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When Hormones Fuel Breast Cancer


Medically Reviewed On: August 13, 2003

Women who have been recently diagnosed with breast cancer are often overwhelmed with the amount of information they need to make informed decisions about their care. First there are decisions about surgery, and then decisions about follow-up treatment to help prevent recurrence. One highly important piece of information, which helps determine future treatment, is the cancer's hormone-receptor status. By testing for the estrogen-receptor and progesterone-receptor proteins, pathologists can determine whether a particular breast cancer uses hormones to stimulate its growth. Breast cancers that require hormones to grow are called hormone-receptor positive, and can be treated with different hormonal treatments that block or otherwise inhibit the circulation of estrogen in the body.

Below, Dr. D. Lawrence Wickerham, the associate chairman of the National Surgical Adjuvant Breast and Project (NSABP) and an associate professor of human oncology at Drexel University in Pittsburgh, discusses the significance of hormone receptor status.

How long have doctors understood the role of the female hormone estrogen in breast cancer?
The impact of estrogen on breast cancer has been known for over 100 years. One of the initial therapies for advanced breast cancer was removing the ovaries (which normally produce estrogen in premenopausal women). We knew that some women responded to the removal of those ovaries and others didn't. It wasn't until the late 60s and early 70s, when we were able to show in the laboratory that estrogen receptors were able to predict which women would respond to hormonal treatments and which wouldn't, that we could be more precise. But indeed, estrogens have been around for a long time as a factor in breast cancer.

Do you find that patients generally understand what's meant by their hormone receptor status?
It's important for patients to understand what is meant by their hormone receptor status. Some but not all breast cancers depend on estrogen, the normal female hormone estrogen, to continue to grow. We can identify which breast cancers need estrogen and which don't based on a simple laboratory test for the estrogen receptor, which is a protein, that is done in almost all breast cancers. Breast cancers that have the estrogen receptor tend to grow more slowly and have a good prognosis. They are also the breast cancers in which we use hormonal treatments.

What role does estrogen normally play in a woman's body?
Estrogen is present in almost all women, obviously, and is responsible for a variety of different activities at different times in the woman's life. It's responsible for developing the secondary sex characteristics at puberty, such as breast development. It's also responsible for, with ovulation, the ability to reproduce and bear children.

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