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June 27, 1977

Estrogen Therapy and Metastatic Breast Cancer

JAMA. 1977;237(26):2812. doi:10.1001/jama.1977.03270530020005

To the Editor.—  Stimulation of breast cancer by estrogen therapy is a phenomenon, though rare, that has been appreciated for many years. Huseby1 reported its occurrence in less than 1% in his series. Various manifestations have been reported as evidence of tumor stimulation, such as hypercalcemia, increase in bone pain, and progression of soft tissue disease. At times it is difficult to determine whether the observations noted indicate exacerbation, spontaneous progression, or a nonspecific estrogen effect. We had an unusual encounter with a patient in whom such excruciating pain developed after administration of one 5-mg tablet of diethylstilbestrol that acute pancreatitis was considered in the differential diagnosis.

Report of a Case.—  A 58-year-old woman underwent left radical mastectomy in 1959 and received postoperative radiation therapy. She did well until January 1974, when pains in her back and chest cage developed. Roentgenograms revealed extensive osteolytic metastases throughout the skeleton. She had