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Therapeutic vs Prophylactic Castration

Edward F. Lewison, MD
JAMA. 1967;200(7):614-615. doi:10.1001/jama.1967.03120200092018.
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During the past 75 years the rival merits of prophylactic vs therapeutic castration have been vigorously championed more or less empirically by many clinicians concerned with the total treatment of breast cancer. In premenopausal patients with operable breast cancer, is it wiser to perform prophylactic castration as an adjunct to mastectomy or is it wiser to reserve this procedure for the palliative treatment of recurrent or metastatic disease? This is, indeed, the doctor's dilemma! As long as the practice of medicine continues to be a "science of uncertainty and an art of probability" then the patient's "destiny trembles in the balance, and the preponderance of either scale is by our own choice."

Therapeutic Castration.—  It is quite obvious that ovarian hormones have a profound effect on hormonesensitive cancers of the breast. The remarkable clinical response of some tumors of the breast to therapeutic castration certainly confirms this concept. This beneficial


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