THE BREAST CANCER DISCRIMINANT: EFFECT OF AGE, OBESITY, HIRSUTISM, STARVATION, AND CHANGES IN ADRENOCORTICAL AND GONADAL ACTIVITY

Abstract

SUMMARY The relationship between 17-oxogenic steroid excretion and the urinary output of certain 17-oxosteroids has been widely used to select women with metastatic breast cancer for ablation of endocrine organs. In this report, the effect of factors other than breast cancer on the ratio of androsterone plus aetiocholanolone to the 17-oxogenic steroids in urine is examined. For 83 normal women the mean value of the ratio was 0·351 ± 0·121 (s.d.). In menstruant women the ratio did not correlate with oestrogen excretion, and was little affected by increasing age, the taking of oral contraceptive tablets, obesity, and the presence of reversible amenorrhoea. Factors causing a marked reduction in the ratio were the absence of functional ovaries (47 women, mean ratio 0·116 ± 0·066), food deprivation (15 obese women, mean decrease by the 9th day of starvation, 53·4 ± 11·7%), and adrenocortical stimulation (14 women, mean decrease on day 2 of corticotrophin infusion, 52·0 ± 17·0%). Suppression of adrenocortical function with dexamethasone treatment caused no systematic change in the value of the ratio, and hirsutism was associated with a significant increase (67 women, mean value 0·447 ± 0·165). The variability of the ratio from day to day in individual women (coefficient of variation, 20·7%) suggests that it is inadvisable to select patients for treatment on the basis of measurements made on a single 24 h sample of urine.