The Changing Role of Castration in Breast Cancer Patients

  • H. J. Stewart
Conference paper


All who are involved with the care of young women with breast cancer must be aware that it is now 100 years since George Beatson (1896) when only 47 years of age, dared to remove the ovaries of a 33-year-old Glasgow woman with progressing recurrent disease. A rapid and convincing remission occurred but, despite reporting this in the Lancet a year later, it was not until the 1930s that real interest in ovarian ablation developed. A few earlier reports had confirmed the effectiveness of the procedure but it was when Taylor (1934) first suggested the possibility of benefit from removing the ovaries at the time of mastectomy that interest seemed to increase. For the next 30 years the results of many small retrospective series were published with indirect comparisons of outcome from early (prophylactic or adjuvant) with that from late (post-relapse or “therapeutic”) ovarian ablation. Conflicting conclusions were drawn but the balance of opinion was in favour of the therapeutic approach, largely because of the dramatic and sometimes prolonged responses which could occur. It was argued that early ablation would be unnecessary in 40% and that the tumour would be unresponsive in 75% of the remainder leaving only 15% to benefit from prophylactic therapy.


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  1. Beatson GT (1896) On the treatment of inoperable cases of carcinoma of the mamma: suggestions for a new method of treatment, with illustrative cases. Lancet 2: 104–107CrossRefGoogle Scholar
  2. Blarney RW, Jonat W, Kaufmann M et al (1992) Goserelin depot in the treatment of premenopausal advanced breast cancer. Eur J Cancer 28A: 810–814Google Scholar
  3. Boyle TJ, O’Boyle CJ, McNamara A, Geoghegan I, Given HF (1995) Laparascopic Oophorectomy: an adjuvant therapy in primary premenopausal breast cancer (Abstr). Scientia 3: 6Google Scholar
  4. Brinkley D, Haybittle JL (1969) The late effects of artificial menopause by X-radiation. Br J Radiol 42: 519–521PubMedCrossRefGoogle Scholar
  5. Bryant AJS, Weir JA (1981) Prophylactic oophorectomy in operable instances of carcinoma of the breast. Surg Gynecol Obstet 153: 660–664PubMedGoogle Scholar
  6. Cole MP (1975) A clinical trial of an artificial menopause in carcinoma of the breast. Horm Breast Cancer INSERM 55: 143–150Google Scholar
  7. Early Breast Cancer Trialists’ Collaborative Group (1992) Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy: 133 randomised trials involving 31000 recurrences and 24000 deaths among 75000 women. Part 1. Lancet 339: 1–15Google Scholar
  8. Fisher B, Costantino J, Redmond C et al (1989) A randomised clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 320: 479–484PubMedCrossRefGoogle Scholar
  9. Forrest APM (1969) Breast Cancer Symposium: points in the practical management of breast cancer. Br J Surg 56: 782–784PubMedCrossRefGoogle Scholar
  10. International Breast Cancer Study Group (1990) Late effects of adjuvant oophorectomy and chemotherapy upon premenopausal breast cancer patients. Ann Oncol 1: 30–35Google Scholar
  11. Johansson BW, Kaij L, Kullander S, et al (1975) On some late effects of bilateral oophorectomy in the age range 15–30 yrs. Acta Obstet Gynecol Scand 54: 449–461PubMedCrossRefGoogle Scholar
  12. Langlands AO, Prescott RJ, Hamilton T (1980) A clinical trial in the management of operable cancer of the breast. Br J Surg 67: 170–174PubMedCrossRefGoogle Scholar
  13. Meakin JW, Allt WEC, Beale FA et al (1977) Ovarian irradiation and prednisone following surgery for carcinoma of the breast. In: Salmon SE, Jones SE (eds) Adjuvant therapy of cancer. Elsevier/North-Holland, Amsterdam, pp 95–99Google Scholar
  14. Nemoto T (1973) Treatment of early breast cancer: survey of surgeons. NY State J Med 1901–1904Google Scholar
  15. Nevinny HB, Nevinny D, Rosoff CB, Hall TC, Muench H (1969) Prophylactic oophorectomy in breast cancer therapy: a preliminary report. Am J Surg 117: 531–536CrossRefGoogle Scholar
  16. Nissen-Meyer R (1964) Prophylactic endocrine treatment in carcinoma of the breast. Clin Radiol 15: 152–160PubMedCrossRefGoogle Scholar
  17. Ravdin RG, Lewison EF, Slack NH, Gardner B, State D, Fisher B (1970) Results of a clinical trial concerning the worth of prophylactic oophorectomy for breast cancer. Surg Gynecol Obstet 131: 1055–1064PubMedGoogle Scholar
  18. Rose DP, Davis TE (1977) Ovarian function in patients receiving adjuvant chemotherapy for breast cancer. Lancet 1: 1174–1176PubMedCrossRefGoogle Scholar
  19. Rosenberg L, Hennekens CH, Rosner B, Belanger C, Rothman KJ, Speizer FE (1981) Early menopause and the risk of myocardial infarction. Am J Obstet Gynecol 139: 47–51PubMedGoogle Scholar
  20. Scottish Cancer Trials Breast Group (1993) and ICRF Breast Unit, Guy’s Hospital, London: Adjuvant ovarian ablation versus CMF chemotherapy in premenopausal women with pathological stage II breast carcinoma: the Scottish trial. Lancet 341: 1293–1298Google Scholar
  21. Stewart HJ (1970) Oophorectomy response as an index to further endocrine ablation. In: Joslin CAF, Gleave EN (eds) The clinical management of advanced breast cancer. Alpha Omega, Cardiff, pp 12–20Google Scholar
  22. Taylor GW (1934) Artificial menopause in carcinoma of the breast. N Engl J Med 211: 1138–1140CrossRefGoogle Scholar
  23. Vingerling JR, Dielemans I, Witteman JCM et al (1995) Macular degeneration and early menopause: a case-control study. Br Med 310: 1570–1571CrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1996

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  • H. J. Stewart

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