EVERY cigarette smoker does not develop lung cancer and so factors other than smoking must determine whether or not this disease develops. I have been investigating the possibility that hormones are involved in the development of lung cancer, and have measured the content of individual and total 17-oxosteroids and total 17-hydroxycorticosteroids (17-OHcs) in the urine of patients and controls. I found that patients with lung cancer excreted less androsterone (3α-hydroxy-5α-androstan-17-one), compared with its 5β-isomer aetiocholanolone, and more 17-OHcs than normal subjects1. Low androsterone excretion in patients with lung cancer had been reported before2. The mean ratios of androsterone to aetiocholanolone and of androsterone to 17-OHcs in eighty-four patients were significantly (P < 0.00001) lower than those of 100 normal men and of fifty-two control patients with chest diseases other than lung cancer (hospital controls). In fact the ratio of 17-OHcs to androsterone can be used as a diagnostic test for lung cancer with an accuracy of about 90% (Fig. 1). When the differences between cancer patients and controls were combined by linear discriminant analysis1, more than 90% of patients had negative discriminant scores whereas more than 90% of normal men had positive scores.
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