Reduced estriol excretion in patients with breast cancer prior to endocrine therapy

Abstract

The urinary quotient of estriol/estrone + estradiol-17 [beta] (Eq) was measured chemically in women with and without breast cancer, as an index of the ratio of noncarcinogenic impeded estrogens to mammary carcinogenic estrogens. In 34 controls, the median Eq was 1. 3 before and 1. 2 after menopause, with only 21% of the patients subnormal. In 26 breast cancer patients without endocrine treatment or recent surgery, the median Eq was 0. 5 and 0. 8 respectively, with 62% of the patients subnormal. After major surgery or hormonal therapy, only 23% of 53 patients were subnormal, no remissions being observed unless the Eq rose toward normal. Matching of 24 controls and patients in pairs by age and ovarian status in the Wilcoxon test indicated that the decreased Eq excreted in untreated cancer was significant at the 0.2% confidence level. The marked increase in Eq induced by castration and androgen, estrogen, and corticosteroid therapy suggests that normalization of a precancerous metabolic imbalance between impeded and active estrogens derived from ovarian and adrenocortical sources contributed to arrested growth of estradiol-dependent metastases.