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A causal link between prolonged estrogen (E) therapy and endometrial cancer is argued for in this report of a case who was treated with large amounts of estrogenic substances almost continuously for an 8-year period. In 1919 a 25-year-old woman was admitted with asthma of 1-year duration. Asthma onset had been very severe, requiring administration of epinephrine hydrochloride every few hours and frequent hospital observation. In 1928, the patient was amenorrheic for 8 months; in 1936, she experienced amenorrhea for 4 months. In 1937 (patient now 45 years old), the relationship between amenorrhea and increased severity of asthma was suspected. At this time, the patient also complained of hot flashes and sweats. Treatment with estrogenic substances was begun in 1937 and continued through 1945. 3 unusual features were noted during therapy: 1) persistence of hot flashes; 2) persistence of high urine titers of follicle stimulating hormone (FSH) despite adequate E doses; and 3) absence of bleeding when E was temporarily withdrawn. By 1945, endometrial cancer had been identified by vaginal smear and verified by biopsy. Because of the previous absence of respose of FSH to prolonged E therapy, Es were omitted for 4 weeks, and after this period
Cancer of endometrium and prolonged estrogen therapy.
Abstract
A causal link between prolonged estrogen (E) therapy and endometrial cancer is argued for in this report of a case who was treated with large amounts of estrogenic substances almost continuously for an 8-year period. In 1919 a 25-year-old woman was admitted with asthma of 1-year duration. Asthma onset had been very severe, requiring administration of epinephrine hydrochloride every few hours and frequent hospital observation. In 1928, the patient was amenorrheic for 8 months; in 1936, she experienced amenorrhea for 4 months. In 1937 (patient now 45 years old), the relationship between amenorrhea and increased severity of asthma was suspected. At this time, the patient also complained of hot flashes and sweats. Treatment with estrogenic substances was begun in 1937 and continued through 1945. 3 unusual features were noted during therapy: 1) persistence of hot flashes; 2) persistence of high urine titers of follicle stimulating hormone (FSH) despite adequate E doses; and 3) absence of bleeding when E was temporarily withdrawn. By 1945, endometrial cancer had been identified by vaginal smear and verified by biopsy. Because of the previous absence of respose of FSH to prolonged E therapy, Es were omitted for 4 weeks, and after this period
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Cancer of endometrium and prolonged estrogen therapy.
Fremont-smith, M.; Meigs, J. V.; Graham, R. M.; Gilbert, H. H.
Journal of the American Medical Association
MEDLINE Abstracts – Jul 6, 1946
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