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Biomedical subjects

B A Stoll

Publications and source records attributed to B A Stoll.

At least 55 records · Page 3Linked to original sources
PubMed1992

Selection of young women with high-risk breast cancer for adjuvant systemic therapy.

Biological criteria of tumour aggressiveness have recently been recommended for use in selecting high-risk cases for adjuvant systemic therapy after primary treatment of breast cancer. Without them, the clinician has considerable difficulty in balancing the morbidity of cytotoxic therapy against the possible benefits. Consistent evidence that patients under the age of 35 years have the worst prognosis of all age groups, while those in the 45-49 age group have the best prognosis, should help in a decision on suitable adjuvant treatment for either node-positive or node-negative young women with breast cancer.

Adult↗
PubMed1992

Does extra height justify a higher risk of breast cancer?

While there are no firm data with respect to its oncogenic potential in the human breast, increasing evidence of the mitogenic activity of IGF on breast tissue at the time of puberty suggests caution in the use of recombinant growth hormone in the treatment of short prepubertal girls. This applies to those without evidence of classic growth hormone deficiency, particularly in the presence of a family history of breast cancer.

Adolescent↗
PubMed1992

New hormone-related markers of high risk to breast cancer.

New markers of increased risk to breast cancer are examined and related to established risk markers. The following new evidence is highlighted: (1) Increased testosterone secretion by the ovaries is currently the only major steroid abnormality shown to be associated with increased risk of both premenopausal and postmenopausal breast cancer. (2) Upper body-type obesity is a marker for both hyperandrogenaemia and hyperinsulinaemia and is associated with an increased risk of breast cancer. Upper body type obesity may already be recognised in early puberty in caucasian girls and is associated with a characteristic androgen/oestrogen profile. (3) Relative tallness in women is associated with an increased risk of breast cancer. A hypothesis is offered on the significance of these markers in the aetiology of mammary cancer in women, and also a means of testing the hypothesis. The hormonal promotion of mammary carcinogenesis is likely to be greatest between puberty and the first full term pregnancy. The presence of hyperinsulinaemia can increase the ovarian production of androgen, and the abnormal hormonal profile may stimulate proliferative activity in mammary epithelium. This may increase the risk of epithelial atypia and carcinogenesis.

Age Factors↗
PubMed1992

Breast cancer risk in Japanese women with special reference to the growth hormone-insulin-like growth factor axis.

Earlier physical maturity in girls, involving an earlier and more marked growth hormone spurt and also an earlier menarche, is a marker of subsequent higher risk to breast cancer. Based on the results of recent research, it is postulated that interaction between growth hormone, insulin-like growth factor and sex steroids at an earlier age, has a major role in stimulating not only linear growth but also precocious proliferative activity in the breasts of adolescent girls. This may promote carcinogenesis in a susceptible mammary epithelium and could partly account for the rising breast cancer mortality rate among both Japanese and Western women.

Body Height↗
PubMed1991

Overprolonged adjuvant tamoxifen therapy in breast cancer.

While adjuvant tamoxifen therapy given continuously for 2-3 years can lead to a modest improvement in survival rates in early breast cancer, there is no evidence that prolonging tamoxifen administration beyond that time is likely to improve survival rates any further in unselected cases. In the case of advanced disease, an alternating tamoxifen/progestagen regimen has been shown to increase the response rate and also its duration, beyond that to be expected from either agent alone. The next generation of adjuvant trials in breast cancer needs to explore the potential of an alternating tamoxifen/megestrol regimen.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Quantifying the risk of breast cancer.

Although all women are potentially breast cancer sufferers, we need to develop a risk index in order to recognize the most vulnerable. Multiple promoting factors are suspected in breast cancer and recent research suggests that different types of clinical risk factor may interact to multiply a women's risk. Such women require skillful counselling with more frequent monitoring and advice about possible protective measures.

Adult↗
PubMed1990

Approaches to breast cancer prevention.

It may be possible to delay the step-by-step progression towards frank invasive cancer by avoiding one or more of the well-known clinical risk factors. In addition current clinical trials in the USA and Europe are assessing whether the use of tamoxifen, vitamin analogues or a low-fat diet can delay the appearance of overt disease in women known to be at high risk, but it will be several years before such trials can be evaluated. For women seeking advice on prevention, non-toxic supplements to the diet such as beta-carotene, vitamin A analogues or selenium compounds, and the avoidance of alcohol and obesity, are examples of practical advice which can do no harm yet may help to protect against breast cancer development. In the case of the very anxious first degree relative of a breast cancer patient, the current choice lies essentially between regular monitoring, mastectomy with reconstruction, early termination of ovarian activity and anti-oestrogen therapy. Currently, considerable research is being directed towards identifying oncogenes and growth factors which are involved in the growth of breast cancer. In the meantime, more research needs to be devoted to the effect of various progestagens in counteracting oestrogen support of breast cancer growth, and to biological observations on different formulations and doses of combined oestrogen/progestagen preparations which may reduce breast cancer risk both in pre- and postmenopausal women.

Breast Neoplasms↗
PubMed1990

Choosing between cancer patients.

The leading ethical problem in medical practice for the coming decade is likely to be how to select patients for priority. Criteria for such decision-making in the case of cancer patients are discussed. Clinicians, ethicists and others need to agree guidelines on giving priority to one patient over another when resources are limited, and such criteria need to be approved by society at large. The public must accept that in a non-explicit rationing system, each individual competes with every other. In the case of even more difficult ethical choices, a multidisciplinary national committee is required to advise on decision-making, and its views need to be debated by the general public.

Advisory Committees↗
PubMed1989

Hormone replacement therapy in women treated for breast cancer.

We must still maintain the conventional advice that unopposed low dosages of oestrogen should not be used for the treatment of menopausal symptoms in women treated previously for breast cancer. There is, however, epidemiological, laboratory and clinical evidence that certain combinations of oestrogen and progestagen are more likely to be beneficial than harmful, in respect to the risk of reactivating subclinical residual breast cancer or causing progression in premalignant lesions. It is no longer justifiable to deprive a woman with a history of breast cancer treatment of a hormonal therapy capable of safely relieving symptoms which are making her life intolerable. A clinical trial of such treatment is reported.

Breast Neoplasms↗