The significance of steroid metabolism in human cancer

Epidemiological and clinical evidence suggests that steroid hormones are intimately involved in the natural history of many cancers, including those of the breast, endometrium and prostate. However, it has been difficult to demonstrate that progressive changes in tumour development are related to circulating levels of steroids. This may be because further metabolism of steroids occurs locally within the tumour and its adjacent host tissue. Using the breast as an example, data has been reviewed that such local metabolism may (a) markedly change the biological potency of steroid hormones and (b) be associated with the risk, presence, pathology, stage and hormone sensitivity of cancer. The implications of these findings are discussed including the need to identify factors which regulate steroid metabolism in peripheral tissue and tumours. In this way the potential to influence the microenvironment around and within tumour cells may be realized in favour of the patient.