Hormone Receptor Status In Breast Cancer
The hormone receptor status of your breast cancer refers to whether your breast cancer cells are fueled by estrogen and/or progesterone due to special proteins inside the tumor cells, called hormone receptors. When hormones attach to hormone receptors, the cancer cells grow.
A hormone receptor status is either hormone receptor positive or hormone receptor negative.
- Hormone receptor-positive breast cancer cells have either estrogen or progesterone receptors. These breast cancers can be treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors. HR-positive cancers tend to grow more slowly than those that are HR-negative. HR-positive cancers are generally more common in women after menopause.
- Hormone receptor-negative breast cancers do not have estrogen or progesterone receptors. These types of cancers will not benefit from hormone therapy drugs and typically grow faster than HR-positive cancers. HR-negative cancers are more common in women who have not yet gone through menopause.
When these receptors attach to the hormones estrogen and progesterone and grow, it can leave you with one of four results:
What Is A Hormone Receptor
Hormones are chemical messengers that circulate in the bloodstream. Hormone receptors are proteins located in and around breast cells. When the corresponding hormone binds to a receptor, it tells the cells how to grow and divide.
In the case of breast cancer, these receptors allow abnormal cells to grow out of control, which results in a tumor.
How Do Hormone Therapies Work
Hormone therapies slow or stop the growth of hormone receptor-positive tumors by preventing the cancer cells from getting the hormones they need to grow.
They work in a few ways:
- Some hormone therapies, such as tamoxifen, attach to the hormone receptor in the cancer cell and block estrogen from attaching to the hormone receptor.
- Some hormone therapies, such as aromatase inhibitors and ovarian suppression, lower the level of estrogen in the body so the cancer cells cant get the estrogen they need to grow.
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Can Other Drugs Interfere With Hormone Therapy
Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.
Other medications that inhibit CYP2D6 include the following:
- quinidine, which is used to treat abnormal heart rhythms
Testing For Hormone Receptors
In advanced cancer, your doctor will take a small part of the cancer that has spread to your lymph nodes, liver, or other areas of your body. They may use a very fine needle or get the tissue during surgery. Lab tests will show if the disease has hormone receptors.
If you’re taking hormones, you may need to stop before getting the test.
Cancer cells may have:
- Estrogen receptors only. Your doctor will call these âER-positiveâ or âER+â cancers.
- Progesterone receptors only. These are âPR-positive,â or âPR+.â
- Both estrogen and progesterone receptors, which doctors call âhormone-responsiveâ
- Neither estrogen or progesterone receptors, called âhormone negativeâ or âHR-“
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How Can I Manage This Diagnosis
- While the diagnosis of breast cancer may be challenging, remember there are many treatment options.
- Learn about your type of breast cancer and common treatments. This can help you ask questions at your oncology visits and feel more in control of your treatment decisions.
- Seek out support groups or peer support .
- All cancers are unique, and you should not compare your experience to others.
Finding The Type Of Cancer
A pathologist looks at the cancer cells under a microscope to see which type of breast cancer it is. They can tell this by the shape of the cells and the pattern of the cells in the breast tissue.
Pathologists also sometimes use particular dyes to stain the cells and show up certain proteins or features of the cells.
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Role Of Hormones In The Body
Our bodies naturally make hormones, including estrogen and progesterone.
Estrogen has multiple roles. It helps sex organs develop, makes pregnancy possible, strengthens bones, and more.
As you get older, the level of estrogen in your body changes.
- In premenopausal women who have periods, the ovaries make most of the bodys estrogen. Estrogen levels in premenopausal women are usually high.
- In perimenopause, the ovaries slow down and make less estrogen. But it is still possible to have menstrual periods, even when the ovaries are working more slowly. Periods may sometimes be irregular. This in-between time happens several years before menopause.
- In menopause, the ovaries gradually stop making estrogen. Periods become irregular and then stop altogether.
- Post-menopausal means a woman has not had any menstrual periods for 12 months in a row and blood work demonstrates hormonal levels are in post-menopausal range.
After menopause, the ovaries no longer make estradiol, the most active form of estrogen. But a womans body still makes estrone, another form of estrogen, after menopause. Estrone is made when an enzyme called aromatase converts the male sex hormone androstenedione made in the adrenal glands, ovaries, and fat cells into estrogen. In men, androstenedione is made in the testes.
Treatments for hormone receptor-positive breast cancer may include hormonal therapy, radiation therapy, chemotherapy, or targeted therapy.
Depending on the type, hormonal therapy works by:
Triple Negative Breast Cancer
Triple negative breast cancers don’t have oestrogen receptors, progesterone receptors or HER2 receptors. Around 15 out of 100 women have this type . It is more common in younger women.
Hormone therapies and targeted cancer drugs do not work well for this type of breast cancer. So you are more likely to have chemotherapy.
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What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. Hormone therapy also may disrupt the menstrual cycle in premenopausal women.
Less common but serious side effects of hormone therapy drugs are listed below.
Tamoxifen
- breathing problems, including painful breathing, shortness of breath, and cough
- loss of appetite
How Does Hormone Therapy Work
About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors for estrogen and/or progesterone which help the cancer cells grow and spread.
There are several types of hormone therapy for breast cancer. Most types of hormone therapy either lower estrogen levels in the body or stop estrogen from helping breast cancer cells grow.
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What Does It Mean To Be Her2
If your breast cancer is HER2-negative, you do not have an excess of the HER2 gene. Tumors such as these will not respond to therapies that specifically target HER2 receptors.
If your breast cancer is HER2-positive, then you have too much HER2 protein or extra copies of the HER2 gene. These breast cancers tend to be fast-growing. HER2-positive breast cancer treatment typically includes targeted therapy drugs that slow the growth and kill these cancer cells. HER2-positive breast cancers account for about 25% of all breast cancer cases.
Knowing your HER2 status will help your WVCI cancer care team create the best treatment plan for you.
Common Breast Cancer Types
Navigating the language of cancer can be confusing, especially when it comes to learning about the different types of breast cancer. Know that we will be with you every step of the way and are here to answer any questions you may have regarding your specific breast cancer type.
Some breast cancers are more common than others. These common types include:
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Is There Anything Else I Need To Know About Er/pr Tests
HER2 testing is often done at the same time as ER/PR testing. That is because some hormone receptor cancers are also HER2-positive. HER2 is a protein found on the surface of all breast cells. Treatments for HER2-positive breast cancer can be very effective but are not effective for HER2-negative cancers.
Are There Any Risks To The Test
You may have a little bruising or bleeding at the biopsy site. Sometimes the site gets infected. If that happens, you will be treated with antibiotics. A surgical biopsy may cause some additional pain and discomfort. Your health care provider may recommend or prescribe medicine to help you feel better.
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Types Of Hormone Receptors
- There are two types of receptors, estrogen, and progesterone.
- If your tumor has estrogen receptors, it is called estrogen receptor-positive or ER+.
- If your tumor has progesterone receptors, it is progesterone receptor positive or PR+.
- Your tumor can be positive for one or both hormone receptors. This may be written ER/PR+, ER+/PR-, ER-/PR+.
- HR+ breast cancer can also be HER2 positive.
How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.
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Many Successful Pregnancies No Increase In Cancer Returning
The POSITIVE trial, which was conducted on four continents, was the first prospective study to follow women who paused hormone therapy as they attempted to conceive.
Most of the women had at least one pregnancy during their treatment pause, Dr. Partridge said, noting that most became pregnant within two years.
She and her colleagues tracked the pregnancy status of 497 women from 20 countries in the trial, which was funded in part by NCI. Of this group, 368 had at least one pregnancy and 317 had at least one live birth.
These rates of conception and childbirth were similar to or higher than rates in the general population, according to Olivia Pagani, M.D., of the International Breast Cancer Study Group, who co-led the trial.
The trial results will likely help patients, their families, and their doctors feel more comfortable about pursuing a pregnancy, according to Dr. Partridge. She stressed that the approach involves interrupting rather than stopping hormone therapy.
In the trial, at a median follow-up of 3.4 months, about 76% of the women had resumed hormone therapy and 15% had not resumed hormone therapy. About 8% of the women had a recurrence, a new cancer, or had died before they had resumed their hormone therapy.
After completing the study, participants will continue to receive hormone therapy for up to 5 to 10 years. Each womans treatment will be determined in consultation with her physician based on her risk of a recurrence.
A Hormone Receptor Status Is Either Hormone Receptor Positive Or Hormone Receptor Negative
- Hormone receptor-positive breast cancer cells have either estrogen or progesterone receptors. These breast cancers can be treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors. HR-positive cancers tend to grow more slowly than those that are HR-negative. HR-positive cancers are generally more common in women after menopause.
- Hormone receptor-negative breast cancers do not have estrogen or progesterone receptors. These types of cancers will not benefit from hormone therapy drugs and typically grow faster than HR-positive cancers. HR-negative cancers are more common in women who have not yet gone through menopause.
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Hormone Therapy After Surgery For Breast Cancer
After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.
These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:
- Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
- Tamoxifen for 2 to 3 years, followed by an AI for 5 years
- Tamoxifen for 4½ to 6 years, followed by an AI for 5 years
- Tamoxifen for 5 to 10 years
- An AI for 5 to 10 years
- An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
- For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option
For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.
These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosed:
What Are Estrogen And Progesterone Receptors
Receptors are proteins in or on cells that can attach to certain substances in the blood. Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone, and need these hormones for the cells to grow.
Breast cancer cells may have one, both, or none of these receptors.
- ER-positive: Breast cancers that have estrogen receptors are called ER-positive cancers.
- PR-positive: Breast cancers with progesterone receptors are called PR-positive cancers.
- Hormone receptor-positive: If the cancer cell has one or both of the receptors above, the term hormone-receptive positive breast cancer may be used.
- Hormone receptor-negative: If the cancer cell does not have the estrogen or the progesterone receptor, it’s called hormone-receptor negative .
Keeping the hormones estrogen and progesterone from attaching to the receptors can help keep the cancer from growing and spreading. There are drugs that can be used to do this.
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Ductal Carcinoma In Situ
Ductal carcinoma in situ is a non-invasive breast cancer where abnormal cells have been contained in the lining of the breast milk duct. Although it isnt considered life-threatening, DCIS can increase the risk of developing an invasive breast cancer later on. Most recurrences happen within 5-10 years after initial diagnosis.
When These Receptors Attach To The Hormones Estrogen And Progesterone And Grow It Can Leave You With One Of Four Results:
- Estrogen-receptor positive or negative : This means the breast cancer cells may or may not have receptors for the hormone estrogen. ER+ results suggest that the cancer cells may receive signals from estrogen that could promote their growth.
- Progesterone-receptor positive or negative : This means the breast cancer cells may or may not have receptors for the hormone progesterone. PR+ results indicate that the cancer cells may receive signals from progesterone that could promote their growth.
- HER2 positive or negative: Treatment can also be affected by the presence of HER2 , which is a protein that appears on the surface of some breast cancer cells and plays a role in how a healthy breast cell grows, divides, and repairs itself. Knowing whether they are present will affect the treatment thats chosen.
- Triple-negative breast cancer: If you are told you have triple-negative cancer, your breast cancer cells test negative for estrogen receptors, progesterone receptors, and HER2. Triple-negative breast cancer will be treated differently from the other types of breast cancer since hormones are not playing a role in breast cancer growth.
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