The stimulus for progressive proliferation in human breast cancer depends on the hormonal secretions which influence normal mammary growth. The alteration of the hormonal milieu is known to modify the proliferation pattern of tumor cells for varying periods of time. The difficulty is that 50% of all breast cancers are primarily hormone-independent and nonresponsive to hormone therapy, while an increasing proportion of hormone-dependent tumors develop secondary independence during their course.30 The availability of modalities for varying the hormonal environment are many and the clinician managing the patient with disseminated cancer generally follows a scheme in which he sequentially selects the addition or subtraction of hormones. Let us examine the rationale for selection and study the physiologic vs the pragmatic factors influencing our choice.
The primary axiom is alteration of the existent hormone state. The choice of ablative procedures in the premenopausal woman is logical in that hormone deprivation, specifically
Rubin P. Comment: The Basis for Selection of Hormonal Addition or Subtraction. JAMA. 1967;200(11):977–978. doi:10.1001/jama.1967.03120240105020
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