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August 14, 1967

Carcinoma of the Breast in Pregnancy and Lactation

JAMA. 1967;201(7):529. doi:10.1001/jama.1967.03130070049013

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Several decades ago, carcinoma of the breast first diagnosed during pregnancy or lactation acquired an evil reputation. Some clinicians concluded that the association was so ominous that such women were categorically inoperable. The unfavorable course of these patients was thought to be due to high levels of hormonal production characteristic of pregnancy and lactation. These dismal convictions of incurability became most prevalent in the decade after Lacassagne11 produced experimental murine breast cancer by the use of diethylstilbestrol. From this classic demonstration, a number of extrapolative assumptions were derived, some of which still becloud clinical thinking today. Although investigations in later years showed basic disparities in breast cancer in mice and women, there is a persistent belief in the importance of estrogens in the causation of mammary carcinoma in women and as an incitant of its pattern of growth. A corollary phobia is the supposed hazard of substitutional therapy with