Hormone Receptor Positive Breast Cancer Status
As part of the staging process for confirmed breast cancer tumors, a pathological-histological evaluation of a biopsy sample will be conducted. In addition to visual features under the microscope, such as:-
- the shapes of the cells
- the cell formation
the pathologist will also test the tumor to determine the levels of expression for various hormones, proteins, and hormone receptors.
This process is typically undertaken through the injection of the tumor sample with ‘dyes‘ that react chemically with certain proteins contained in in the breast tumor.
Determining the hormone receptor status of a given breast cancer will give the doctors information on how fast the tumor is growing. Also, whether or not there is evidence of cell damage and death. In addition, doctors will determine the particular genetic ‘type‘ of cells which have become malignant. Finally, medics will try to determine how the breast carcinoma will likely respond to chemotherapy and endocrine therapy treatments.
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Estrogen and progesterone give ‘fuel’ to breast tumor growth
Some breast cancers feature malignant cells which have an abnormally high level of estrogen and/or progesterone ‘receptors’ in the nucleus.
Estrogen and progesterone are hormones which more or less give ‘fuel’ to cancer growth. Breast cancers with high levels of estrogen or progesterone receptors are often described as ER/PR ‘positive’.
On the one hand, it means that the breast cancer may be somewhat more ‘aggressive’, and prone to grow quickly.
On the other hand, breast cancers which have higher levels of estrogen and progesterone receptors are highly receptive to endocrine therapy (hormone-based chemotherapy) and are easier to overcome.
High progesterone levels could potentially increase breast cancer risk
Progesterone is a steroid hormone associated with the female reproductive process. So, this hormone is critical for normal female development and growth. In fact, during puberty it is an inflammatory response to progesterone within the breast which actually stimulates breast development. During this response, a certain type of white blood cell (a macrophage) moves into the breast as part of a normal body response to inflammation. But it is actually the presence of these macrophages that create a risk of breast cancer development in the future.
Macrophages create blood vessels to deliver nutrients, that in turn feed nutrients to any emerging breast cancer tumors. In additon, the effects of progesterone are amplified in the presence of estrogen. Estrogen receptors actually regulate the uptake of progesterone receptors. Long term ‘voluntary‘ exposure to progesterone, for example through post menopausal hormone replacement therapy, can significantly increase a woman’s risk of breast cancer development.
Endocrine breast cancer therapy interferes with ER and PR hormone uptake
Endocrine therapy frequently involves treatment with either tamoxifen or an aromatase inhibitor. These agents interfere with the hormone receptors in the breast cancer cells, making it very difficult for the malignant cells to grow and spread. As a result, hormone-receptor positive tumors generally have a better outlook than hormone-receptor negative breast tumors.
In other words, the hormone receptor positive breast cancer status can help ‘predict‘ how the cancer will behave. In that sense, the hormone receptor status of a breast tumor is more of a predictive indicator rather than a prognostic indicator.
Hormone Receptor Positive Breast Cancer has a more favorable outlook following diagnosis
About 70% of all invasive breast cancers demonstrate positive ER expression. Estrogen functions as a ‘transcription factor’ and is an essential element in the tumorigenesis, differentiation, and growth of breast cancer tumors. Nonetheless, women with ER and PR positive breast tumors do have a lower mortality risk following diagnosis as compared to women with either ER- PR+, or ER- PR- breast tumors. Furthermore, women with ER and PR receptor negative tumors also tend to show HER-2 overexpression, which has also been shown to exert a negative influence on breast cancer outlook.
Q&A on hormone receptor status
Why is testing for hormone receptor statuses important?
Testing for hormone receptors are important because the results help you can your doctor decide whether the cancer is likely to respond to hormonal therapy or other treatments. Hormonal thereapy includes medications that either 1) lower the amount of estrogen into your body or 2) block estrogen from supporting the growth and function of breast cells. If the brest cancer cells have hormone receptors, then these medications could help to slow or even stop their growth. If the cancer is hormone receptor negative (no receptors are present), then hormonal therapy is unlikely to work. You and your doctor will then have to choose another kind of treatment.
What do hormone receptors do?
It’s worth noting that some breast cancers that are hormone receptor positive can lose their receptors over time. The opposite is also true: hormone receptor negative cancers can gain receptors. If the breast cancer recurs in the future as advanced disease, doctors should order a repeat biopsy and retest the cancer for hormone receptors. However, if the cancer cells no long have receptors, hormonal therapy is unlikely to help treat the cancer. If the cells have gained hormone receptors, however, then hormonal therapy may be helpful.
How do you read the hormone receptor test results?
Most testing labs use a special staining process that makes the hormone receptors show up in a sample of breast cancer tissue, The test is called an immunohistochemical staining assay, or ImmunoHistoChemistry (IHC). Not all labs use the same method for analyzing the results of the test, and they do not have to report the results in exactly the same way. So you may see any of these on your pathology report: 1) a percentage that tells you how many cells out of 100 stain positive for hormone receptors, 2) an allred score between 0 and 8, and 3) the word ‘positive’ or ‘negative’.
What are some known treatments for hormone receptor positive breast cancer?
Hormone therapy works by lowering the amount of estrogen in the body or blocking estrogen from attaching to the breast cancer cells. You and your doctor will work together to decide which form of hormonal therapy is best in your situation. Topics you may discuss include other feature of the breast cancer, such a stage; other medical conditions you may havel whether or not you have been through menopause (menstrual periods have stopped), and your personal preference.
What are the main types of hormonal therapy?
Selective estrogen-receptor response modulators, aromatase inhibitors, estrogen-receptor downregulators, and/or luteinizing hormone-releasing hormone agents.
What are some treatments for hormone receptor negative breast cancer?
If you’ve been told that you have hormone receptor negative breast cancer, you may be worried. It might feel like you’re missing out on the potential that hormonal therapies have for treating breast cancer. It is also impoprtant to know that treatments such as surgery, radiation therapy, and chemotherapy are very effective against breast cancer – whether it’s hormone receptor positive or negative. Research also suggests that hormone receptor negative breast cancers may respond better to chemotherapy.
Why is hormone receptor status testing done?
Knowing the hormone receptor status of the tumor helps doctors predict how well the breast cancer is likely to respond to hormonal therapy, how the tumor may behave, and what other treatments may be effective.
What if hormone receptor statuses recur?
Sometimes breast cancer may come back after it has been treated. A biopsy tissue from a tumor may be done to confirm the diagnosis of breast cancer recurrence or to rule out a new primary breast cancer. Hormone receptor status may be rechecked at this time. Women whose first tumors were ER positive may develop ER negative tumors at the time of recurrence. This is an important prognostic factor because the tumor may respond poorly to additional hormone therapy. The cancer may respond to hormonal therapy if a recurrence occurs several years after the first diagnosis of breast cancer and the first tumor was hormone receptor negative.
References
- Jardines, L., Haffty, BG., Fisher, P.,Weitzel, J., Royce, M.,Breast cancer overview Risk factors, screening, genetic testing, and prevention . Chapter 8 in “Cancer Management: A multidisciplinary approach.”
- Altamirano, CC., Gomez, HL, Carlos, VE., Cruz, WR., Velarde, RG., Garces, MR>, Suazo, JF., Viduarre, T., Neciosup, SP., Sologuren, CV. Prognostic effect of hormone receptor status in early HER2-positive breast cancer. J Clin Oncol 28 (2010)
- Althuis MD, Fergenbaum JH, Garcia-Closas M, Brinton LA, Madigan MP, Sherman ME. Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomarkers Prev.(Oct. 2004) 13(10):1558-68.
- Bao PP, Shu XO, Gao YT, Zheng Y, Cai H, Deming SL, Ruan ZX, Su Y, Gu K, Lu W, Zheng W. Association of Hormone-Related Characteristics and Breast Cancer Risk by Estrogen Receptor/Progesterone Receptor Status in the Shanghai Breast Cancer Study. Am J Epidemiol. (July 2011)
- Dunnwald, LK., Rossing, MA., Li, CI.,Hormone Receptor Status, Tumor Characteristics, and Prognosis: A Prospective Cohort of Breast Cancer Patients Breast Cancer Research. (2007);9(1)
And some more references …
- Parl FF, Schmidt BP, Dupont WD, Wagner RK: Prognostic significance of estrogen receptor status in breast cancer in relation to tumor stage, axillary node metastasis, and histopathologic grading. Cancer 1984, 54:2237-2242.
- Bardou VJ, Arpino G, Elledge RM, Osborne CK, Clark GM: Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases. J Clin Oncol (2003), 21:1973-1979.
- Li CI, Daling JR, Malone KE: Incidence of invasive breast cancer by hormone receptor status from 1992 to 1998. J Clin Oncol (2003), 21:28-34.
- Pourzand, A., Bassir, M., Fakhree, A., Hashemzadeh, S., Halimi, M., Daryani, A., Hormone Receptor Status in Breast Cancer and its Relation to Age and Other Prognostic Factors. Breast Cancer: Basic and Clinical Research (2011) 5:87-92
- Fitzgibbons PL, Page DL, Weaver D, Thor AD, Allred DC, Clark GM, et al. Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med (2000);124(7):966-78.
- Elledge RM, Green S, Pugh R, Allred DC, Clark GM, Hill J, et al. Estrogen receptor (ER) and progesterone receptor (PgR), by ligand-binding assay compared with ER, PgR and pS2, by immuno-histochemistry in predicting response to tamoxifen in metastatic breast cancer: a Southwest Oncology Group Study. Int J Cancer (2000);89(2):111-7
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