Biological Principles of Endocrine Therapy
Breast cancer is the leading cause of cancer death in women in the United States. Breast cancer is one of a group of neoplasms arising in target tissues which are physiologically dependent on hormones (others are prostate, endometrium, etc.). The normal development of the female breast requires the action of many hormones: estrogen, progesterone, prolactin, insulin, growth hormone, adrenal steroids, and thyroid hormone. This hormonal milieu will be closely related to the development and progression of breast cancer. Even though it is a heterogeneous tumor, there is an abundance of epidemiologic, experimental, and clinical data supporting an important and indispensable role by endocrine factors (Table 1). Evidence for a hormonal role in cancer comes from oophorectomy-induced regression of breast cancer in premenopausal women (1896), and from castration-induced regression of prostate cancer in elderly men (1941). The precise role of hormones in carcinogenesis is unclear, but might include: initiator, whereby interacting with DNA can lead to the development of the malignant state; promoter, promoting the carcinogenic action of other carcinogens; permissive role, allowing carcinogenic events to occur.
KeywordsEstrogen Testosterone Flare Tamoxifen Glucocorticoid
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