H growth of breast cancer. The pituitary, adrenals, ovaries, and testes have all been implicated. In the female, the oldest historical factor relates to the ovaries. In 1889, Schin-zinger19 suggested that since breast cancer seemed to be worse in younger women, they should be made older by removing the ovaries. This would allow the cancer to be encapsulated in the breast tissue undergoing atrophy. Surgical castration was proposed as a rational therapeutic approach to cancer of the breast.19. 2O Since then, investigators have repeatedly demonstrated the favorable effect of castration in advanced breast cancer.
Disagreement has existed for many years as to the proper time to perform castration: at the initial primary tumor therapy or later when recurrent disease is manifest. Recently, Kennedy et al.13 demonstrated that regardless of when castration was performed, total survival time from initial tumor therapy to death is the same. In view of these findings, it was concluded that castration should be performed when metastatic disease is manifest. The result provides an index to the hormonal responsiveness of the tumor and is a guide to the subsequent selection of other hormonal or chemical therapies.
The present report presents the effectiveness of therapeutic castration in advanced breast cancer and the course of patients treated by subsequent or secondary therapies.
Methods
Therapeutic castration was performed in 177 patients from 1931 to 1961; 150 of the patients were treated after 1945. Irradiation to the ovaries was carried out in 123 patients and bilateral ovariectomy in 54 patients. All TABLE 1 STAGE OF PRIMARY BREAST CANCER AT TIME OF INITIAL THERAPY COMPARED TO SUBSEQUENT RESPONSE TO CASTRATION Castration, no. pt. Stage Non-Total primary Responders responders no. pt.