Breast cancer is probably the most frequent and fatal neoplasm in women of the western world, and it causes more fear, suffering and morbidity than any other disease in our times. It is also one of the most costly diseases not only in "lost earnings" but also in terms of physical and psychic energy spent and skills used for the many aspects of its care. Furthermore, the incidence of this tumor is slowly but steadily increasing while our means of treating it remain ineffec tive in distressingly many patients. Breast cancer thus represents an increasing threat to public health. The clinician…mehr
Breast cancer is probably the most frequent and fatal neoplasm in women of the western world, and it causes more fear, suffering and morbidity than any other disease in our times. It is also one of the most costly diseases not only in "lost earnings" but also in terms of physical and psychic energy spent and skills used for the many aspects of its care. Furthermore, the incidence of this tumor is slowly but steadily increasing while our means of treating it remain ineffec tive in distressingly many patients. Breast cancer thus represents an increasing threat to public health. The clinician responsible for the management of patients with this distressing disease has found himself, in recent years more than ever before, in a very awkward state of uncertainty. Many of his tradi tional views or practices have been questioned. The new concepts challenging his position are based on evidence at times so esoteric that, being often unable to comprehend it, he may subconsciously tend to distrust it. To his further dismay, clinicians and investigators of equal caliber and repute in this field disagree so widely and on so many important issues that he can no longer refer to an authoritative source for guidance; his horizons are therefore blurred and the stage is set for confusion. Much of what underlies the current controversy stems from our ignorance concerning the etiology of breast cancer and our inability to comprehend the many eccentricities of its clinical behavior.
1 Endocrine Considerations.- 1.1 Estrogens and Ovarian Activity.- 1.1.1 Clinical Observations.- 1.1.2 The Evidence in the Male.- 1.1.3 Other Observations.- 1.1.4 Epidemiologic Studies.- 1.1.5 Laboratory Endocrine Findings.- 1.2 Estrogens from the Gut.- 1.3 Other Hormones.- 1.3.1 Progesterone.- 1.3.2 Androgens.- 1.3.3 Thyroid Hormones.- 1.3.4 Corticosteroids.- 1.3.5 Pituitary Hormones.- 1.4 Oral Contraceptives.- 1.4.1 General Considerations.- 1.4.2 Side-Effects in the Breast.- 1.4.3 Other Effects.- 1.4.4 Contraceptives and Neoplasms of the Breast.- 1.5 Steroid Excretion and Tryptophan Metabolism.- 1.6 Summary and Conclusions.- References.- 2 Genetic Considerations.- 2.1 Epidemiologic Observations.- 2.1.1 Female Breast.- 2.1.2 Familial Predisposition.- 2.1.3 Male Breast Cancer.- 2.2 Experimental Observations.- 2.2.1 Endocrine Studies.- 2.2.2 Chromosomal Changes.- 2.2.3 IR Genes and HL-A Antigens.- 2.3 Blood Group Associations.- 2.4 Genetics of Apocrine Glands.- 2.5 Summary and Conclusions.- References.- 3 Viral Considerations.- 3.1 Experimental Data.- 3.1.1 Historical Notes.- 3.1.2 General Properties of Murine Mammary Tumor Virus.- 3.1.3 Reverse Transcriptase.- 3.1.4 Viral Transmission.- 3.1.5 Tumor Induction.- 3.1.6 Tumor Prevention.- 3.2 The Evidence in Man.- 3.2.1 Virus Isolation and Identification.- 3.2.2 The Possible Route of Viral Transmission.- 3.3 Endogenous RNA Virus Oncogenesis.- 3.4 The Significance of Viral Studies.- 3.5 Summary and Conclusions.- References.- 4 Immunologic Considerations.- 4.1 Experimental and General Observations.- 4.1.1 Tumor-Specific Transplantation Antigens.- 4.1.2 Fetal Antigens in Tumors.- 4.1.3 Immunosurveillance, Immunosuppression and Oncogenesis.- 4.1.4 Genetic Control of Immune Response.- 4.1.5 The Immunostimulation Hypothesis.- 4.1.6 Nonimmunologic Surveillance.- 4.2 The Evidence in Man.- 4.2.1 Clinical Observations.- 4.2.2 The Clinical Consequences of Impaired Immunity.- 4.2.3 Morphologic Evidence of Immunity.- 4.2.4 Tumor-Associated Antigens.- 4.2.5 Cell-Mediated Immunity.- 4.2.6 Humoral Immunity.- 4.3 Thymus and Breast Cancer.- 4.3.1 Animal Data.- 4.3.2 Observations in Man.- 4.4 Lymphocyte Counts in Breast Cancer.- 4.5 Hormonal Modulation of Immune Responses.- 4.5.1 Corticosteroids.- 4.5.2 Estrogens and Androgens.- 4.5.3 Growth Hormone and Thyroxine.- 4.5.4 Progestogens.- 4.5.5 Other Hormones.- 4.6 Summary and Conclusions.- References.- 5 Miscellaneous.- 5.1 Trauma.- 5.2 Socioeconomic and Other Factors.- 5.2.1 Socioeconomic Status.- 5.2.2 Histology.- 5.2.3 Epidemiology of Survival.- 5.2.4 Relationship to Other Illnesses or Factors.- 5.3 Association with Benign Breast Conditions.- 5.4 Association with Other Cancers.- 5.4.1 Second Primaries.- 5.4.2 Multicentricity and Bilaterality.- 5.4.3 Possible Etiologic Associations.- 5.5 Miscellaneous Other Studies.- 5.5.1 Enzyme Studies.- 5.5.2 Nuclear DNA Abnormalities.- 5.5.3 Nature of Autonomy of Breast Tumors.- 5.5.4 Inducible Enzymes and Chemical Carcinogenesis.- 5.6 Environmental Temperature.- 5.7 Radiation Exposure.- 5.7.1 Carcinogenic Potential on the Human Breast.- 5.7.1 Possible Effects of Diagnostic Procedures.- 5.7.1 Immunosuppression after Mediastinal Radiotherapy.- 5.8 Dietary and Chemical Factors.- 5.8.1 Fats.- 5.8.2 Proteins.- 5.8.3 Other Foodstuffs.- 5.8.4 Environmental Carcinogens.- 5.8.5 Carcinogens in Food.- 5.8.6 Drugs.- 5.9 Sebaceous Glands and Breast Cancer.- 5.9.1 Considerations on Sebaceous Gland Function.- 5.9.2 Sebum Excretion in Breast Cancer Patients.- 5.9.3 A Possible Endocrine Interpretation.- 5.10 Psychological Factors.- 5.10.1 Animal Studies.- 5.10.2 Emotional Status of Women with Breast Cancer.- 5.10.3 Psychological Stress and Carcinogenesis.- 5.11 Summary and Conclusions.- References.- 6 Concluding Remarks.- 6.1 Generalities.- 6.2 The Comparative Importance of Carcinogenic Factors in Man.- 6.3 Implications for Therapy and Prevention.
1 Endocrine Considerations.- 1.1 Estrogens and Ovarian Activity.- 1.1.1 Clinical Observations.- 1.1.2 The Evidence in the Male.- 1.1.3 Other Observations.- 1.1.4 Epidemiologic Studies.- 1.1.5 Laboratory Endocrine Findings.- 1.2 Estrogens from the Gut.- 1.3 Other Hormones.- 1.3.1 Progesterone.- 1.3.2 Androgens.- 1.3.3 Thyroid Hormones.- 1.3.4 Corticosteroids.- 1.3.5 Pituitary Hormones.- 1.4 Oral Contraceptives.- 1.4.1 General Considerations.- 1.4.2 Side-Effects in the Breast.- 1.4.3 Other Effects.- 1.4.4 Contraceptives and Neoplasms of the Breast.- 1.5 Steroid Excretion and Tryptophan Metabolism.- 1.6 Summary and Conclusions.- References.- 2 Genetic Considerations.- 2.1 Epidemiologic Observations.- 2.1.1 Female Breast.- 2.1.2 Familial Predisposition.- 2.1.3 Male Breast Cancer.- 2.2 Experimental Observations.- 2.2.1 Endocrine Studies.- 2.2.2 Chromosomal Changes.- 2.2.3 IR Genes and HL-A Antigens.- 2.3 Blood Group Associations.- 2.4 Genetics of Apocrine Glands.- 2.5 Summary and Conclusions.- References.- 3 Viral Considerations.- 3.1 Experimental Data.- 3.1.1 Historical Notes.- 3.1.2 General Properties of Murine Mammary Tumor Virus.- 3.1.3 Reverse Transcriptase.- 3.1.4 Viral Transmission.- 3.1.5 Tumor Induction.- 3.1.6 Tumor Prevention.- 3.2 The Evidence in Man.- 3.2.1 Virus Isolation and Identification.- 3.2.2 The Possible Route of Viral Transmission.- 3.3 Endogenous RNA Virus Oncogenesis.- 3.4 The Significance of Viral Studies.- 3.5 Summary and Conclusions.- References.- 4 Immunologic Considerations.- 4.1 Experimental and General Observations.- 4.1.1 Tumor-Specific Transplantation Antigens.- 4.1.2 Fetal Antigens in Tumors.- 4.1.3 Immunosurveillance, Immunosuppression and Oncogenesis.- 4.1.4 Genetic Control of Immune Response.- 4.1.5 The Immunostimulation Hypothesis.- 4.1.6 Nonimmunologic Surveillance.- 4.2 The Evidence in Man.- 4.2.1 Clinical Observations.- 4.2.2 The Clinical Consequences of Impaired Immunity.- 4.2.3 Morphologic Evidence of Immunity.- 4.2.4 Tumor-Associated Antigens.- 4.2.5 Cell-Mediated Immunity.- 4.2.6 Humoral Immunity.- 4.3 Thymus and Breast Cancer.- 4.3.1 Animal Data.- 4.3.2 Observations in Man.- 4.4 Lymphocyte Counts in Breast Cancer.- 4.5 Hormonal Modulation of Immune Responses.- 4.5.1 Corticosteroids.- 4.5.2 Estrogens and Androgens.- 4.5.3 Growth Hormone and Thyroxine.- 4.5.4 Progestogens.- 4.5.5 Other Hormones.- 4.6 Summary and Conclusions.- References.- 5 Miscellaneous.- 5.1 Trauma.- 5.2 Socioeconomic and Other Factors.- 5.2.1 Socioeconomic Status.- 5.2.2 Histology.- 5.2.3 Epidemiology of Survival.- 5.2.4 Relationship to Other Illnesses or Factors.- 5.3 Association with Benign Breast Conditions.- 5.4 Association with Other Cancers.- 5.4.1 Second Primaries.- 5.4.2 Multicentricity and Bilaterality.- 5.4.3 Possible Etiologic Associations.- 5.5 Miscellaneous Other Studies.- 5.5.1 Enzyme Studies.- 5.5.2 Nuclear DNA Abnormalities.- 5.5.3 Nature of Autonomy of Breast Tumors.- 5.5.4 Inducible Enzymes and Chemical Carcinogenesis.- 5.6 Environmental Temperature.- 5.7 Radiation Exposure.- 5.7.1 Carcinogenic Potential on the Human Breast.- 5.7.1 Possible Effects of Diagnostic Procedures.- 5.7.1 Immunosuppression after Mediastinal Radiotherapy.- 5.8 Dietary and Chemical Factors.- 5.8.1 Fats.- 5.8.2 Proteins.- 5.8.3 Other Foodstuffs.- 5.8.4 Environmental Carcinogens.- 5.8.5 Carcinogens in Food.- 5.8.6 Drugs.- 5.9 Sebaceous Glands and Breast Cancer.- 5.9.1 Considerations on Sebaceous Gland Function.- 5.9.2 Sebum Excretion in Breast Cancer Patients.- 5.9.3 A Possible Endocrine Interpretation.- 5.10 Psychological Factors.- 5.10.1 Animal Studies.- 5.10.2 Emotional Status of Women with Breast Cancer.- 5.10.3 Psychological Stress and Carcinogenesis.- 5.11 Summary and Conclusions.- References.- 6 Concluding Remarks.- 6.1 Generalities.- 6.2 The Comparative Importance of Carcinogenic Factors in Man.- 6.3 Implications for Therapy and Prevention.
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