors were identified which influenced the cosmetic outcome: (1) the extent and location of the biopsy procedure, (2) the time/dose factors of the radiation therapy and (3) the technique of the radiation therapy. Cosmetic results were lessened when the biopsy procedure included a wide resection of adjacent breast tissue or when the biopsy scar was obvious. Increasing doses of external beam radiation were associated with greater degrees of retraction and fibrosis of the treated breast. All 6 patients who received 6000 rad by external beam had significant retraction and fibrosis while patients who received 5000 rad rarely showed significant changes. Local boost doses by interstitial implantation did not diminish the cosmetic outcome. All patients were treated using supervoltage equipment without bolus and skin changes secondary to treatment were infrequent. Seventeen patients developed localized areas of fibrosis and skin changes at the matchline between adjacent radiation fields. Recommendations are made for improved cosmetic results based on these findings.
656 citations
TL;DR: This review covers the major aspects of the epidemiology of breast cancer included in the 1973 review and emphasizes recently reported work, as well as focusing on the magnitude of the problem in the U.S.
Abstract: A comprehensive review of what was known of the epidemiology of breast cancer as of the early 1970s was published by MacMahon et al. in 1973. This review covers the major aspects of the epidemiology of breast cancer included in the 1973 review and additionally emphasizes recently reported work. Attention is directed to the following: magnitude of the problem in the U.S.; demographic characteristics of breast cancer cases; international variation; laterality of breast cancer; reproductive variables; benign breast diseases; multiple primary cancers involving the breast and other sites; familial aggregation and genetics; endogenous hormones (estrogens progesterone prolactin androgens and thyroid); exogenous estrogens; diet; body build; radiation; exposure to radiation in screening for breast cancer; mammographic parenchymal patterns; viruses; other exposures of current interest (reserpine hair dyes); and breast cancer in males. The high incidence and mortality rates and the detrimental impact on the quality of life of those affected indicate that breast cancer in the U.S. continues to be a serious problem for women. An annual age-adjusted incidence rate of 84.9/100000 women was reported for the 1973-1976 years; the annual age-adjusted mortality rate among women in the U.S. was 27.7/100000 over this same time period. From these figures it may be estimated that each year in the U.S. almost 100000 cases of breast cancer are diagnosed and over 30000 deaths occur. Age specific incidence rates increase rapidly with age until about 45-50 years of age after which they continue to increase but at a slower rate. In addition to age a few other risk factors including a history of bilateral premenopausal breast cancer in a 1st degree relative a history of breast cancer in the contralateral breast and residence from an early age in North America compared to Asia are associated with large relative risks. Other risk factors including whether or not an oophorectomy has been performed age at 1st birth a history of fibrocystic disease previous exposure to high levels of radiation in the chest socioeconomic status obesity and a previous cancer in the ovary or endometrium are associated with relative risks of at least 2 but less than 4-fold. Finally age at menarche age at menopause marital status place of residence and the white compared to the black race are associated with small but real differentials in risk.
447 citations
TL;DR: Results revealed no statistically significant difference in that incidence of thrombophlebitis, myocardial infarction (MI), or uterine cancer, and patients in the treated group who began the study with elevated beta/alpha lipoprotein ratios showed a reduction in that ratio over the course of the study.
445 citations
Journal Article•
TL;DR: High-pressure liquid chromatographic analyses of liver and breast extracts from rats treated for 6 months with retinoids show the pharmacokinetic basis for the superiority of 4-hydroxyphenylretinamide; this retinoid and its metabolites were found in high concentrations in breast tissue, without any measurable accumulation in the liver or evident liver toxicity.
Abstract: The synethesis of a new retinoid, N-(4-hydroxyphenyl)-all-trans-retinamide, which has useful biological properties, is described. This retinoid was more potent than retinyl acetate in reversing keratinization caused by retinoid deficiency in tracheal organ culture. It was markedly less toxic than retinyl acetate when fed p.o. to rats over 2-week or 6-month periods. It was an effective agent for inhibition of the development of breast cancer induced in rats by N-nitroso-N-methylurea, although it was not as potent as retinyl acetate in this regard. However, the lesser toxicity of 4-hydroxyphenylretinamide makes it a superior agent for prevention of breast cancer. High-pressure liquid chromatographic analyses of liver and breast extracts from rats treated for 6 months with retinoids show the pharmacokinetic basis for the superiority of 4-hydroxyphenylretinamide; this retinoid and its metabolites were found in high concentrations in breast tissue, without any measurable accumulation in the liver or evident liver toxicity. In contrast, chronic feeding of retinyl acetate caused marked deposition of retinyl esters in the liver and severe hepatotoxicity. Whole mounts of rat mammary glands, made after chronic feeding of 4-hydroxyphenylretinamide, showed that it had a marked antiproliferative effect on mammary epithelium.
393 citations
TL;DR: Prolonged survival was seen in patients who underwent surgical resection, those with the brain as site of first metastasis, and those with a long free interval who survived the initial 5 months after BM.
Abstract: One hundred one breast cancer patients with brain metastases (BM) were reviewed. The median survival from BM was 4.0 months. Seventy percent were receiving chemotherapy at the diagnosis of BM and 43% were showing a clinical response. Prolonged survival was seen in patients who underwent surgical resection, those with the brain as site of first metastasis, and those with a long free interval who survived the initial 5 months after BM. Long-term survivors (greater than 18 months from BM) demonstrated indolent disease by all parameters measured.
279 citations
TL;DR: Because a "negative" mammogram that is followed by a biopsy diagnostic of cancer is a matter of deep concern, a retrospective review was conducted of 48 such missed diagnoses at four Breast Cancer Detection Centers.
Abstract: Because a "negative" mammogram that is followed by a biopsy diagnostic of cancer is a matter of deep concern, a retrospective review was conducted of 48 such missed diagnoses at four Breast Cancer Detection Centers. The study group comprised 40,000 women participating in breast cancer screening examinations. From 3,271 biopsies during screening, 499 cancers had been found. Biopsies in the interval between screening examinations totaled 630 and yielded 48 malignancies. These 48 interval cancers were studied in an attempt to discover why they were not found on the preceding mammographic examination. Three major categories of error were disclosed and each is discussed: (1) poor radiographic technique; (2) absence of radiographic criteria of cancer; (3a) obvious oversight by the radiologist; and (3b) lack of recognition of subtle radiographic signs. This last reason is discussed in detail in the belief that better recognition of these indirect radiographic signs will lead to more accurate diagnoses, particularly in early cancers.
271 citations
Journal Article•
TL;DR: An estimate of total extent of disease based on criteria for rating extent of involvement at 12 potential sites was a much more important prognostic factor related to response and survival than actual sites of involvement or the traditional "dominant site" classification.
Abstract: Six hundred nineteen patients with metastatic breast cancer, treated with a combination of 5-fluorouracil, Adriamycin, and cyclophosphamide, or close variations of this program, with or without immunotherapy were analyzed retrospectively to identify those host, tumor, or treatment characteristics that might be of prognostic importance in predicting response to chemotherapy and survival from onset of the 5-fluorouracil-Adriamycin-cyclophosphamide treatments. Primary tumor characteristics such as size of primary, number of axillary nodes involved, stage at diagnosis, and type of surgery used for primary treatment were not found to be of prognostic significance. Host characteristics such as age, menstrual status, or family history of breast cancer were similarly unrelated to outcome. Non-Caucasian patients had a lower response rate and somewhat shorter survival than did Caucasians. Pretreatment weight loss, poor performance status, and abnormal biochemical and hematological values were of adverse prognostic significance. An estimate of total extent of disease based on criteria for rating extent of involvement at 12 potential sites was a much more important prognostic factor related to response and survival than actual sites of involvement or the traditional "dominant site" classification. There was a trend, however, for patients with bone involvement to have a longer survival than did patients with metastases to other organ sites. Shorter survival times were observed among patients exposed to extensive prior radiotherapy and those who failed to respond to prior hormonal treatment. The prognostic variables identified in this paper should be used for the design and comparison of clinical trials in the future.
267 citations
TL;DR: The estrogen receptor status in 335 primary breast carcinomas was correlated with disease‐free interval, survival and site of recurrent disease, and estrogen receptor positive cancers had a significantly better chance of survival independent of lymph node status.
Abstract: This study was designed to determine whether the estrogen receptor (ER) status of a primary breast cancer has prognostic value and how this information compares with the information gained from lymph node status at masectomy 335 primary breast carcinomas were tested for ER in tumor cytosol fractions Of the 335 177 contained ER and 158 contained no significant amounts of ER; the respective percentages of ER positive and negative tumors were 528 and 472 151 patients experienced carcinoma spread to the regional lymph nodes (484%) and 161 had no detectable metastases (516%) There was no connection between lymph node status and receptor status The ER status was correlated with disease-free interval survival and site of recurrent disease ER positive carcinomas had a longer disease-free interval longer survival (calculated from time of mastectomy to death) and longer time interval between recurrence and death Lymph node status at mastectomy also influenced these parameters ER positive cancers had significantly better chance of survival independent of lymph node status ERs also delayed recurrence in lymph-node-positive carcinomas; this advantage deteriorated with increasing time from operation ER positive or negative primary carcinomas showed no predilection for spread to any particular site however The significant differences in this report were P < 01
257 citations
TL;DR: This deplorable state of affairs can be directly related to the very severe reduction in the amount of time which the authors' medical schools allocate to the teaching and study of anatomy.
Abstract: This deplorable state of affairs, which is a cause of much wasted time and many unnecessary x-ray examinations, can be directly related to the very severe reduction in the amount of time which our medical schools allocate to the teaching and study of anatomy. In practical terms, it means that students become involved with contemplation of the abnormal before they have acquired a sound knowledge of the normal. Perhaps the tide is now beginning to turn, for, during the past year or so, there have been at least three publications affirming the importance of teaching radiological anatomy from the outset of the preclinical course. Can this really be just a coincidence ?
238 citations
TL;DR: This paper reviewed the American Society for Clinical Nutrition task force consensus statement on calories and found that obesity contributes to cardiovascular disease, diabetes mellitus, gallbladder disease, psychosocial disability, and musculoskeletal disorders.
Journal Article•
TL;DR: Long-term p.o. treatment with dehydroepiandrosterone, an adrenal steroid found in subnormal plasma concentrations in women predisposed to develop breast cancer, inhibits the formation of spontaneous mammary cancer in female C3H(Avy/a) mice.
Abstract: Long-term p.o. treatment with dehydroepiandrosterone, an adrenal steroid found in subnormal plasma concentrations in women predisposed to develop breast cancer, inhibits the formation of spontaneous mammary cancer in female C3H (Avy/a) mice.
TL;DR: The addition of synthetic progestin to estrogen therapy provided significant protection against the likelihood of developing endometrial cancer and did not reduce previously reported metabolic benefits of estrogen treatment.
TL;DR: Only patients who have undergone the menopause before presentation and who are disease-free 15 years after primary treatment may prove to be cured by conventional techniques such as simple mastectomy and postoperative radiotherapy.
Abstract: A retrospective analysis was made of 3878 cases of breast carcinoma first seen in Edinburgh from 1954 to 1964. During this time there was a policy to treat breast cancer by simple mastectomy and x-ray therapy, and over 90% of cases classified as international stages I and II were so treated. The mortality in these women was compared with that in an equivalent normal population using Scottish national age-specific death rates. For every year of follow-up within 20 years of initial treatment there was an excess mortality from all causes. There was an overall excess mortality of 58% among patients with breast cancer 15-20 years after initial treatment, and 20 times more deaths occurred in this period from breast cancer than in a normal population. For patients disease-free after 15 years there was still a 28% excess mortality from all causes. Factors known to be of major prognostic significance for five-year survivorship had less influence than might have been expected when the ratio of observed to expected deaths was considered for longer periods of follow-up. The effect of clinical staging (I, II, or III), though initially marked, largely disappeared by the 10th year of follow-up, and after allowing for age there was no evidence beyond 10 years of an effect on survival of the original stage of the disease. Similarly, the effect of tumour size on survival disappeared after 10 years. Women who were premenopausal at presentation still had a significant excess of deaths in the fourth quinquennium of follow-up. In the menopausal and postmenopausal groups combined there was still a small non-significant excess of deaths from all causes after 15 years but this almost disappeared when patients who had already relapsed were excluded. In terms of overall mortality only patients who have undergone the menopause before presentation and who are disease-free 15 years after primary treatment may prove to be cured by conventional techniques such as simple mastectomy and postoperative radiotherapy.
TL;DR: For example, the authors found that patients with both estrogen and progestin receptors have a better response to endocrine therapy than patients with only one of the receptors present, although even in such cases the response rate is higher than that seen in patients whose tumors lack both receptors.
Abstract: Knowledge of the steroid receptor content of human breast cancer is important for proper diagnosis and for deciding the proper treatment for metastatic disease. Few patients whose breast cancers lack estrogen receptor will benefit from endocrine therapy, while more than half of patients with estrophilin-rich cancers will obtain objective remissions. The probability of objective response to endocrine therapy increases with an increase in the quantity of estrogen receptor in the cancer. Furthermore, patients whose cancers have both estrogen and progestin receptors have a better probability of response than patients whose lesions have only one of the receptors present, although even in such cases the response rate is higher than that seen in patients whose tumors lack both receptors. The data currently available suggest that receptor assays carried out on the primary tumor can be used for prediction of subsequent response to endocrine therapy, even at a later time of recurrent disease. Nonetheless, while sequential assays of receptors in lesions from the same patients are likely to be in agreement, when changes occur they tend to be reductions in amount of receptor or loss of receptor during disease progression . Breast cancer patients with receptor-positive tumors appear to have longer disease-free intervals and prolonged survival when compared with patients whose cancers lack ER, but clearly a part of the prolonged survival relates to response to endocrine therapies. Receptor positivity is frequently associated with well-differentiated tumors, while more poorly differentiated cancers, as well as medullary tumors, in general, and possibly cancers with significant lymphocytic infiltration, are more likely to be receptor negative. While there are some problems reproducing the exact quantitative receptor results among various laboratories assaying the same breast cancer, standard biochemical assays are still the only clinically proven and generally accepted procedure for assessing receptor status of a tumor. Histochemical assays based both on the steroid content of a tumor or using steroid-protein fluorescein complexes, while showing some correlation with standard biochemical assays for estrogen receptor, do not appear to detect receptor protein itself and can not be used instead of standard receptor assays. With the recent availability of monoclonal antibodies to the estrogen receptor, newer assays based on immunochemical procedures are under development and can be expected to provide simpler, less expensive, and more useful biochemical as well as immunohistochemical methods for receptor determination.(ABSTRACT TRUNCATED AT 400 WORDS)
TL;DR: Breast cancer incidence and mortality rates in different countries were found to be correlated with height, weight and age at menarche, all of which have been identified as risk factors in cohort or case-control studies of breast cancer.
Abstract: Breast-cancer incidence and mortality rates in different countries were found to be correlated with height, weight and age at menarche, all of which have been identified as risk factors in cohort or case-control studies of breast cancer. There were, however, correlations with total fat and animal protein consumption per capita even after controlling for the 3 anthropometric variables. This suggests that, while some of the effects of diet on breast-cancer rates may be mediated through effects on these known risk factors, there may be more direct effects as well.
TL;DR: Analysis suggests that the risk of breast cancer following radiation exposure is greatest for persons exposed as adolescents, although exposure at all ages carries some risk, and age-specific absolute risk estimates for all studies are remarkably similar.
Abstract: Risk of breast cancer following radiation exposure was studied, based on surveys of tuberculosis patients who had multiple fluoroscopic examinations of the chest, mastitis patients given radiotherapy, and atomic bomb survivors. Analysis suggests that the risk is greatest for persons exposed as adolescents, although exposure at all ages carries some risk. The dose-response relationship was consistent with linearity in all studies. Direct evidence of radiation risk at doses under 0.5 Gy (50 rad) is apparent among A-bomb survivors. Fractionation does not appear to diminish risk, nor does time since exposure (even after 45 years of observation). The interval between exposure and the clinical appearance of radiogenic breast cancer may be mediated by hormonal or other age-related factors but is unrelated to dose. Age-specific absolute risk estimates for all studies are remarkably similar. The best estimate of risk among American women exposed after age 20 is 6.6 excess cancers/10(4) WY-G-Y (10(6) WY-rad).
TL;DR: Serum-calcium dropped to low normal values in all 14 patients, accompanied by a decrease in urine calcium and hydroxyproline excretion-rate, and results show that A.P.D. may inhibit tumour-induced osteolysis.
TL;DR: Excess risk estimates for Hiroshima and Nagasaki did not differ significantly, which indicates that for radiogenic breast cancer the effects of neutrons (emitted only in the Hiroshima explosion) and gamma radiation were about equal.
Abstract: For 1950-74, 360 cases of malignant breast tumors were identified among the 63,000 females of the Radiation Effects Research Foundation's (Hiroshima and Nagasaki) Extended Life-Span Study sample of survivors of the 1945 atomic bombings of Hiroshima and Nagasaki; 288 of these females were residing in one of these two cities at the time of bombing (ATB). Two-thirds of all cases were classified as breast cancers on the basis of microscopic review of slides, and 108 cases received an estimated breast tissue dose of at least 10 rads. The number of cases of radiogenic breast cancer could be well estimated by a linear function of radiation dose for tissue doses below 200 rads. Excess risk estimates, based on this function, for women 10-19, 20-29, 30-39, and 50 years old or older ATB were 7.3, 4.2, 2.6, and 4.7 cases per million women per year per rad, respectively. Women irradiated in their forties showed no dose effect. Among all women who received at least 10 rads, those irradiated before age 20 years will have experienced the highest rates of breast cancer throughout their lifetimes. Separate excess risk estimates for Hiroshima and Nagasaki did not differ significantly, which indicates that for radiogenic breast cancer the effects of neutrons (emitted only in the Hiroshima explosion) and gamma radiation were about equal. Radiation did not reduce the latency period for the development of breast cancer, which was at least 10 years. The distribution of histologic types of cancers did not vary significantly with radiation dose. The data suggested that irradiation prior to menarche conferred a greater risk than irradiation after menarche.
TL;DR: A specific receptor for 1,25-dihydroxyvitamin D has been demonstrated in a cultured human breast cancer cell line, the first such demonstration in any cancer cell.
TL;DR: The œstrogen-receptor content of a primary breast cancer appears to be an independent guide to early recurrence of the disease.
TL;DR: Experimental appraoches are outlined, based on observations such as the finding that the probability of tumor regression correlates better with quantitative rather than qualitative assessment of estrogen receptors, that the specific end product of hormone action is unknown and without this information an ideal biochemical marker to a tumor's sensitivity of hormones is unavailable.
TL;DR: The proliferative activity of breast cancer has been analyzed in relation to the hormonal characteristics of the host and of the tumor for 199 patients and lower levels of ER in premenopausal in comparison to postmenopausal patients were found in low proliferatives activity tumors.
Abstract: The proliferative activity of breast cancer has been analyzed in relation to the hormonal characteristics of the host and of the tumor for 199 patients. The analyses of labeling index frequency distributions of estrogen receptor positive (ER+) and negative (ER-) cancers from premenopausal and postmenopausal patients have allowed us to identify three different kinetic groups. A first group, with a very low proliferative activity, includes ER+ cancers from postmenopausal patients; a second group, with an intermediate proliferative activity, includes ER+ cancers from premenopausal and ER- cancers from postmenopausal patients; and a third group, with a very high proliferative activity, includes ER- cancers from premenopausal patients. Generally, the amount of estrogen receptors in ER+ cancers is inversely correlated with the proliferative activity. Lower levels of ER in premenopausal in comparison to postmenopausal patients were found in low proliferative activity tumors.
TL;DR: In a 10-year prospective study 84 women were treated with a sequential estrogen and progestagen regime and 84 were given placebos; in the placebo group 2 women developed endometrial cancer and 5 developed mammary cancer; however in the treated group all of the women remained free of both types of cancer.
TL;DR: Analysis of survival curves of women with breast cancer suggests that two or more populations exist, with about 40% suffering fatal outcome unaffected by treatment, and the remaining 60% exhibit a relative mortality only modestly different from that of women of similar ages without evidence of disease.
Abstract: Randomized trials comparing surgical treatments of breast cancer show that radical mastectomy offers no greater benefit than simple mastectomy followed by radiotherapy. Furthermore, in terms of survival, radical mastectomy seems to be no better than wide excision followed by radiotherapy when the disease is clinically diagnosed as stage 1. The incidence of diagnosed breast cancer showed an 18% increase between 1935 and 1965 and a 50% increase between 1965 and 1975. However, breast cancer mortality has remained unchanged for at least the past 40 years. Analysis of survival curves of women with breast cancer suggests that two or more populations exist, with about 40% suffering fatal outcome unaffected by treatment. The remaining 60% exhibit a relative mortality only modestly different from that of women of similar ages without evidence of disease. Increasing detection of an entity that is histologically defined as malignant but biologically relatively benign could account for the observed increase in incidence. (JAMA241:489-494, 1979)
TL;DR: The results indicate the need for further study of women with extended periods of OC use, particularly when accompanied by other known risk indicators, to examine whether the usual risk indicators for breast cancer apply to individuals participating in screening programs.
Abstract: Data were obtained by mailed questionnaire from 405 breast cancer patients identified during the first 2 years of operation of the Breast Cancer detection Demonstration Project in the U.S. and from a sample of 1156 normal screenees (response rate = 88%) in an attempt to examine whetHer the usual risk indicators for breast cancer apply to individuals participating in screening programs. No substantial differences were found between the respondents and the nonrespondents for the variables on which information had been obtained at the time of the initial screening. Nearly all of t(e recognized risk factors were seen in this population. The relative risk (FF) of breast cancer was 3.9 among women whose mothers were also affected; this finding was statistically significant. Relative risk was increased for women reporting early menarche late menopause nulliparity late age when 1st child was born and excessive weight. The relative risk was not elevated in women with a prior breast biopsy but was excessive for those with more than 1 biopsy. No association with thyroid medications or menopausal hormones was found. Among women having undergone a natural menopause a nonstatistically significant elevation in the relative risk was noted for long term oral contraceptive users; this excess relative risk was restricted to those using OCs in the presence of breast cancer risk indicators. The results indicate the need for further study of women with extended periods of OC use particularly when accompanied by other known risk indicators.
Journal Article•
TL;DR: Estrogen receptor positivity was associated with a prolonged disease-free interval and there was no association between the presence or absence of progesterone, androgen, or glucocorticoid receptor and disease- free interval.
Abstract: The possibility of an association between steroid hormone receptor status and disease-free interval was examined in 292 patients with breast cancer. Estrogen receptor positivity was associated with a prolonged disease-free interval. This association was independent of age, menopausal status, tumor size, or nodal status. There was no association between the presence or absence of progesterone, androgen, or glucocorticoid receptor and disease-free interval.
TL;DR: Breast cancer patients participating in a prospective randomized clinical trial who were ≤49 years of age, had positive axillary nodes, and who received prolonged l‐phenylalanine mustard as an adjuvant to mastectomy continue (after 4 years) to demonstrate a significantly greater disease‐free survival than do patients who received placebo.
Abstract: Breast cancer patients participating in a prospective randomized clinical trial who were less than or equal to 49 years of age, had positive axillary nodes, and who received prolonged 1-phenylalanine mustard (L-PAM) as an adjuvant to mastectomy continue (after 4 years) to demonstrate a significantly greater disease-free survival (p = .007) than do patients who received placebo. Benefit was achieved in patients who were less than or equal to 39 years as well as those who were 40-49 years of age. Those in the younger age group showed a greater improvement in disease-free survival at 4 years relative to their controls (32% vs. 69%; p = .01) than did those in the older age group (48% vs. 61%; p = .09). When patients were examined relative to their nodal status, a highly favorable effect was found to have been achieved with L-PAM in those with 1-3 positive nodes (54% vs. 86%; p = .006). Results indicate that both age groups were benefited. When considered over time, they demonstrate that a relatively greater effect was achieved in the younger women. While L-PAM failed to significantly alter the disease-free survival of those with greater than or equal to 4 positive nodes a slightly better effect was achieved in the group less than or equal to 39 years. Since adjuvant chemotherapy has been found to be more effective in premenopausal than postmenopausal women, it has been presumed that decreased ovarian function, as a result of the chemotherapy, is responsible for the findings. To support or repudiate that concept, information regarding serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), as well as menstrual function, has been obtained from women receiving L-PAM or L-PAM plus 5-FU therapy. In contrast to findings relative to disease-free survival, ovarian function and menses were most affected in patients 40-49 years of age. Amenorrhea occurred in 73% of patients in that age group and in only 22% of those less than or equal to 39 years (p less than .001). Similarly, a significant increase in LH and FSH and a decrease in E2, all indicative of ovarian suppression, was observed only in the older group of patients. Thus, it is concluded that while ovarian suppression may account for some of the adjuvant chemotherapeutic effect in premenopausal women, the dichotomy of findings in younger and older premenopausal women relative to therapeutic response and ovarian function indicates that other factors could be responsible.
TL;DR: The findings demonstrate the long term effectiveness of relatively short‐term surgical adjuvant combination chemotherapy in pre‐ and postmenopausal patients with breast cancer at righ risk.
Abstract: One hundred women with primary breast cancer with 4 or more metastatic axillary nodes were treated for 9 months postoperatively with vincristine, prednisone, cyclophosphamide, methotrexate, and fluorouracil (VPCMF). Sixty-five women have been observed for a minimum of 5 years or until failure and the rest for 3 years or more. For 73 women who received adjuvant chemotherapy only, observed for 5 1/2 years median, disease-free status by life table analysis is 68% at 8 years. No significance difference was found between response of pre- and postmenopausal women in disease-free interval or survival. Mortality compared to expectation was sharply reduced; only 9 of 73 have died. These findings demonstrate the long term effectiveness of relatively short-term surgical adjuvant combination chemotherapy in pre- and post-menopausal patients with breast cancer at high risk.