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July 4, 1980

Medical adrenalectomy may replace surgery for advanced breast cancer

JAMA. 1980;244(1):9-10. doi:10.1001/jama.1980.03310010005001

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Surgical adrenalectomy as a treatment for advanced breast cancer in postmenopausal women may soon become obsolete.

A group of physicians at the Hershey Medical Center, Hershey, Pa, has demonstrated that pharmacologic antiestrogenic therapy suppresses estrogen secretion as effectively as surgical adrenalectomy and is at least as effective in producing objective tumor regression.

Since 1896 it has been known that in many women breast cancer regresses after removal of the ovaries. With the more recent understanding that estrogens promote the growth of tumors bearing estrogen receptors, surgeons have been able to apply oophorectomy, adrenalectomy, and hypophysectomy more selectively to those patients most likely to benefit. Even so, up to 50% of women with estrogen receptor-positive breast cancer do not show improvement after surgical endocrine ablation.

This is a high failure rate for an operation that is considered major surgery and carries up to a 5% risk of death, and it has