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Beatson identified the fact that some breast cancers responded to oophorectomy. Equally, some did not but the surgical procedures carried considerable morbidity. In the more recent years of additive endocrine therapy, there is still a very good case for only giving first-line endocrine therapy to those patients who will definitely benefit from it. There is now convincing evidence from many fields that breast cancers are only steroid hormone sensitive if the majority of cells contain functional oestrogen receptors. Further evidence shows that the extent of response is proportional to the amount of receptor present in the tumour. Thus, there is a case for measuring receptor content by both a biochemical (quantitative) assay and an immunohistochemical assay (semi-quantitative but also a measure of extent of heterogenicity). Steroid receptor content is very useful as a predictive tool for response to endocrine therapy but has limited use as a prognostic index. Overall, biological markers of tumour growth and invasive potential should only be used as combinations which may be useful in specific clinical subgroups. Nevertheless, tumour receptor content is an important/essential piece of information that should be established in the primary tumour of every breast cancer patient. Receptor status is remarkably constant from initial detection to death and so therapies should be geared to keeping receptor-mediated therapies useful, rather than basing treatment on the concept that steroid-sensitive tumours become totally insensitive as they progress.

Endocrine-Related Cancer (1997) 4 289-296

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