On the Bimodal Age Distribution of Mammary Carcinoma

Waard, F. de; Laive, J. W. J. de; Halewijn, E.A. Baanders-van

doi:10.1038/bjc.1960.47

Cited by 78 publications

(41 citation statements)

References 11 publications

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“…This may indicate a bimodal distribution arising from existence of two types of breast cancer occurring before and after the menopause and affected predominantly by activity of the ovarian and adrenal glands respectively (de Waard et al, 1960). Indications that cancers appearing before middle age tend to be influenced by previous sex and marital history (Stocks, 1955) whereas those occurring later are often accompanied by hypertension and obesity support this hypothesis.…”

mentioning

confidence: 97%

Breast Cancer Anomalies

Stocks¹

1970

Br J Cancer

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SUMMARY.-The death rate from breast cancer among females in England and Wales which had been falling during at ages before 45 increased from 1960 to 1967; and at ages 45-64 there has been a progressive increase ever since 1955. Regional rates at the early ages were considerably higher in Greater London than in the north until 1961, but the difference then gradually disappeared; and at higher ages an excess in the south over that in the north and Wales has persisted at ages 45-64.Whilst the total mortality from breast and uterine cancers combined has shown little regional variation, the proportion of breast cancer in the total has been consistently higher in the south than in the north, and possible implications of this are discussed. Breast cancer rates in the regions are positively associated with the dietary intake per person of butter, cheese, liquid milk and green vegetables but this in itself does not prove a causative connection.SINCE it is incredible that during 1948-68 treatment of breast cancer has become less effective for survival or that certification of it as the cause of death has become appreciably more accurate, recent upward trends of age-specific death rates from the disease in England and Wales must indicate an increasing incidence of new cases and need serious attention.One of the unresolved problems uncovered by epidemiological studies of breast cancer is the curious dip or flattening of the incidence curve which occurs, in Scandinavian countries most notably, about the age of the menopause. This may indicate a bimodal distribution arising from existence of two types of breast cancer occurring before and after the menopause and affected predominantly by activity of the ovarian and adrenal glands respectively (de Waard et al., 1960). Indications that cancers appearing before middle age tend to be influenced by previous sex and marital history (Stocks, 1955) whereas those occurring later are often accompanied by hypertension and obesity support this hypothesis. If there is any truth in the dual nature of the associated factors one would expect that the relative trends of mortality over a period of years in different parts of the country might not be the same at ages under 45 as at later ages.

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confidence: 97%

Breast Cancer Anomalies

Stocks¹

1970

Br J Cancer

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“…DeWaard (1960) and his associates suggested that obesity might increase the risk of breast cancer in the postmenopausal women. Generally, obesity is not more frequently seen in Japanese women than in Western women.…”

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confidence: 99%

Biological Characteristics of Breast Cancer in Obesity

Abe

Kumagai

Kimura

et al. 1976

Tohoku J. Exp. Med.

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“…The hypothesis was advanced that premenopausal breast cancer was the result of an endocrine dysfunction involving ovarian oestrogens, whereas the post-menopausal type involved adrenal oestrogens (De Waard et al, 1960, 1964. A two-disease mathematical model has been described by Manton and Stallard (1980) based on American breast cancer mortality rates which successfully predicted the age frequency of breast cancer deaths over an age range of 25-94 years.…”

Section: Discussionmentioning

confidence: 99%

Urinary androgens and breast cancer risk: results from a long-term prospective study based in Guernsey

2000

Climacteric

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It would be very useful if it were possible to identify, within an apparently normal population, those who will develop breast cancer. Although this can be achieved by genetic testing for mutations of BRCA1 and BRCA2, such susceptibility genes are involved in the aetiology of only about 5% of breast cancer cases (Lynch and Lynch, 1986). By contrast, events related to a woman's menstrual and reproductive history, which have been widely recognized as determinants of breast cancer incidence, are not impressive predictors of individual risks. Such poor predictive performance could result from these epidemiological variables being only manifestations of other underlying factors. Indeed the size of the effects of the menstrual and reproductive variables and the observation that breast cancer rates change over a woman's life have stimulated investigation of endogenous sex hormones as potential causes underlying these observed effects (Key and Pike, 1988;Toniolo et al, 1995;Key et al, 1996). Methodological issues related to hormone measurements, however, complicate the study of their relationship with breast cancer. Furthermore, there is no general consensus regarding which biological forms of these hormones are actually associated with the observed changes in incidence rates.The role of steroids in the aetiology of breast cancer is uncertain. Extensive analysis of the scientific literature shows a highly significant increase in blood oestradiol levels in post-menopausal women with breast cancer (Thomas et al, 1997). The position of oestrogens and premenopausal women is uncertain (Key and Pike, 1988; Thomas et al, 1997). Androgens have been studied less extensively than oestrogens and no meta-analysis has yet been undertaken.The first prospective study in this field was performed by Bulbrook and Hayward who showed that levels of androsterone (A) and aetiocholanolone (E) were abnormally low in women who subsequently developed breast cancer (Bulbrook and Hayward, 1967;Bulbrook et al, 1971). Most of the cases were premenopausal and the abnormality was present up to 11 years before the clinical diagnosis of the disease, suggesting that high levels of androgen metabolites might have a protective effect, at least in younger women. However, other mainly retrospective casecontrol studies have claimed that high androgen excretion is positively associated with breast cancer risk (e.g. Secreto and Zumoff, 1994). Such contrasting results could be reconciled if the effects of androgens depended on menopausal status. This would occur if the androgens acted as oestrogen inhibitors in premenopausal women and as oestrogen enhancers (or even oestrogens) in the postmenopausal (Secreto and Zumoff, 1994;Adams, 1998 Summary Between 1961 and 1967 a cohort of over 5000 women volunteered for a prospective study to determine the relationship between the urinary androgen metabolites, androsterone (A) and aetiocholanolone (E), and risk of breast cancer. During the first 10 years of the study the concentration of urinary A and E was determined in 1...

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On the Bimodal Age Distribution of Mammary Carcinoma

Cited by 78 publications

References 11 publications

Breast Cancer Anomalies

Breast Cancer Anomalies

Biological Characteristics of Breast Cancer in Obesity

Urinary androgens and breast cancer risk: results from a long-term prospective study based in Guernsey

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