- Email: [email protected]
GROWING UP TODAY
140
Claims
are
recent review
TREATMENT OF ADVANCED BREAST CANCER
still made for every new treatment. In a of a ten-year study of pertussis, hyperimmune
DESPITE many reports in the past decade on the use of androgens and oestrogens in metastatic breast cancer, doubt still surrounds some aspects of this treatment. In the last of a series of reports which began in 1947 the American Medical Associationdescribes a twelve-year collaborative study of the effects of administering androgens or oestrogens to nearly two thousand patients with disseminated breast cancer. Of the 1983 cases submitted, only 944 were included in the analysis. Of these, 580 were treated with various androgenic hormones, and in this group the overall
gamma-globulin was strongly recommended, although " biostatical proof is lacking as to its efficiency ". A carefully controlled trial showed that there was no evidence that this had any effect on the disease.4 Since pertussis is still lethal to children, particularly under 1 year old, every effort should be made to immunise those at risk. This, with early diagnosis and isolation, and with antibiotics to control secondary infection, should further reduce both the incidence and the severity of
pertussis.
regression-rate was 21.4% (regression was strictly defined
GROWING UP TODAY
as a distinct and measurable decrease in one or more of in reminded us a the dominant metastatic lesions with no progression of lately broadcast,5 young people are growing up faster nowadays. any other metastases and no evidence of new growth). During the past century the age of puberty has come down Androgen treatment was as effective in premenopausal from about seventeen to thirteen years, and not only has as in postmenopausal women and was equally effective growth been speeded but the final sizes attained are against metastases in viscera, soft tissue, and bone. larger. Vigorous, thriving teenagers are a welcome Patients who responded to treatment survived significantly addition to the nation, but there have been signs that longer than those who did not respond (nineteen months early development is causing difficulties for some. For compared with ten months). The regression-rate in 364 instance, a disturbing increase in cases of gonorrhoea in patients treated with various oestrogens was 36-8%; this the 18-19 age-groupwas reported some months ago, group included only 7 premenopausal patients. The and last week the National Council for the Unmarried average survival of patients who responded to treatment Mother and Her Child recordedtheir grave concern was 27-3 months, compared with 10’4 months in at the extreme youth of so many of the girls who came those who failed to respond-a highly significant to them for help. The Council see with regret many girls difference. whose youth renders them incapable of supporting or Direct comparison of the regression-rates with andro. understanding the responsibility of motherhood, with gens and with oestrogens would not be valid since a subtheir school lives broken and disrupted, and their home stantial proportion of the patients treated with androgens conditions unnaturally complicated. were premenopausal. When the whole series was broken Many young people seek to solve their problems by down according to age, there appeared to be a higher early marriage and in this they are helped by high wages remission-rate with oestrogens than with androgens; but and hindered by the housing shortage. But it is a solution the differences were not significant except for the group which may impose responsibility prematurely, and the aged 70 and above. With cestrogens, the remission-rate Council are receiving an increasing number of letters for soft-tissue lesions (breast, skin nodules, and lymphfrom married couples who ask " if we can treat their nodes) in postmenopausal women was 40.7%, whereas legitimate children as illegitimate and help to get them with androgens it was only 18%. Moreover oestrogens adopted ". Some of these are young couples who are were at least as effective as androgens in the control of students; others are living in expensive furnished rooms skeletal metastases. The older the patient at the start with heavy hire-purchase commitments; others have of treatment with either type of hormone, the greater was been forced into marriage by their parents. the chance of regression. In cases where the menopause Sex education seems a sensible way of meeting the: intervened between the primary treatment and recurrence situation, but the needs of some children at any rate will the free period was over seven years (compared with not be met by conventional notions of content andl roughly three years in others). one London school teacher 8 in At least conversatiming. When administration of hormones to patients with tion with a class of 14-year-old boys living in a so-called disseminated breast cancer fails to check the disease, the " tough area was met with requests not to give them any last effective treatment is endocrine ablation. Three of this birds and bees nonsense ". Many of the boys had papers concerned with this subject have lately appeared their concern was for in these columns. Mr. Atkins and his colleaguesat already had sexual experience and information on such topics as " how can I avoid getting Guy’s Hospital compared the clinical results of adrenalv.D. ? " These young people are of course only a minority ectomy with those of hypophysectomy, the patients being of their age-group. But the whole cohort is living in a randomly selected for either operation. Hypophysectomy world to whose difficulties their elders have made a proved marginally the better operation, judged by the substantial contribution. The social pattern is changing state of the patients three months after operation and only slowly in response to modifications in the physio- the length of survival. These workers found no relation logical pattern; and meantime many of our customs and between the response to hormone administration and to values are actively unhelpful to those who have had ablative treatment. The longer the duration of the physical maturity thrust upon them at a time which is disease, the greater was the chance of remission. The inconvenient to society but may be biologically approGuy’s workers3 reported two years ago that the ratio of priate. the 11-deoxy- to the 11-oxy-17-ketosteroids (determined before operation) correlated with the patient’s response 3. Kaufman, S., Bruyn, H. B. A.M.A.J. Dis. Child. 1960, 99, 417.
As Dr. Alex Comfort has
.
4. Morris, D., McDonald, J. C. Arch. Dis. Childh. 1957, 32, 236. 5. Listener, July 7, 1960, p. 25. 6. See Lancet, 1960, ii, 1396. 7. Report for 1959-60. Obtainable from 21, Coram Street, London, W.C.1. 8. Guardian, July 4, 1960, p. 8.
J. Amer. med. Ass. 1960, 172, 1271. Atkins, H. J. B., Falconer, M. A., Hayward, J. L., MacLean, K. S., Schurr, P. H., Armitage, P. Lancet, 1960, i, 1148. 3. Allen, B. J., Hayward, J. L., Merivale, W. H. H. ibid. 1957, i, 496, 1. 2.
Claims
are
recent review
TREATMENT OF ADVANCED BREAST CANCER
still made for every new treatment. In a of a ten-year study of pertussis, hyperimmune
DESPITE many reports in the past decade on the use of androgens and oestrogens in metastatic breast cancer, doubt still surrounds some aspects of this treatment. In the last of a series of reports which began in 1947 the American Medical Associationdescribes a twelve-year collaborative study of the effects of administering androgens or oestrogens to nearly two thousand patients with disseminated breast cancer. Of the 1983 cases submitted, only 944 were included in the analysis. Of these, 580 were treated with various androgenic hormones, and in this group the overall
gamma-globulin was strongly recommended, although " biostatical proof is lacking as to its efficiency ". A carefully controlled trial showed that there was no evidence that this had any effect on the disease.4 Since pertussis is still lethal to children, particularly under 1 year old, every effort should be made to immunise those at risk. This, with early diagnosis and isolation, and with antibiotics to control secondary infection, should further reduce both the incidence and the severity of
pertussis.
regression-rate was 21.4% (regression was strictly defined
GROWING UP TODAY
as a distinct and measurable decrease in one or more of in reminded us a the dominant metastatic lesions with no progression of lately broadcast,5 young people are growing up faster nowadays. any other metastases and no evidence of new growth). During the past century the age of puberty has come down Androgen treatment was as effective in premenopausal from about seventeen to thirteen years, and not only has as in postmenopausal women and was equally effective growth been speeded but the final sizes attained are against metastases in viscera, soft tissue, and bone. larger. Vigorous, thriving teenagers are a welcome Patients who responded to treatment survived significantly addition to the nation, but there have been signs that longer than those who did not respond (nineteen months early development is causing difficulties for some. For compared with ten months). The regression-rate in 364 instance, a disturbing increase in cases of gonorrhoea in patients treated with various oestrogens was 36-8%; this the 18-19 age-groupwas reported some months ago, group included only 7 premenopausal patients. The and last week the National Council for the Unmarried average survival of patients who responded to treatment Mother and Her Child recordedtheir grave concern was 27-3 months, compared with 10’4 months in at the extreme youth of so many of the girls who came those who failed to respond-a highly significant to them for help. The Council see with regret many girls difference. whose youth renders them incapable of supporting or Direct comparison of the regression-rates with andro. understanding the responsibility of motherhood, with gens and with oestrogens would not be valid since a subtheir school lives broken and disrupted, and their home stantial proportion of the patients treated with androgens conditions unnaturally complicated. were premenopausal. When the whole series was broken Many young people seek to solve their problems by down according to age, there appeared to be a higher early marriage and in this they are helped by high wages remission-rate with oestrogens than with androgens; but and hindered by the housing shortage. But it is a solution the differences were not significant except for the group which may impose responsibility prematurely, and the aged 70 and above. With cestrogens, the remission-rate Council are receiving an increasing number of letters for soft-tissue lesions (breast, skin nodules, and lymphfrom married couples who ask " if we can treat their nodes) in postmenopausal women was 40.7%, whereas legitimate children as illegitimate and help to get them with androgens it was only 18%. Moreover oestrogens adopted ". Some of these are young couples who are were at least as effective as androgens in the control of students; others are living in expensive furnished rooms skeletal metastases. The older the patient at the start with heavy hire-purchase commitments; others have of treatment with either type of hormone, the greater was been forced into marriage by their parents. the chance of regression. In cases where the menopause Sex education seems a sensible way of meeting the: intervened between the primary treatment and recurrence situation, but the needs of some children at any rate will the free period was over seven years (compared with not be met by conventional notions of content andl roughly three years in others). one London school teacher 8 in At least conversatiming. When administration of hormones to patients with tion with a class of 14-year-old boys living in a so-called disseminated breast cancer fails to check the disease, the " tough area was met with requests not to give them any last effective treatment is endocrine ablation. Three of this birds and bees nonsense ". Many of the boys had papers concerned with this subject have lately appeared their concern was for in these columns. Mr. Atkins and his colleaguesat already had sexual experience and information on such topics as " how can I avoid getting Guy’s Hospital compared the clinical results of adrenalv.D. ? " These young people are of course only a minority ectomy with those of hypophysectomy, the patients being of their age-group. But the whole cohort is living in a randomly selected for either operation. Hypophysectomy world to whose difficulties their elders have made a proved marginally the better operation, judged by the substantial contribution. The social pattern is changing state of the patients three months after operation and only slowly in response to modifications in the physio- the length of survival. These workers found no relation logical pattern; and meantime many of our customs and between the response to hormone administration and to values are actively unhelpful to those who have had ablative treatment. The longer the duration of the physical maturity thrust upon them at a time which is disease, the greater was the chance of remission. The inconvenient to society but may be biologically approGuy’s workers3 reported two years ago that the ratio of priate. the 11-deoxy- to the 11-oxy-17-ketosteroids (determined before operation) correlated with the patient’s response 3. Kaufman, S., Bruyn, H. B. A.M.A.J. Dis. Child. 1960, 99, 417.
As Dr. Alex Comfort has
.
4. Morris, D., McDonald, J. C. Arch. Dis. Childh. 1957, 32, 236. 5. Listener, July 7, 1960, p. 25. 6. See Lancet, 1960, ii, 1396. 7. Report for 1959-60. Obtainable from 21, Coram Street, London, W.C.1. 8. Guardian, July 4, 1960, p. 8.
J. Amer. med. Ass. 1960, 172, 1271. Atkins, H. J. B., Falconer, M. A., Hayward, J. L., MacLean, K. S., Schurr, P. H., Armitage, P. Lancet, 1960, i, 1148. 3. Allen, B. J., Hayward, J. L., Merivale, W. H. H. ibid. 1957, i, 496, 1. 2.