Enhancement by prolactin of carcinogen induced mammary cancerigenesis in the male rat

Altered prolactin and androgen receptors expression in companion rat benign mammary tumours

Benign mammary tumours are among the most common tumours of companion rats (Rattus norvegicus domestica), as well as a major animal welfare concern and euthanasia. The first objective of this study was to evaluate the expression of oestrogen, progesterone, androgen, and prolactin receptors in neoplastic and normal mammary gland tissues and compare the expression of these receptors between groups. The second objective was to determine if the expression of these receptors in neoplastic mammary gland tissue correlates with overall survival and occurrence of an additional mass after initial mammary mass excision. The third objective was to determine if the expression of oestrogen, progesterone, androgen and prolactin receptors was associated with mammary tumor clinical parameters or with the age of the animals. Thirty-two benign mammary tumours were collected from companion rats and submitted for immunohistochemistry staining of prolactin receptor, oestrogen receptor alpha (ERa), progesterone and androgen receptors (AR). Allred score were obtained for mammary tumours (n = 32) and surrounding normal mammary tissue (n = 20) when present. Prolactin receptor expression increased significantly with mammary gland tumorigenesis (P < .0001), while AR expression decreased with tumorigenesis (P < .0001). Lower expression of ERa in tumor stroma was associated with shorter survival (P = .02). Hormonal receptor expression was not significantly associated with age, mass diameter, location nor likelihood of additional mass development. Further studies should investigate the effects of prolactin antagonists in a prospective study involving companion rats with benign mammary tumours.

Prolactinoma through the female life cycle

Prolactinomas are the most common secretory pituitary adenoma. They typically occur in women in the 3rd-6th decade of life and rarely in the pediatric population or after menopause. Most women present with irregular menses and/or infertility. Dopamine (DA) agonists, used in their treatment, are safe during pregnancy, but in most cases are discontinued at conception with close monitoring for signs or symptoms of tumor growth. Breastfeeding is safe postpartum, provided there was no significant growth during pregnancy. Some women will experience normalization of prolactin levels postpartum. Menopause may also decrease prolactin levels and even those with macroprolactinomas may consider discontinuing their DA agonist with close follow-up. Prolactinomas may be associated with decreased quality of life scores in women, and play a role in bone health and cardiovascular risk factors. This review discusses the current literature and clinical understanding of prolactinomas throughout the entirety of the female life cycle.

Prolactin--to be reconsidered in canine mammary tumourigenesis?

Mammary tumours represent the most common neoplastic disease of the female dog, and the incidence in female dogs is much higher than in women. Whereas the influence of sexual steroids on breast cancer (BC) development in dogs has been studied, very little is known about the role of prolactin (PRL). New studies show that until recently, the importance of PRL in human BC development and progression has been highly underestimated. PRL plays a role in promoting benign as well as malignant neoplastic cell growth in BC in vitro and in vivo. Sporadic publications proposed a tumour promotor role in the dog. The goal of this review is to summarize our knowledge about PRL and human BC as well as canine mammary tumourigenesis, and propose future research in this area.

Cancer risk in hyperprolactinemia patients: a population-based cohort study

OBJECTIVE

Experimental evidence indicates that prolactin might play a role in tumorigenesis of several human cancers, but data on cancer risk in hyperprolactinemia patients are sparse. The aim of this study was to investigate cancer risk in hyperprolactinemia patients. Design A population-based matched cohort study in Sweden.

METHODS

The hyperprolactinemia cohort consisted of patients hospitalized for hyperprolactinemia from 1987 to 1995 identified in the National Patient Register (n=585) and a hospital cohort of prolactinoma patients at Karolinska University Hospital (n=384). For each patient, ten matched individuals were identified via the Register of Population. Cancer occurrence was ascertained via the Swedish Cancer Registry. Hazard ratios (HRs) were estimated by Cox proportional hazards regression.

RESULTS

Seventy-three malignant tumors were identified in the hyperprolactinemia patients and 660 tumors in the comparison group (HR 1.31; 95% confidence interval (CI): 1.02-1.68), mainly attributed to an increased risk of upper gastrointestinal cancer in both males and females (HR 3.69; 95% CI: 1.70-8.03) and hematopoietic cancer in females (HR 3.51; 95% CI: 1.06-11.6). Twelve breast cancers occurred in the female patients, corresponding to an HR of 1.09 (95% CI: 0.60-1.99). Prostate cancer risk in hyperprolactinemia men was reduced (HR 0.40; 95% CI: 0.16-0.99).

CONCLUSIONS

An increased overall cancer risk was found in hyperprolactinemia patients, but no increased risk of breast cancer in women and a reduced risk of prostate cancer in men. These findings warrant further investigations and to be confirmed in larger studies but may indicate the importance of an active treatment strategy and follow-up of hyperprolactinemia patients.

Adverse effects of prolactin in rodents and humans: breast and prostate cancer

Drugs and chemicals shown to induce mammary carcinogenesis in the rat/rodent via prolactin excess have traditionally been argued to pose little or no risk to humans in a regulatory toxicology context. The basis for this assumption is reviewed and placed into context with new evidence in humans that prolactin may be a tumour promoter in the breast and prostate. This evidence includes epidemiology, patient studies involving endocrine evaluation and molecular biology in human cells. It is concluded that hyperprolactinaemia is associated with an increase in breast cancer risk in both post and premenopausal women, that rat carcinogenicity studies are predictive of the human response, and that in a regulatory toxicology context prolactin-induced mammary tumours from nongenotoxic drugs and chemicals are an adverse effect that should not be ignored. More evidence is required concerning prostate cancer risk but molecular biology indicates that prolactin also induces prostate cell proliferation and inhibits apoptosis, which are similar to the responses observed in breast cancer cells.

Hyperprolactinaemia as an adverse effect in regulatory and clinical toxicology: role in breast and prostate cancer

Historically, hyperprolactinaemia has been considered of low toxicological relevance when detected in toxicity studies, and even mammary carcinogenesis induced in the rat by prolactin excess has been considered of no relevance to humans. However, recent findings from human epidemiology and molecular biology suggests that prolactin is a risk factor for human breast cancer, and probably prostate cancer. Therefore, this new evidence should be considered in the various decisions to develop and license a new drug or chemical if the compound causes hyperprolactinaemia. This emerging evidence suggests that prolactin can also be produced locally from human breast cancer cells, and that, regardless of source (ie, pituitary or autocrine/paracrine production from cancer cells), prolactin is mitogenic, stimulates proliferation and suppresses apoptosis in breast and prostate cancer cells. This review outlines the evidence that hyperprolactinaemia should be considered a toxicological adverse effect and concludes that prolactin-induced rodent mammary carcinogenesis is relevant to humans and is not species-specific. The effects of prolactin on the prostate gland are also discussed; hyperprolactinaemia may be an additional risk factor for prostate cancer and this also requires consideration in toxicological risk assessments. The implications of increased prolactin secretion as an adverse effect for regulatory toxicology of drugs and chemicals, and in high risk patients receiving therapeutic drugs with hyperprolactinaemic side effects, is discussed. Alteration of prolactin level is also a novel mechanism that requires consideration in endocrine disruption research, since both endogenous oestrogens and also xenoestrogens stimulate prolactin secretion or affect prolactin receptors.

Loss of mammary epithelial prolactin receptor delays tumor formation by reducing cell proliferation in low-grade preinvasive lesions

Top quartile serum prolactin levels confer a twofold increase in the relative risk of developing breast cancer. Prolactin exerts this effect at an ill defined point in the carcinogenic process, via mechanisms involving direct action via prolactin receptors within mammary epithelium and/or indirect action through regulation of other hormones such as estrogen and progesterone. We have addressed these questions by examining mammary carcinogenesis in transplants of mouse mammary epithelium expressing the SV40T oncogene, with or without the prolactin receptor, using host animals with a normal endocrine system. In prolactin receptor knockout transplants the area of neoplasia was significantly smaller (7 versus 17%; P < 0.001 at 22 weeks and 7 versus 14%; P = 0.009 at 32 weeks). Low-grade neoplastic lesions displayed reduced BrdU incorporation rate (11.3 versus 17% P = 0.003) but no change in apoptosis rate. Tumor latency increased (289 days versus 236 days, P < 0.001). Tumor frequency, growth rate, morphology, cell proliferation and apoptosis were not altered. Thus, prolactin acts directly on the mammary epithelial cells to increase cell proliferation in preinvasive lesions, resulting in more neoplasia and acceleration of the transition to invasive carcinoma. Targeting of mammary prolactin signaling thus provides a strategy to prevent the early progression of neoplasia to invasive carcinoma.

The prophylaxis of rat and mouse mammary gland tumorigenesis by suppression of prolactin secretion: a reappraisal

The purpose of this study was to evaluate the effect of early and temporal CB-154 induced suppression of prolactin secretion on the genesis of mammary tumors in female Sprague-Dawley rats treated i.g. with 3 doses of 7,12-dimethylbenzanthracene (DMBA); doses which yield a high (20 mg), moderate (5 mg) and low (1.25 mg) mammary carcinoma incidence. In addition, the effect of prolactin suppression on the genesis of mammary tumors in strains of rodents which, when treated with maximally tolerated doses of DMBA, develop a moderate (female Lewis rats) and a low (female Long-Evans rats and female Balb/c mice) mammary carcinoma incidence was also evaluated. Daily suppression of prolactin secretion during DMBA treatment (30 days before, during and 30 days after) (series 1) or commencing 30 days after DMBA treatment (for 60-81 days) (series 2) significantly (P less than 0.05) reduced the number of mammary carcinomas in Sprague-Dawley rats treated with 20 and 5 mg DMBA and in Lewis rats (series 2); treatment with CB-154 did not significantly lower mammary carcinoma incidence in Sprague-Dawley rats treated with 1.25 mg DMBA, nor in Lewis rats (series 1), Long-Evans rats and Balb/c mice. These results provide evidence that the effectiveness of prolactin suppression in the prophylaxis of chemical carcinogenesis of the rodent mammary gland is enhanced when a moderate or large dose of the carcinogen is used, or a strain of rodent is used which is moderately or highly susceptible to the mammary oncogenic effects of the carcinogen. Low doses of the carcinogen or use of a rodent strain relatively resistant to the carcinogen nullifies the chemopreventive activities of early prolactin suppression.

DMBA is Ineffective in Inducing Breast Cancer in Feminized Male Holtzman Rats

Mammary tissue of male rats « feminized » by in utero treatment with cyproterone acetate, accrues the capacity to convert circulating androgens to estrogens at the mammary tissue level in adult life. DMBA-induced mammary tumorigenesis was studied in these feminized males to find out whether or not this altered steroid metabolism leading to heightened estrogenicity would increase mammary tumor yield when compared to that seen in normal males, where such conversion is significantly low. Results on the incidence of mammary tumors, tumor pathology and latency period of tumor appearance in these 2 groups, however, do not differ significantly. From observations on mammary morphology of these feminized males it appears that in vivo conversion of testosterone to estrogen probably is not total and that the available testosterone inhibits tumor induction.

The human pineal gland in malignancy

The weight and degree of calcification of 500 pineal glands has been measured. The degree of cellularity, the size of the pineocyte nuclei and the extent of degeneration has been estimated in histological examinations of the glands. There are some differences in the weight of the gland in males and females of different ages and part of this is due to variations in the amount of calcium in the glands. There is only a minor decrease in the cellularity of the glands with increasing age, and this is accompanied in females by a slight increase in fibrosis and gliosis. The weight of the gland is high in patients dying from trauma and burns. No statistical differences are found in the weight of the pineal glands from patients dying of malignant and non-malignant conditions, although in most age-groups the glands tend to be smaller in patients dying of malignancy. On the other hand patients dying from carcinoma of the breast and from melanoma have much larger glands than those dying from sarcoma.