Estrogen receptor values in patients with benign breast disease

Radioiodinated 4-(p-Iodophenyl) Butanoic Acid-Modified Estradiol Derivative for ER Targeting SPECT Imaging

Overexpression of estrogen receptors (ERs) is one of the important characteristics of most breast cancers. We aim to develop a new type of ER-specific radioiodine-labeled estrogen derivative ([¹³¹I]IPBA-EE), which was modified with an albumin-specific ligand 4-(p-iodophenyl) butyric acid (IPBA) to improve the metabolic stability and enhance the ER-targeting ability of estrogen. [¹³¹I]IPBA-EE can effectively bind to albumin in vitro, and its dissociation constant (K_d = 0.31 μM) is similar to IPBA (K_d = 0.30 μM). The uptake of [¹³¹I]IPBA-EE in ER-positive MCF-7 cells (41.81 ± 3.41%) was significantly higher than that in ER-negative MDA-MB-231 cells (8.78 ± 2.37%, ***P < 0.0005) and could be significantly blocked (3.92 ± 0.35%, ***P < 0.0005). The uptakes of [¹³¹I]IPBA-EE in rat uterus and ovaries were 5.66 ± 0.34% ID/g and 5.71 ± 2.77% ID/g, respectively, at 1 h p.i., and these uptakes could be blocked by estradiol (uterus: 2.81 ± 0.41% ID/g, *P < 0.05; ovarian: 3.02 ± 0.08% ID/g, *P < 0.05). SPECT/CT imaging showed that ER-positive MCF-7 tumor uptake of [¹³¹I]IPBA-EE reached to 6.07 ± 0.20% ID/g at 7 h p.i., which was significantly higher than that of ER-negative MDA-MB-231 tumor (0.87 ± 0.08% ID/g, **P < 0.005) and could be blocked obviously with fulvestrant (1.65 ± 1.56% ID/g, *P < 0.05). In conclusion, a novel radioiodinated estradiol derivative, [¹³¹I]IPBA-EE with albumin-binding property and good metabolic stability, was developed to image the ER in breast cancer. This promising ER-targeted probe has the potential to warrant further preclinical investigations.

Variations in Estrogen and Progesterone Receptor Content in Premenopausal Breast Cancer Patients Throughout the Menstrual Cycle

Estrogen (ER) and progesterone (PgR) receptor content was assayed in 290 premenopausal women with primary breast cancer, in order to investigate the influence of endogenous hormones on cytoplasmic receptor concentrations throughout the menstrual cycle, subdivided into four phases of ovarian function (early and late follicular phase, early and late luteal phase). Of the total population, 231 (79.7 %) patients were ER positive and 59 (20.3 %) were ER negative; 220 (75.9 %) were PgR positive and 70 (24.1 %) were PgR negative. The percentages of positive cases were almost constant in each phase. No significant difference in mean values of ER concentration was noted throughout the cycle. Instead, the PgR concentration significantly increased from the first to the third phase (P = 0.02) and decreased from the third to the fourth phase (P = 0.01). Our results suggest that ER- and PgR- cases are homogeneously distributed and not influenced by the phase of the cycle. Moreover, they suggest that PgR measurement in the luteal phase, rather than in other phases, prevents the occurrence of false low PgR levels and, at the same time, improves its prognostic significance and response rate to endocrine therapy.

Estrogen and Progesterone Receptors in Breast Carcinoma and in Nonmalignant Breast Tissue

Since 1983 we have studied the relationship, in the same patient, between receptor status in breast carcinoma and in nonmalignant breast tissue. Fifty patients have been evaluated to date. The total unoccupied cytosol estrogen and progesterone receptors were determined by a dextran-coated charcoal method. In nonmalignant breast tissue we found a measurable receptor concentration above the sensitivity of the method in 62 % of cases for estrogen receptors and in 44 % of cases for progesterone receptors. No relationships were found between the receptor level of each tumor and that of the corresponding benign tissue. The data suggest that the levels of the receptors in the tumor and in the nonmalignant tissue are totally independent.

Tongshu capsule down-regulates the expression of estrogen receptor α and suppresses human breast cancer cell proliferation

The Tongshu Capsule (TSC) is a prevalent form of traditional Chinese medicine widely used for its purported effects in treating mammary gland hyperplasia and inflammation. Though successful in several clinical studies, there is no clear evidence as to why TSC has a positive treatment effect, and little known about underlying mechanism that may account for it. In this study, we examined the effects of TSC and found that it has a comparatively strong growth inhibition on ERα positive breast cancer cells. TSC seems to cause G1 cell cycle arrest instead of apoptosis. Interestingly, TSC also down-regulated the expression of ERα and Cyclin D1. Consistently, TSC suppressed E2 mediated ERα downstream gene expression and cell proliferation in ERα positive breast cancer cell lines MCF7 and T47D. Depletion of ERα partially abolished the effects of TSC on the decrease of Cyclin D1 and cell viability. Our findings suggest that TSC may have therapeutic effects on ERα positive breast cancers and moreover that TSC may suppress breast epithelial cell proliferation by inhibiting the estrogen pathway.

Progesterone receptor targeting with radiolabelled steroids: an approach in predicting breast cancer response to therapy

Steroid receptors have demonstrated to be potentially useful biological targets for the diagnosis and therapy follow-up of hormonally responsive cancers. The over-expression of these proteins in human cancer cells as well as their binding characteristics provides a favourable mechanism for the localization of malignant tumours. The need for newer and more selective probes to non-invasively assess steroid receptor expression in hormone-responsive tumours has encouraged the synthesis and the biological evaluation of several steroidal derivatives labelled with positron and gamma emitters. The physiological effects of the steroid hormone progesterone are mediated by the progesterone receptor (PR). Since PR expression is stimulated by the oestrogen receptor (ER), PR status has been considered as a biomarker of ER activity and its value for predicting and monitoring therapeutic efficacy of hormonal therapy has been studied. Imaging of PR-expressing breast cancer patients under hormonal therapy may be advantageous, since the response to therapy can be more accurately predicted after quantification of both ER and PR status. Thus, ligands for PR targeting, although much less explored than ER ligands, have gained some importance lately as potential PET and SPECT tumour imaging agents. In this review, we present a brief survey of explored approaches for progesterone targeting using radiolabelled progestins as potential clinical probes to predict responsiveness to breast cancer therapy. This article is part of a Special Issue entitled "Synthesis and biological testing of steroid derivatives as inhibitors".

Estrogen receptor beta binds Sp1 and recruits a corepressor complex to the estrogen receptor alpha gene promoter

Human estrogen receptors alpha and beta are crucially involved in the regulation of mammary growth and development. Normal breast tissues display a relative higher expression of ER beta than ER alpha, which drastically changes during breast tumorogenesis. Thus, it is reasonable to suggest that a dysregulation of the two estrogen receptor subtypes may induce breast cancer development. However, the molecular mechanisms underlying the potential opposing roles played by the two estrogen receptors on tumor cell growth remain to be elucidated. In the present study, we have demonstrated that ER beta overexpression in breast cancer cells decreases cell proliferation and down-regulates ER alpha mRNA and protein content, along with a concomitant repression of estrogen-regulated genes. Transient transfection experiments, using a vector containing the human ER alpha promoter region, showed that elevated levels of ER beta down-regulated basal ER alpha promoter activity. Furthermore, site-directed mutagenesis and deletion analysis revealed that the proximal GC-rich motifs at -223 and -214 are critical for the ER beta-induced ER alpha down-regulation in breast cancer cells. This occurred through ER beta-Sp1 protein-protein interactions within the ER alpha promoter region and the recruitment of a corepressor complex containing the nuclear receptor corepressor NCoR, accompanied by hypoacetylation of histone H4 and displacement of RNA-polymerase II. Silencing of NCoR gene expression by RNA interference reversed the down-regulatory effects of ER beta on ER alpha gene expression and cell proliferation. Our results provide evidence for a novel mechanism by which overexpression of ER beta through NCoR is able to down regulate ER alpha gene expression, thus blocking ER alpha's driving role on breast cancer cell growth.

Estrogen receptor expression in atypical hyperplasia: lack of association with breast cancer

Estrogen receptor (ER) is expressed in normal and malignant breast epithelium, and expression levels have been found to increase with age in normal breast epithelium but not in atypical hyperplasia (AH) and carcinoma in situ. Here we assess ER expression in AH and its association with later breast cancer. ER expression was assessed immunohistochemically in archival sections from 246 women with AH who had open benign breast biopsy from 1967 to 1991. The ACIS III (Dako) was utilized to calculate ER expression in all atypical foci. Using multivariate linear regression, we examined associations of ER expression with age at biopsy, indication for biopsy, type of atypia, number of atypical foci, involution status, and family history. Breast cancer risk across levels of ER expression was also assessed compared with the Iowa SEER control population. Among 246 women, 87 (35%) had atypical ductal hyperplasia (ADH), 141 (57%) had atypical lobular hyperplasia (ALH), and 18 (7%) had both. Forty-nine (20%) developed breast cancer (median follow-up of 14.4 years). Multivariate analysis indicated that type of atypia and age at diagnosis were significantly associated with ER percent staining and intensity (P < 0.05). ER expression was increased in women with ADH and/or those over age 55. ER expression did not significantly impact breast cancer risk in patients diagnosed with atypia. We found increasing ER expression in AH with increasing age. ER expression in AH does not further discriminate breast cancer risk in women with atypia.

Immunolocalization of estrogen-producing and metabolizing enzymes in benign breast disease: comparison with normal breast and breast carcinoma

It is well known that estrogens play important roles in the cell proliferation of breast carcinoma. Benign breast disease (BBD) contains a wide spectrum of diseases, and some are considered an important risk factor for subsequent breast carcinoma development. However, the significance of estrogens in BBD has remained largely unknown. Therefore, in this study, we examined tissue concentrations of estrogens and immunolocalization of estrogen-producing/metabolizing enzymes in BBD, and compared these findings with those in the normal breast and ductal carcinoma in situ (DCIS). Tissue concentration of estradiol in BBD (n = 9) was significantly (3.4-fold) higher than normal breast (n = 9) and nearly the same (0.7-fold) as in DCIS (n = 9). Immunoreactivity of estrogen sulfotransferase in BBD was significantly lower (n = 82) than normal breast (n = 28) but was not significantly different from DCIS (n = 28). Aromatase and steroid sulfatase immunoreactivities tended to be higher (P = 0.07) in BBD than in normal breast, and 17β-hydroxysteroid dehydrogenase type 1 immunoreactivity was significantly higher in BBD than normal breast in the postmenopausal tissues. Immunoreactivity of estrogen and progesterone receptors was also significantly higher in BBD than normal breast. These results suggest that tissue concentration of estradiol is increased in BBD at a level similar to DCIS, which is considered mainly due to loss of estrogen sulfotransferase expression. Increased local estradiol concentration in BBD due to aberrant expression of estrogen-producing/metabolizing enzymes may play important roles in the accumulation of estradiol-mediated growth and/or subsequent development of breast carcinoma.

Expression of ER, Ki-67 and cylinD1 in the pre-cancerous breast of Chinese patients

To investigate the expression and association of ER, Ki-67 and cyclinD1 in usual ductal hyperplasia(UDH), atypical ductal hyperplasia (ADH) and ductal carcinoma in situ(DCIS) in the breast. The study included 56 cases of pre-cancerous lesions which were surgically excised at Qi Lu Hospital of Shangdong University. Immunohistochemistry was used to determine the expression of ER, Ki-67 and cyclinD1 and double-labelling immunofluorescence technique was used to observe the coexpression of ER and Ki-67. The expression and distribution of ER-positive cells were significantly different in UDH, ADH and DCIS. The ER-positive cells were much more in UDH than in normal TDLUs (terminal duct lobular units). The distribution of ER-positive cells interspersed amid ER-negative cells within UDH. However , the ER positive cells showed marked increases in ADH and low grade nuclear DCIS (P < 0.05), distributing in almost all constituent cells. The expression of ki-67 and cyclinD1 were significantly different between UDH and DCIS (P < 0.05) , and a positive correlation was found between expression of Ki-67 and morphological classification of pre-cancerous lesions (r = 0.3522, P < 0.05) as well as cyclinD1 (r = 0.3901, P < 0.05). Double-labelling immunofluorescence showed that there was no coexpression of ER and Ki-67 in normal breast tissue. The coexpression of the two markers was found in ADH and increased in DCIS. Overexpression of ER, Ki-67 and cyclinD1 significantly accompanies the transition of normal cells and UDH to ADH and DCIS. The coexpression of ER and ki-67 may present the early change in carcinogenesis of breast cancer.

7α-Alkoxyestra-1,3,5(10)-Trienes

α-Alkoxyestradiols were prepared through LiAlH4 reduction of a suitably protected 6α,7α-epoxyestra-1,3,5(10)-trien-3-ol-17-one, alkylation of the resultant 7α-hydroxyestra-1,3,5(10)-trien-3-ol-17-one derivative and subsequent transformation of the C17 functionality.

Benign breast diseases

Benign breast diseases have always been neglected in comparison to cancer, despite the fact that there are many more patients with such diseases than patients presenting to a breast clinic for cancer. Like normal breast tissues, benign breast diseases are under a complex system of controls by both systemic hormonal and local factors. In this review, we attempt to present an overview of the latest knowledge concerning the epidemiology, classification, clinical presentation, management, and physiopathology of these disorders.

Estrogen receptor mutations in human disease

As early as the 1800s, the actions of estrogen have been implicated in the development and progression of breast cancer. The estrogen receptor (ER) was identified in the late 1950s and purified a few years later. However, it was not until the 1980s that the first ER was molecularly cloned, and in the mid 1990s, a second ER was cloned. These two related receptors are now called ERalpha and ERbeta, respectively. Since their discovery, much research has focused on identifying alterations within the coding sequence of these receptors in clinical samples. As a result, a large number of naturally occurring splice variants of both ERalpha and ERbeta have been identified in normal epithelium and diseased or cancerous tissues. In contrast, only a few point mutations have been identified in human patient samples from a variety of disease states, including breast cancer, endometrial cancer, and psychiatric diseases. To elucidate the mechanism of action for these variant isoforms or mutant receptors, experimental mutagenesis has been used to analyze the function of distinct amino acid residues in the ERs. This review will focus on ERalpha and ERbeta alterations in breast cancer.

Regulation of the estrogen receptor alpha minimal promoter by Sp1, USF-1 and ERalpha

The exact molecular mechanisms regulating estrogen receptor alpha (ERalpha) expression in breast tumors are unclear, but studies suggest that they are partly at the level of transcription. We have focused on the transcription factors that regulate the ERalpha minimal promoter, which we have previously shown to reside within the first 245 bp of the 5'-flanking region of the gene. Within this region are several elements essential for full ERalpha promoter transcriptional activity, including a GC box and an imperfect E box. In earlier studies we demonstrated an essential function for the Sp1 family of transcription factors in the regulation of ERalpha expression. We have now identified both USF-1 and ERalpha itself as components of a multi-protein complex of transcription factors that interacts at the ERalpha minimal promoter and is essential for its full transcriptional activity. Electrophoretic mobility shift assays demonstrated that Sp1 and USF-1, but not ERalpha, bind directly to the ERalpha minimal promoter. We showed by GST pull-down assays that ERalpha is able to interact in vitro with USF-1, suggesting, in addition to a possible interaction between ERalpha and Sp1, a mechanism whereby ERalpha is able to interact with the protein complex. Combined exogenous expression of the components of the complex in MCF-7 breast cancer cells resulted in a synergistic effect on transactivation of the ERalpha minimal promoter, suggesting that the importance of the protein complex is in the interactions among the components. Based upon these findings, we propose a possible model for transcription from the ERalpha minimal promoter.

Behaviour of estrogen receptor, histological correlation, and clinical outcome in patients with benign breast disorders

OBJECTIVE

To estimate the value of estrogen receptor (ER) in benign breast diseases and to find out if the response of benign breast diseases to danazol depends on the ER status of the tissue.

DESIGN

Prospective study.

SETTING

University hospital, India.

MATERIAL

Samples of tissue from benign breast lesions, 40 fibrocystic disease and 10 fibroadenomas.

INTERVENTIONS

Enzyme immunoassay for the presence of cytosolic ER.

MAIN OUTCOME MEASURES

ER concentrations, and correlation with effect of treatment with danazol.

RESULTS

Fibrocystic disease and fibroadenomas showed 30% and 40% ER positivity, respectively. The mean (SD) ER concentration was significantly higher in premenopausal than postmenopausal patients 14.75 (3.79) fmol/mgm compared with 6.2 (1.59) fmol/mg (p < 0.05). All ten patients with mastalgia who had ER-positive lesions (n = 26) responded to danazol, compared with 6 of 16 patients who had ER-negative lesions (p < 0.05). Lesions with diffuse fibrosis (n = 14) and five with lymphocytic infiltration on histology were all ER-negative.

CONCLUSION

The patients with ER positive breast disease responded better to danazol than patients with ER negative breast disease.

Effects of tamoxifen on benign breast disease in women at high risk for breast cancer

BACKGROUND

In 1998 the National Surgical Adjuvant Breast and Bowel Project (NSABP) demonstrated that tamoxifen treatment reduced the incidence of both invasive and noninvasive breast cancer in women at high risk for the disease. We examined the effect of tamoxifen treatment on the incidence of benign breast disease and the number of breast biopsies in the same group of women.

METHODS

We examined the medical records of 13 203 women with follow-up who participated in the NSABP Breast Cancer Prevention Trial. Included in this analysis were women who had undergone a breast biopsy and who had histologic diagnoses of adenosis, cyst, duct ectasia, fibrocystic disease, fibroadenoma, fibrosis, hyperplasia, or metaplasia. The relative risk (RR) for each histologic diagnosis was estimated for women who received tamoxifen and for women who received placebo. We also tallied the number of biopsies that women in the placebo and tamoxifen groups underwent.

RESULTS

Overall, tamoxifen treatment reduced the risk of benign breast disease by 28% (RR = 0.72, 95% confidence interval [CI] = 0.65 to 0.79). Tamoxifen therapy resulted in statistically significant reductions in the risk of adenosis (RR = 0.59, 95% CI = 0.47 to 0.73), cyst (RR = 0.66, 95% CI = 0.58 to 0.75), duct ectasia (RR = 0.72, 95% CI = 0.53 to 0.97), fibrocystic disease (RR = 0.67, 95% CI = 0.58 to 0.77), hyperplasia (RR = 0.60, 95% CI = 0.50 to 0.71), and metaplasia (RR = 0.51, 95% CI = 0.41 to 0.62). Tamoxifen therapy also reduced the risk for fibroadenoma (RR = 0.77, 95% CI = 0.56 to 1.04) and fibrosis (RR = 0.86, 95% CI = 0.72 to 1.03). Compared with the placebo group, the tamoxifen group had 29% (95% CI = 23% to 34%) fewer biopsies (1048 versus 1469) and 19% fewer women who underwent a biopsy (811 versus 1019). This resulted in a 29% reduction in the risk of biopsy in women treated with tamoxifen (RR = 0.71, 95% CI = 0.66 to 0.77). This risk reduction occurred predominantly in women younger than 50 years.

CONCLUSION

Women in this study who received tamoxifen, especially younger women (i.e., <50 years), had a reduced incidence of clinically detected benign breast disease and underwent fewer breast biopsies.

Sp1 is essential for estrogen receptor alpha gene transcription

The exact molecular mechanisms regulating estrogen receptor (ER)alpha expression in breast tumors are unclear, but studies suggest that the regulation is at least partly transcriptional. We therefore undertook a detailed analysis of ERalpha promoter activity in a number of breast cancer cell lines. We find that the majority of ERalpha promoter activity lies within the first 245bp of the 5'-flanking region of the gene. Three elements essential for full ERalpha promoter transcriptional activity were identified within the -245 to -192bp region in transient transactivation assays using linker-scanner mutation analysis. These three elements include two binding sites for the Sp1 family of transcription factors as well as a non-consensus E box. We show that both Sp1 and Sp3 bind to this region using electrophoretic mobility shift assays. Exogenous expression of Sp1 or Sp3 in Sp1/3-negative Drosophila Schneider SL2 cells results in transactivation of the -245 to +212bp fragment of the ERalpha promoter. These data demonstrate that transcription of ERalpha is dependent upon the expression of members of the Sp1 family.

Molecular and biologic markers of premalignant lesions of human breast

There is currently great interest in the detection and characterization of putative precursor breast cancer lesions because of the possibility of chemoprevention. Knowledge of the biologic features of premalignant lesions, although limited, is rapidly evolving. Premalignant breast lesions have been examined for the presence of genetic alterations and for the expression of biomarkers such as the estrogen receptor (ER), Ki67, p53, and HER2/neu. Data obtained from genetic studies of precursor breast lesions clearly support the contention that genetic alterations begin quite early in selected subsets of histologically benign lesions. Although the results of biomarker expression profiles have been contradictory, most studies agree that precursor lesions significantly overexpress ER and that progressive alterations in ER expression accompany the transition of normal cells to hyperplastic lesions and carcinoma in situ. So far, the collected evidence indicates that precursor lesions in the breast demonstrate biomarker expression profiles and genetic abnormalities that are distinct from those of terminal ductal lobular units but share some of these features with invasive tumors. Future research in this field is urgently needed to identify specific biomarkers of prognostic and predictive value, which can help not only in the selection of patients for chemopreventive therapy but in monitoring the progression of high-risk lesions.

Morphometric Analysis of the Epithelium of Mammary Fibroadenomas During the Proliferative and Secretory Phases of the Menstrual Cycle

Fibroadenoma of the breast is a benign neoplasia with a mixture of glandular and mesenchymal elements of high incidence and is mainly present in young women. This aspect and the presence of estrogen and progesterone receptors reinforce its hormone dependency. Recent studies have demonstrated that the proliferative activity of the mammary epithelium is significantly increased during the luteal phase. In order to assess whether fibroadenomas behave like the normal breast under the cyclic action of hormones we counted the number of mitoses and calculated the nuclear volume of epithelial cells in both the proliferative and luteal phases. We selected 20 women with clinically diagnosed fibroadenomas, 10 in the proliferative phase and 10 in the secretory phase. Our results showed no significant differences in mitotic index or nuclear volume between the proliferative and the luteal phases of fibroadenomas. We therefore conclude that the epithelium of fibroadenomas behaves like a true neoplasia whose regulation may occur via paracrine mechanisms, which in turn would explain its self-limited growth.

The role of estrogen receptors in breast cancer metastasis

It has long been appreciated that the estrogen receptor (ER) plays an important role in the biology of breast cancer. It is an accepted factor predicting favorable disease outcome and treatment response, and as such is generally considered to represent a "good" prognostic marker in breast cancer. In this review we present data suggesting that the ER may also play a pivotal role in the metastatic behavior of breast cancer, and present an argument that the up-regulation of ER and/or the selection of specific ER mutations are early events important for facilitating tumor progression. Thus, ER could serve dual roles in breast cancer, acting as a "bad" prognostic marker later in the disease process.

Biological features of premalignant disease in the human breast

Most human invasive breast cancers (IBCs) arise from preexisting benign lesions. There are many types of benign lesions in the human breast and only a few appear to have significant premalignant potential (atypical hyperplasias and in situ carcinomas). These lesions are relatively common and only a small proportion progress to IBC. They are currently defined by their histological features and their prognosis is imprecisely estimated from indirect evidence based on epidemiological studies. Although lesions within specific categories look alike, they must possess morphologically silent biological differences motivating some to remain stable and others to progress. Understanding the biological changes responsible for the development and progression of premalignant disease is a very active area of medical research. Progress in this area may provide new opportunities for breast cancer prevention by providing strategies to treat premalignant lesions before they develop or become cancerous. A large number of biological features have been evaluated in this setting during the past decade. This review discusses a few features that appear to be particularly important and have been studied in a relatively comprehensive manner.

Comparison of immunohistochemical and biochemical measurement of steroid receptors in primary breast cancer: evaluation of discordant findings

Tumor samples of 240 patients with primary breast cancer were biochemically and immunohistochemically investigated for estrogen receptors (ER) and, in 130 of the samples, for progesterone-receptors (PgR) in order to examine reasons for discordant findings. The biochemical (DCCA) and immunohistochemical assays (ICA) yielded positivity in 71% for ER, and in 44% for PgR. Concordant ER-DCCA and ER-ICA results were obtained in 84%; two thirds of the discordant ER-findings manifested as DCCA-neg/ICA-pos. Concordance in the case of PgR amounted to 72%, and of the discordances 60% were DCCA-neg/ICA-pos. Significant association with postmenopausal status existed only for ER positivity in ICA (p = 0.01), whereas ER-DCCA, PgR-DCCA and PgR-ICA were all more or less independent of the menopausal status. The frequency of discordances was independent of menopausal status. Discordance for ER-assays increased significantly near the respective cut-off point; this was not unequivocally true for PgR-assays. The correlation of tumor types of sparse cellularity, as well as prominent stroma content ('scirrhous carcinoma') with increased frequency of the constellation DCCA-neg/ICA-pos was of borderline significance for PgR (p = 0.06), but not for ER. The percentage of discordant ER-findings, figuring as DCCA-neg/ICA-pos, was statistically significantly increased in locally advanced breast cancer (p = 0.03). Fibrocystic disease in peritumoral breast tissue had no impact on receptor-assay discordance. In any case, the models derived from theoretical thought, laboratory data and singular observations can only in part explain the discordance in steroid receptor values measured with different methods.

Estrogen receptor variants

Estrogen receptor (ER)3 gene expression in breast epithelium is an intricately regulated event. The human ER gene is transcribed from at least three different promoters which are expressed in a cell- and tissue-specific manner, and result in mRNA isoforms with unique 5'-untranslated exons. The ER is overexpressed in about two thirds of breast tumors, and even in early premalignant breast lesions compared with adjacent normal breast epithelium. Furthermore, normal breast epithelium as well as breast cancer tissue contains alternatively spliced ER mRNA variants where single or multiple exons are skipped. It is still unclear if any or all of the ER mRNA splicing variants are translated in vivo, and if a change in the balance of ER variants could effect tumor development and progression to hormone-independent growth. Although infrequent in primary breast cancer, single amino acid changes within the ER in metastatic disease which might influence cell proliferation may also contribute to neoplastic progression of the mammary epithelium.

Concentrations of estrone, estradiol and their sulfates, and evaluation of sulfatase and aromatase activities in patients with breast fibroadenoma

In the present studies, the concentrations (mammary tissue and plasma) of estrone (E1), estradiol (E2) and their sulfates (E1S and E2S), as well as the sulfatase and aromatase activities, were evaluated in patients with breast fibroadenomas. Comparative studies of the evaluation of these parameters were carried out in: (A) tumor tissue, (B) areas surrounding the tumor and (C) areas distant from the tumor (glandular tissue) considered as normal tissue. The concentrations in the tumor tissue (in pmol/g tissue) of E1, E2 and E1S were significantly higher (2-3 times) than in the area of the breast considered as normal. Sulfatase and aromatase activities were found in the breast fibroadenoma tissue. Sulfatase activity was much higher than aromatase (30-150 times) and sulfatase levels were significantly higher in the fibroadenoma tissue than in the area considered as normal. Plasma evaluation of E1, E2, E1S and E2S concentrations showed no significant differences in relation to those of healthy control women. In conclusion, the high levels of estrogens and their sulfates, as well as the enzymes involved in estrogen formation--sulfatase and aromatase in breast fibroadenoma--contribute to the hypothesis that this disease may be hormone-dependent.

Expression of the estrogen receptor gene in developing and adult human breast

Although studies of the estrogen receptor gene abound in rodent models and breast cancer cell lines, little is known about expression of this gene in normal human breast. Information regarding the physiology of this gene's expression is important if we are to elucidate abnormalities of the gene that may be involved in breast carcinogenesis. We evaluated levels of mRNA expression of the estrogen receptor (ER) gene and its protein product in a set of 89 breasts from clinically normal female infants, children, adolescents, and adult premenopausal and post-menopausal women. mRNA expression of the gene varied with the hormonal status. Relatively higher levels of gene transcripts were found in breasts of peri-menarchal girls, women in the luteal phase of the menstrual cycle, and in those with fibrocystic change. Higher levels were also occasionally found in breasts of infants and in most pre-adolescent children. Lower levels were seen in breasts of women in the follicular phase of the menstrual cycle, during pregnancy, and after menopause. Nuclear protein staining was common in breasts of normal children and peri-menarchal adolescents, and in post-menopausal atrophic breasts. Nuclear ER protein was infrequently detected in reproductive aged women's breasts, but was more often seen in follicular than in luteal menstrual phase or pregnant breast. ER protein was more frequently seen in post-menopausal than in pre-menopausal breasts with fibrocystic change. The results fit a model in which circulating levels of estrogen are inversely related to levels of mRNA transcribed from the estrogen receptor gene in normal physiologic states. Abnormally high levels of gene transcription may occur in some cases of fibrocystic change.

The role of the estrogen receptor in tumor progression

We will discuss two estrogen receptor (ER) variants that may play a role in breast cancer initiation or progression. One is a truncated receptor, which has been named the exon 5 ER deletion variant, and the other is called a hyper-sensitive variant of the ER that is sensitive to low levels of hormone. Both ER variants differ from the wild-type ER in their hormone binding domains (HBD). The exon 5 ER deletion variant lacks a large portion of the HBD, while the hyper-sensitive ER variant has a point mutation in a conserved region of the HBD. The exon 5 ER deletion variant is transcriptionally active in the absence of hormone, and is thus considered constitutively-active. In contrast, the hyper-sensitive ER variant is functionally active in response to subphysiological concentrations of estrogen. We speculate that both ER variants may form productive heterodimers with wild-type receptor to modify the normal function of ER in the breast.

Steroid receptors in breast cancer

Recent advances in steroid receptor structure and function now indicate that oestrogen binds to the oestrogen receptor (ER) molecule at a specific site, denoted region E. This allows binding of the oestrogen-ER complex to DNA via cysteine residues in region C of the ER molecule, which tetrahedrally co-ordinate zinc. This modulates transcription and stimulates cell growth. A number of newly discovered growth factors are also regulated by ER, as is the progesterone receptor. Steroid receptor concentrations in tissues can now be measured on smaller tissue samples using enzyme immunoassay or on cells obtained by fine needle aspiration using monoclonal antibody technology. The prognostic value of steroid receptor is limited, but still constitutes the best marker for predicting response to endocrine therapy. The role of steroid receptors in selecting patients for adjuvant therapy is discussed.

Fibrocystic disease of the breast in premenopausal women: histohormonal correlation and response to luteinizing hormone releasing hormone analog treatment

Sixty-six patients with fibrocystic mastopathy were enrolled in the trial after being selected according to clinical, radioultrasonographic, and histologic criteria. No characteristic hormonal profile was noted in most patients (52%). Estrogen receptors or progesterone receptors, or both, were found in 57% of patients. Hormone receptor levels were correlated with atypical proliferative mastopathy (87.5%). Mastopathy was associated with a uterine fibroma or a fibromatous uterus in 73% of cases. All patients received intramuscular injections of a sustained delivery system (microcapsules) of luteinizing hormone releasing hormone agonist [D-Trp6]-LHRH, Ipsen-Biotech, Paris) for 3 to 6 months. In case of partial response at 3 months, an antiestrogen (tamoxifen, 40 mg/day, for estrogen receptor-predominant lesions) or a progestin (cyproterone acetate, 50 mg/day, for progesterone receptor-predominant lesions) was added to the luteinizing hormone releasing hormone agonist. A complete response was observed in more than half of the patients (n = 35, 53%) treated by [D-Trp6]-LHRH alone (n = 29) or associated with tamoxifen (n = 4) or cyproterone acetate (n = 2). A significant partial response was observed in 30 other patients (45%). Additionally, half of them received inhibitory drugs. The best responses were seen with cyst reformation (complete response, 100%) and fibrous block. Clinical responses to treatment with [D-Trp6]-LHRH alone were independent of hormone receptor status, but synergistic effects occurred with concomitant use of the corresponding inhibitory drugs. We conclude that chronic mastopathy, particularly when associated with uterine fibroma, can be successfully treated by luteinizing hormone releasing hormone analogs in premenopausal women.

Steroid patterns of benign breast disease

We briefly review some biochemical aspects of benign breast disease (BBD), mainly focusing on free and conjugate estrogen content of breast cyst fluid (BCF), also in relation to cyst type. Evidence is reported that high K(+)-type I-cysts clearly associate with low Cl- levels and accumulate significantly higher quantities of dehydroepiandrosterone sulfate (DHAS) and estrone-3-sulfate (E1S). In spite of the limited number of cases, both increasing DHAS and E1S levels correlate with the increment of K+ to Na+ ratio. A positive correlation was also found between DHAS and E1S. Using electrochemical detection (ECD) on-line to high performance liquid chromatography (HPLC) in the reverse phase mode, we also studied the free estrogen profile. We observed that in type I BCF there are significantly increased amounts of free estrone (E1). The E1S to E1 ratio was significantly different in the two cyst subpopulations; again, a positive correlation was found between free and sulfated E1 (r = 0.820, p less than 10(-6). This last, together with other experimental observations, allows us to hypothesize that in BCF a main pathway of steroids should be E1S----E1. Besides, high specific activity of sulfatase, as well as beta-glucuronidase enzymes, has been demonstrated for BBD. Preliminary information is also reported concerning the BCF pattern of free estrogens, including the highly polar ones, i.e., catecholestrogens (CCE) and the parent methoxy (MeO) conjugates, which represent, in BCF, a predominant portion of all free estrogens. Both CCE levels and ratios appear unevenly distributed in the two different cyst types. In addition, some BCFs show very high concentrations of 16 alpha-OH-E1. Further studies are needed to answer the main question: whether estrogen patterns could represent additive parameters to further categorize breast cystic disease (BCD) or whether they are of minor interest to determine patients' risk of developing breast cancer.

Oestrogen receptors in benign epithelial lesions and intraduct carcinomas of the breast: an immunohistological study

We examined 198 breast lesions, representing commonly encountered benign epithelial proliferative disorders, lobular carcinoma in situ and intraduct carcinoma, immunohistologically for oestrogen receptors (ER). A mixture of three ER monoclonal antibodies--H222, D75 and D547--was used on sections of routinely processed and paraffin-embedded tissue blocks. Over 65% of the benign and malignant lesions showed some evidence of ER expression and significant staining was recorded by two observers in 28-31% of fibroadenomas, 18-28% of ductal epithelial hyperplasias, 30-40% of sclerosing adenosis cases, 38-45% of papillomas, 60% of in situ lobular carcinomas and 42-45% of intraduct carcinomas. Apocrine metaplastic cells and myoepithelial cells showed absent or only weak staining. Amongst intraduct carcinomas, less than 20% of comedo carcinomas and over 50% of cribriform, papillary and solid variants showed significant ER staining.

Oestrogen (ER) and progestin receptors (PR) in mammary tissue of the female dog: different receptor profile in non-malignant and malignant states

Oestrogen (ER) and progestin receptors (PR) were measured in cytosols from histologically normal mammary tissues (n = 30), and in benign (n = 59) and malignant mammary lesions (n = 49) from female dogs. Receptor levels greater than or equal to 5 fmol mg-1 protein were considered positive. The presence of histologically normal mammary epithelium within specimens of primary tumours was noticed as a factor that may cause false-positive receptor results. Receptor levels in non-malignant tissues, and the receptor status of primary cancers did not vary significantly with regard to the phase of oestrous cycle (anoestrus/metoestrus) or the influence of exogenous progestins. ER- or PR-positivity was more frequent and levels of both receptors were higher in 'normal' tissues and in benign lesions than in primary cancers (P less than 0.001). ER and PR levels were higher in benign lesions of dogs also developing malignant mammary tumours than in benign lesions of dogs that did not (P less than 0.02 and P less than 0.05, respectively). Regional and distant cancer metastases were frequently receptor-negative. In some dogs heterogeneity of receptor status was found between different sites of the same cancer. These findings indicate that in non-malignant mammary tissues of adult female dogs expression of the genes encoding ER and PR is common. In malignant tumours this property may become lost, in particular in advanced states of disease.

Presence and characterization of insulin-like growth factor 1 receptors in human benign breast disease

Insulin-like growth factor 1 binding sites were characterized in human benign breast disease. We demonstrated the presence of one high affinity binding site. Chemical cross-linking of [125I]IGF1 to benign breast disease membranes in reducing condition and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) revealed one band with an apparent Mr of 130,000. The specificity of the binding was studied: IGF 2 was a good competitor whereas insulin competed for binding with a potency lower than 1/100 that of IGF1. This IGF1 binding corresponded to the previously described type I IGF receptor (IGF1-R). IGF1-R was assayed in 35 cases of benign breast disease and two samples of normal breast tissue. Forty-three per cent of the lesions were IGF1-R positive. The mean geometric level of specific binding was 1.98% in the whole population, it was significantly lower in adenofibromas (1.55%) than in epithelial hyperplasia (2.5%); it was 2% in dystrophic disease. IGF1-R was undetectable in normal tissue. Considering our previous results showing that almost all the breast cancers contained IGF1-R, these data suggest that the increase in IGF1-R could be a marker of malignant tumor development.

Immunohistochemical study of D5 antigen (an oestrogen receptor related protein) in normal breast, benign breast disease, and mammary carcinoma in situ

Patterns of staining with a monoclonal antibody which recognises D5 antigen (a 29,000 kD oestrogen receptor-related protein) were studied in seven normal and 76 benign breast biopsy specimens as well as in 12 cases of pure in situ mammary carcinoma. Staining in benign breast lesions was weak and heterogeneous when compared with that seen in most infiltrating carcinomas. In situ carcinomas showed an intermediate pattern of staining. The finding of only small foci of weak positivity for D5 antigen in normal and benign breast disease indicated that there are similarities between the expression of D5 antigen and the presence of oestrogen receptor protein in these tissues. A further similarity was seen with in situ carcinomas, which have been shown to have lower oestrogen receptor content than infiltrating carcinomas and a more heterogeneous staining pattern with D5 than is seen in infiltrating tumours. The importance of these findings remains to be evaluated because the precise nature of D5 antigen and its association with the oestrogen receptor molecule is not fully understood.

Hormone receptors in breast cancer: a conservative determination of receptors' presence in tumor tissue and ipsilateral normal mammary gland

Estrogen (ER) and progesterone (PgR) receptors were evaluated in the tumor tissue (T) and in the mammary gland far from malignancy (D) in 36 breast cancers. Results were correlated with the pathological grading of the tumor and the axillary nodal status. It is suggested that a lower cancer malignancy with negative nodes and lower values of pathological grading (G1-G2) may be associated with a high level of ER in the mammary parenchyma far from the tumor (D).

Estrogen and progesterone receptor determinations in breast cancer. Technology, biology and clinical significance

Our present state of knowledge regarding estrogen and progesterone receptors (ER and PgR) has led to changes in treatment strategies: patients without receptors in their tumor tissues cannot be expected to respond to endocrine therapy. Furthermore, groups of patients with specifically good or poor prognoses can be selected. Treatment of the disease now approaches being of a rational rather than of an empirical nature. However, it is imperative that we achieve a considerably higher level of understanding before we can predict, with high probabilities, which patients will benefit from endocrine therapy. Only through a coordinated effort by many centers can we hope to attain this goal. In such collaborations there are several factors that must be taken into consideration if reproducible conclusions are to be reached: a) sampling of the tumor biopsy for analysis, b) potential differences in assay procedures which may affect results, and c) the composition of the population studied. Since the traditionally used ligand binding assay (dextran-coated charcoal (DCC) method) is highly sensitive even to slight modifications in assay procedure, intra- and interlaboratory standardization of receptor analyses is challenging. Accordingly, correlations between receptor status and/or concentrations and the clinical course of the disease from different centers often demonstrate discrepant results. With the greater reproducibility and sensitivity of the newly developed immunoenzymometric assay (IEMA) methods, many of these problems might be solved in the future and inter-center clinical studies will thus be facilitated. In the national Danish Breast Cancer Cooperative Group (DBCG) project, approximately 90% of all patients with primary breast cancer are registered. Estrogen and progesterone receptor (ER and PgR) determinations have been performed on tumor tissue from approximately 30% of these patients in one single laboratory. The results of these analyses are presented here for approximately 4,000 patients in relation to age, menopausal status, tumor size, grade of anaplasia, and lymph node involvement. Biologically and clinically there appear to be three fundamental types of tumor tissues; hormone responsive (ER+PgR+ and ER-PgR+), hormone non-responsive (ER-PgR-), and tissues of a more dubious hormone responsive nature (ER+PgR-), which occur predominantly among postmenopausal patients. Several lines of evidence indicate that among the postmenopausal patients there may be an estrogen binding molecule similar to but distinct from the normal, physiologically functioning ER molecule.(ABSTRACT TRUNCATED AT 400 WORDS)

Ornithine decarboxylase activity, prolactin blood levels, and estradiol and progesterone receptors in human breast cancer

Ornithine decarboxylase (ODC) activity in human breast cancer tissues was correlated with prolactinemia (Prl), estradiol and progesterone cytosol receptors (ER and PR), and histopathologic pattern. Ninety-two cases of breast cancer, six benign mammary disease, and three normal breast tissues were studied for ER, PR, and ODC. Prolactinemia was assessed in 59 cancer patients, 14 of whom showed hyper-Prl along with significantly higher ODC than in patients with normal-Prl [(20.01 +/- 6.33) 10(-2) vs (5.20 +/- 0.90) 10(-2) pmol CO2/micrograms protein/h; P less than 0.0125]. A direct correlation was found between Prl and ODC in postmenopausal women (n = 40). Prl was assayed in seven of 13 ER-PR breast cancer patients; a highly significant, direct correlation was found between Prl and ODC in this group (r = 0.934, P less than 0.0025). ODC did not correlate with ER or PR. Carcinomas with higher ODC (n = 17) had higher cellularity, lower histologic differentiation, and higher nuclear anaplasia than those in which ODC was not detectable (n = 13). In normal breast and five of six benign mammary disease tissues, ODC was not detectable. These findings suggest that ODC could be a reliable marker for prognosis.

Steroid receptors in breast cancer: sources of inter-laboratory variation in dextran-charcoal assays

The presently recognized correlations between various clinical parameters and the concentrations of estrogen and progesterone receptors in breast cancer biopsies are largely based on receptor values obtained using the dextran-coated charcoal (DCC) method. This assay method is highly sensitive to slight changes in assay protocol, and differences in assay methodology may account for the wide variation in proportions of receptor positive patients reported by different centers. A survey of various aspects of the assay method that may lead to reproducible, systematic differences in concentrations of receptor levels is presented; and methods of compensating for or correcting these potential differences are discussed. The following aspects are considered: a) constitution of biopsy tissue, b) method of tissue homogenization, c) absorption of ligands to surfaces, d) inclusion of molybdate in the assay buffer, e) composition of the DCC slurry, and f) handling of samples for liquid scintillation counting. Differences in methods used to homogenize tissue in Europe and the U.S.A. may account for differences observed in the correlation of DCC assay results obtained using the recently-introduced monoclonal ER-EIA technique.

Effects of danazol on incidence of progesterone and oestrogen receptors in benign breast disease

Results from a continuing clinical trial in benign breast disease indicate that danazol may induce progesterone receptors and that this effect persists after treatment. In women given danazol the number of biopsy specimens that were positive for progesterone receptors rose from 14 out of 31 before treatment to 23 out of 30 at the end of six months' treatment and remained raised at 21 out of 31 six months later. The number of biopsy specimens that were positive for oestrogen receptors rose transiently from eight out of 31 to 12 out of 30 and then fell to six out of 31. A satisfactory clinical response was achieved in 26 of the 31 patients but was maintained in only 11 six months or more after the end of treatment. It was only in this group that a significant and long-standing increase in progesterone receptors was observed. These findings suggest that in some women with benign breast disease who have been treated with danazol changes occur that may have long term benefit.

Oestrogen and progesterone receptor distribution in the cancerous breast

To test the hypothesis that steroid hormone receptor expression is particularly pronounced in breast tumours when compared with non-neoplastic tissue, mastectomy samples were divided into 16 sectors. Multifocal tumours, of varying receptor phenotype were found in 4 patients and in addition different regions of large tumours also showed varying receptor contents. Remaining samples were found to consist of normal tissue, with fat, connective tissue and some benign breast disease. In the 9 patients with oestrogen receptor positive tumours (ER), ER content was invariably much greater in the tumours than in the remainder of the breast. Progesterone receptor (PR) content was not closely related to ER, and was lowest in the poorly differentiated tumours. This relation to differentiation was not seen in ER. The data support the view that ER concentration in ER positive tumours may reflect the transformed nature of neoplastic tissue.

Estrogen and progesterone receptors in human breast cancer. Correlation with histologic subtype and degree of differentiation

Microscopic review of 490 consecutive human breast biopsy and mastectomy specimens were correlated with estrogen and progesterone receptor content of the tissue, by subtype and degree of differentiation. Of the 4 grades of differentiation, the less differentiated Grade III and IV tumors showed significantly lower levels of estrogen and progesterone receptors in infiltrating ductal and lobular carcinoma (P less than 0.001). In contrast, patients with medullary carcinoma had the lowest tissue levels of estrogen and progesterone receptors with approximately 80% of the cases with less than 10 fmol/mg protein. Patients with mucinous carcinoma had the highest percentages of positive estrogen and progesterone receptor levels (75% and 87%, respectively). Sixty-three percent of the patients with Grade IV infiltrating ductal carcinoma were younger than 53 years of age (P less than 0.001). Patients younger than 53 years of age with Grade II and III infiltrating ductal carcinoma also had significantly lower levels of estrogen receptors, but not of progesterone receptors, than those patients older than 53 years of age (P less than 0.001). Nineteen of 20 "normal" breast tissue specimens were negative (less than 3 fmol/mg protein) for estrogen and progesterone receptors. About 50% of 17 tissue specimens from benign breast lesions (fibroadenoma, fibrocystic disease, sclerosing adenosis) showed positive estrogen (greater than 10 fmol/mg protein) or progesterone receptor values. In two patients with gynecomastia, no estrogen or progesterone receptors were detectable.

Estrogen and progesterone receptors in benign breast tumors and lesions: relationship with histological and cytological features

The pattern of estrogen (ER) and progesterone receptors (PR) and their relationship to histo- and cyto-pathological parameters has been studied in 97 cases of benign breast disease and benign phyllode tumors (95 women, of whom 76 were premenopausal, and 2 men). Total (cytosolic + nuclear) ER and PR were assayed by a single-saturating dose method using a tris-KCl buffer. The cut-off between positive and negative ER and PR assay was 100 femtomoles/g tissue. All specimens were processed for histological examination: epithelial and fibroblastic proliferation, epithelial/stromal ratio and presence of focal or diffuse hyalinosis. In 33% of the 46 cases of fibrocystic disease one receptor at least was present (13% ER+, 31% PR+). All the 8 cases in which infiltrating epitheliosis was present were PR+ and 4 of them were also ER+. In 72% of the 31 fibroadenomas one receptor at least was present (19% ER+, 71% PR+). In all these cases levels of receptors were lower than in malignant tumors. An inverse correlation between PR + prevalence and fibrohyalinosis was observed; on the other hand a positive relationship between PR + and fibroblastic (p less than 0.001) or epithelial (p less than 0.01) proliferation was found. In all 5 benign phyllode tumors examined PR + were present at a very high level, almost as high as in malignant tumors. Of the 15 other benign breast lesions, all but one (1 hamartoma) were ER- and PR-.

Better prognosis of many cancers in female: a phenomenon not explained by study of steroid receptors

Experimental evidence indicates that specific sex hormonal imbalance, deficiency, and excess may be causes of tumors or at least contribute in some way to their development. Clinical observations show that the prognoses of patients with various malignancies differ among males and females, and some cancers can be alleviated and partially controlled by altering the accustomed hormonal environment. Although beneficial effects usually are only temporary, there is no doubt that some cancers are hormone-dependent to a degree. A significant number of prostatic carcinoma in males and breast carcinoma in both sexes have been treated with various additive or ablative endocrine manipulations. The detection and quantitation of specific steroid binding proteins in hormone-sensitive tumors have enhanced our understanding of the mechanism of endocrinal therapy. Excluding carcinoma of the breast and of the sex organs (ovary and uterus in females, testis and prostate in males), many other solid tumors have been tested for the presence of estrogen and other steroid receptors. A fair number of solid cancers contains estrogen and progesterone receptors (ER, PR), even those from male patients. Thus, the better prognosis of females with sarcoma, melanoma, liver, colorectal and other cancers cannot simply be explained by the presence or absence of estrogen or progesterone receptors. This review attempts to summarize clinical reports of this interesting phenomenon, including therapeutic results with estrogenic, antiestrogenic, and other hormonal approaches.

Cytochemical and competitive protein binding assays for estrogen receptor in breast disease. A comparative study of 62 cases

Estrogen receptor content of breast lesions was estimated using a fluorescent cytochemical technique and a competitive protein binding assay. Of 48 cancers examined, an equal proportion contained significant quantities of receptor by either method (62.5%). The concordance between methods for individual patients was also 62.5%. A greater proportion (26%) of patients younger than 45 years of age had receptor-positive cancers using the cytochemical method than were found by the biochemical method (10%). Benign breast disease was also studied using the fluorescent cytochemical method. A greater proportion of lesions containing estrogen receptors was found compared with that cited in the literature for the competitive protein-binding assay. Because of the methodologic simplicity of the fluorescent cytochemical method, further study for routine use is indicated.

Relationships between steroid receptor and epithelial cell proliferation in benign fibrocystic disease of the breast

Tissue specimens from 27 patients with mammary fibrocystic disease were assayed for estrogen (ER) and progestin (PR) receptors. Seventeen patients (63%) had ER-positive lesions (greater than 5 fmol/mg protein). A progression in ER presence was noted from fibrocystic disease (35%) and fibrosing adenosis (50%) to lobular and ductal hyperplasia (85%). Similarly, ER content increased from 14.5 +/- 13 fmol/mg cytosol protein in fibrocystic disease and fibrosing adenosis to 31.5 +/- 23 fmol/mg protein in epithelial hyperplastic lesions. Furthermore, the ER-PR couple was only encountered in lobular and ductal hyperplasia. The authors' data indicate that the incidence of steroid receptor parallels the intensity of hyperplasia in benign breast disease.

Quantitative estrogen receptor analyses: the response to endocrine and cytotoxic chemotherapy in human breast cancer and the disease-free interval

The usefulness of estrogen receptor (ER) analyses was assessed in a variety of clinical situations. The predictive accuracy of the test is substantially increased by quantification. ER analyses accurately predict objective responses to endocrine therapy independently of other clinical prognostic criteria. In addition, ER positivity is associated with a decreased response rate to cytotoxic chemotherapy in patients with metastatic breast cancer. Finally, the presence of ER is positively associated with a prolonged disease-free interval independent of menopausal status, tumor size, and axillary lymph node involvement.