Hormone Profiles in Hormone-Dependent Cancers

Studies on the relationship of urinary excretion of androgen metabolites and estrogens to the natural history of breast cancer are reviewed. The importance of distinguishing between “within-population” studies (i.e., cancer patients versus normal controls) and “between population” studies (i.e., low-risk versus high-risk populations) is emphasized, and it is pointed out that “qualitative” agreement (i.e., the same direction of differences) between the two types of studies must be present in order to implicate a hormonal parameter as a determinant of the natural history of breast cancer. For reasons detailed in this paper, it is concluded that the reported relationship of low urinary androgen metabolite excretion to increased risk of developing breast cancer and poor response to adrenalectomy or hypophysectomy and the validity of the “estriol hypothesis,” namely, that a high urinary ratio of estriol to estrone-plus-estradiol in early life is protective against subsequent development of breast cancer, are both dubious. A new hypothesis concerning the relationship of estrogens to breast cancer risk is presented: “A period of time, prior to age 30, during which the amount or biological availability of active estrogens (i.e., estrone and estradiol) is diminished, protects against subsequent development of cancer.” This hypothesis is shown to be compatible with the epidemiological and biochemical data. Reports concerning the influence of nutrition on endocrine parameters are reviewed. Inanition and obesity have been shown to alter steroid metabolism but it is not known whether nutritional “microdifferences” (i.e., differences between populations or individuals that are due to cultural, geographic, or socioeconomic factors, but that fall within the range of “normal” or adequate nutrition) can also alter steroid metabolism.