To the Editor:
—The discussion of the therapy of disseminated mammary carcinoma (JAMA184:306 [April 27] 1963) is based on a concept which has become untenable in the light of accumulated evidence in the past 5 or more years. It amounts to an expression of the idea of estrogen-dependence of the neoplasm, and assigns an unjustified importance to a chronological landmark rather than, correctly, to the woman's endocrinologic age as gauged by the menopause. If estrogen-dependence were the key, the best results of hormonal, additive treatment should be secured by the use of androgens in menstruants. Actually, the proportion of responsive patients with treatment either by androgens or estrogens increases with succeeding decades beyond the menopause. For several years I have used estrogens as the initial treatment of choice in disseminated disease in women who are more than 1 year postmenopausal, with no single observation of augmentation.Although done
Macdonald I. Disseminated Mammary Carcinoma. JAMA. 1963;186(3):273. doi:https://doi.org/10.1001/jama.1963.03710030113026
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