Breast cancer is a complex disease. Its aetiology is multifactorial,
its period of development can span decades, and its
clinical course is highly variable. Evaluation of the role of the immune
response in either the development or control of
breast cancer is also complex. Nevertheless, there is substantial information
that in this disease, the immune response is
not a host defence reaction and may even serve to facilitate cancer development.
This evidence comes from a variety of
sources including clinical–pathological investigations in women that
show a correlation between the intensity of lymphocytic infiltration into
the tumour mass with poor prognosis, studies in breast cancer patients
that demonstrate a similar
correlation between delayed hypersensitivity reactivity or in vitro
assays of immune reactivity to tumour cell membranes
or non-specific antigens and poor prognosis, and analyses of cancer
incidence in chronically immunosuppressed, kidney
transplant recipients who develop an unexpectedly low incidence of breast
cancer. The overall conclusions from these
human studies are corroborated by observations in mouse mammary tumour
models that also demonstrate immune
enhancement of breast cell proliferation in vitro and of breast
cancer development in vivo. Potential mechanisms for these
effects include production, by inflammatory cell infiltrates, of direct
or indirect modulators of breast cell growth, e.g.
cytokines, peptide or steroid hormones, enzymes involved in steroid
metabolism, as well as of antibodies to growth factors
or their receptors. These immune facilitatory mechanisms must be overcome
if immune-based therapies are to be applied successfully in breast cancer.