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Endocrine Treatment of Breast Cancer in Women

Department of Medicine, Divisions of Endocrinology and Oncology, The Milton S. Hershey Medical Center, The Pennsylvania State University Hershey, Pennsylvania 17033
Department of Biostatistics, University of Pittsburgh Graduate School of Public Health Pittsburgh, Pennsylvania 15261

Correspondence: Address requests for reprints to: Richard J. Santen, M. D., Department of Medicine, Division of Endocrinology, The Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania 17033.

Abstract

I. Introduction: Hormonal therapy for breast carcinoma began with the observation by George Beatson (1) in 1898 that bilateral oophorectomy caused tumor regression in selected premenopausal patients. Huggins and Bergenstal (2) later introduced surgical adrenalectomy as a form of hormone ablative treatment for postmenopausal women. To these methods were added surgical hypophysectomy and hormonal additive therapies such as the use of androgens, estrogens, progestins, and glucocorticoids (3). Since only one-third of patients experienced objective tumor regression with any of these hormonal therapies, clinicians began to favor use of cytotoxic chemotherapies in the 1960s and 1970s. During this time multiple chemotherapeutic regimens were developed which gained wide acceptance and enthusiastic support (3). However, when hormone receptor measurements were introduced in the mid-1970s, better selection of patients with hormonally responsive tumors became possible, and new impetus was provided for optimizing hormonal therapies. These developments led to the accumulation of a large body of clinical data regarding hormonal agents and provided clinicians with a broad armamentarium for the treatment of patients at the present time. We will summarize this information with the goals of highlighting specific endocrinological aspects of breast cancer treatment and providing practical perspective for choosing among various agents. Where recent comprehensive reviews are readily available, only pertinent concepts are highlighted.

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