Abstract
Epidemiological evidence suggests that dietary fat may be an aetiological factor for breast cancer. In this study the plasma lipid profile and prolactin on first presentation are compared with the same analysis in patients benign breast disease. When matched for menopausal status, the plasma concentration of total lipids, phospholipids, triglycerides, cholesterol, B-lipoproteins and free fatty acids were higher in patients with cancer than in those with benign disease. Patients with duct papilloma had plasma concentrations of total lipids, and total cholesterol that were higher than those of patients with other benign disease not significantly different from those of the cancer patients. In contrast, the concentration of triglycerides, and free fatty acids were lower than in cancer patients and similar to those in patients with other non-cancerous breast disease. It is suggested that these results support the view that lipids are associated with the development of breast cancer. This may be by aiding the retention in the body of carcinogen. It is also possible that the blood lipid profile is secondary to hormon changes which predispose certain women to develop breast cancer. The mean concentration of prolactin was higher in individuals with cancer than in those with benign disease patients. In both groups prolactin levels were higher in pre-than in postmenopausal, patients. In cancer, but not in non-cancer patients, prolactin was positively correlated with total plasma lipid concentration after, but not before, the menopause. These relationships are discussed in relation to a possible link between prolactin, blood lipids and aetiology of breast cancer. Human breast cancer is probably of multifactorial aetiology, and the present findings would be in agreement with some involvement of dietary fat. Immediately after surgery in the cancer patients there was a fall in the plasma concentration of total lipids, phospholipids, cholesterol B-lipoproteins. During the same period there was a rise in the concentration of free fatty acids and HDL-cholesterol. Total lipids, phospholipids and triglycerides had regained their preoperative values by 28 days. The orthopaedic surgery study was undertaken to assess the metabolic response to trauma in patients having either emergency surgery or elective surgery for femoral neck fractures. This study also provided data for comparison with that obtained in the breast cancer patient in order to make it possible to identify changes which are more likey to be of general occurrence, rather than being limited to occurring after mastectomy. Twenty-seven elderly patients who had undergone surgery to treat, a fractured neck of femur were included in the study. Blood samples were taken 48 hours, 7 days and 14 days postoperatively. A preoperative baseline sample was obtained in the elective surgery group. Analysis of the plasma samples revealed a significant fall in the total lipids, total cholesterol and triglycerides in the immediate postoperative period in the elective surgery group. However, the concentration of HDL-cholesterol rose significantly during the same period. In the emergency group the HDL-cholesterol fell on the seventh day, but regained its pre-operative value by the second week. The downward trend in total lipids, total cholesterol, and triglycerides, in the immediate post-operative period, may conceal a high plasma lipid concentration prior to injury, so that the patient may not be recognized as being hyperlipidaemic due to the lowering effect of the trauma. The marked fall in the concentration of cholesterol was associated with trauma regardless of the pathological state of the patients.