Oestrogen receptors and survival in early breast cancer
BMJ (Clinical Research Edition)
597 protruding upper ends of the metal uprights in certain types of older cot (30 January, p 351). On 28 January 1982 I had a similar case of a 1-year-old baby boy who had been given a feed and then put into the cot by his mother, who went to have a rest. He was wearing a knitted woollen jumper with small open spaces in the pattern. The sleeve of the jumper appeared to have caught in the fittings of the cot and the baby's arm had come out of the sleeve. The neck of the jumper had acted as a
... had acted as a ligature around the baby's neck and in this case, tragically, death had occurred. Perhaps general practitioners visiting babies in their homes should draw the attention of mothers to the potential hazard of this type of cot, particularly for the older and more active infant. M A WOODHOUSE County Laboratory, Dorchester, Dorset DT1 IXD I thank Mr M Johnston, HM Coroner for West Dorset, for permission to submit this letter. Oestrogen receptors and survival in early breast cancer SIR,-There is considerable optimism about the value of oestrogen receptor analysis in breast cancer,' though some reservations have also been noted.2 We hope that it will prove to be an important aid in patient management. However, the conclusions that oestrogen receptor status is an independent prognostic indicator in breast cancer, as suggested by Mr R Croton and others (28 November, p 1289), and that determination of the oestrogen receptor level in breast tumours is essential to the selection of patients for therapy regimens3 are, we believe, premature. There are, for instance, wide interlaboratory differences in reporting the oestrogen receptor status of the same tumour, and oestrogen receptor status may well vary at different sites within the same tumour.4 We have recently looked at our own five-year survival figures for a small series of patients with operable breast cancer treated in Yorkshire from 1972 to 1975, in each of whom oestrogen receptor analysis was performed on the primary tumour (figure). All patients were treated by mastectomy and received radiotherapy if axillary lymph nodes were invaded. Results have been included only when we were certain that tissue handling and transport satisfied the strict criteria required by our laboratory. The assay used was the multiple point, dextran-coated charcoal method, and the cut-off point used was 12 fmol/mg cytosol protein. The series comprised 292 patients, of whom 172 (59 ?) were oestrogen receptor positive and 100C 80 X229 80 LA~~~~"~x 2 =2 98 p =008 b60 40 ", Oestrogen receptor positive ---172 20 Oestrogen receptor negative -120 C 16 32 48 64 80 Time ( mths) Survival in women with breast cancer with and without oestrogen receptors. 120 oestrogen receptor negative. There were 66 and 59 deaths respectively with behaved-toexpected ratios of 0-88 and 1 99. The two survival curves move in the generally accepted direction up to five years, with oestrogen-receptor-positive women having the better prognosis. At five years the curves cross; and beyond this point, although the numbers are too small to be of value, there appears to be no benefit for the oestrogen-receptorpositive women. We have not further analysed this series by tumour grade, clinical stage, or lymph node status, all of which are important prognostic factors. We are at present analysing data from a much larger group of women (1200) with primary operable breast cancer, treated from 1975 to 1980, in whom we have measured as many prognostic variables as possible, including oestrogen receptors. We hope that we will then be in a better position to define more clearly the role of oestrogen-receptor analysis in prognosis. However, at present it may be premature for clinicians in Britain to take therapeutic action on the basis of an oestrogen receptor result.