What Are Hormones And Hormone Receptors
Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.
The hormones estrogen and progesterone are produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.
Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.
Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative.
Approximately 67%80% of breast cancers in women are ER positive . Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive .
What Are The Stages Of Breast Cancer
Breast cancer is staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. One is low grade cancer and three is high grade cancer that grows and spreads rapidly.
The four stages of breast cancer are:
- Stage I: The tumor is relatively small and localized to the original site, with possible spread to the sentinel lymph nodes, which are the first lymph nodes the cancer is likely to spread to.
- Stage II: The tumor has grown and spread to a few nearby lymph nodes.
- Stage III: The tumor has grown into many lymph nodes and other tissue in the breast.
- Stage IV: The cancer has spread to distant parts of the body.
Another highly detailed classification system is the TNM classification system based on tumor size, lymph node involvement and metastatic spread.
What Is Her2 And What Does It Mean
HER2 is a growth-promoting protein on the outside of all breast cells. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than other breast cancers, but are much more likely to respond to treatment with drugs that target the HER2 protein.
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What Does Estrogen Positive Breast Cancer Mean
What causes estrogen positive breast cancer?
Some breast cancers develop due to a problem involving hormones, including estrogen and progesterone. These hormones play a role in telling breast cells to grow. In hormone receptor-positive breast cancer, the receptors for hormones cause breast cells to grow in an uncontrolled way.
How Her2 Affects Staging
Your HER2 status helps determine the pathology of your specific breast cancer. Your HER2 status can also help determine how aggressive the cancer is. Your doctor will use this information to evaluate your treatment options.
As of 2018, the breast cancer staging system that the American Joint Committee on Cancer uses now incorporates HER2 status.
Staging is complex and must take various other factors into account, such as:
- the size of the tumors
- the cancers hormone status
- whether the cancer has spread to nearby lymph nodes
- whether the cancer has spread beyond the breast
- whether the cancer cells look abnormal
For example, these two cancers are both classified as stage 1B:
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Proteins For Targeted Cancer Drugs
Testing cancer cells for particular proteins can help to show whether targeted drug treatments might work for your breast cancer.
Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer.
Some breast cancers have large amounts of a protein called HER2 receptor . They are called HER2 positive breast cancers. About 15 out of every 100 women with early breast cancer have HER2 positive cancer.
Targeted cancer drugs such as trastuzumab can work well for this type of breast cancer. These drugs attach to the HER2 protein and stop the cells growing and dividing.
There Are Two Ways To Measure The Her
The most common way to measure the HER-2 status of a potential breast cancer tumor is through an immunohistochemistry test. This will likely be part of an overall histological/pathological evaluation of the tumor.
Various tumor markers, including the HER-2 status indicators, give the pathologist a characterization of the tumor. This helps to predict the future behavior and probable responses, of the tumor to different types of treatments.
The immunohistochemistry test of the HER-2 status measures the over-expression of a particular protein and is typically given a score of 0 to +3.
The pathologist actually counts the number of receptors on the surface of the cancer cells. Indeed, the pathologist can see the cells microscopically because they are receptive to certain protein-based dyes and change color.
Scores of 0 and +1 are indicative of a negative status , whilst +2 and +3 are HER-2 positive . There is no in-between state.
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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:
What Does Triple Positive Breast Cancer Mean
HER2-Positive Breast Cancer
- Another drug, lapatinib , is often given if trastuzumab did not help. ADO-trastuzumab emtansine may be given after trastuzumab and a class of chemotherapy drugs called taxanes, which is usually used to treat breast cancer.
- Pertuzumab can be used with trastuzumab and chemotherapy others drugs to treat advanced stages breast cancer. This combination can also be given before surgery to treat early-stage breast cancer. In one study, a combination of the two drugs was shown to prolong life.
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What Is Triple Negative Breast Cancer
In addition to being negative for estrogen and progesterone receptors, triple negative breast cancer cells also lack a protein known as HER2. Human epidermal growth factor receptor-2 is a protein that promotes cell growth and HER2 positive breast cancers have a higher than normal presence of these proteins, because of mutations in HER2 gene.
Triple negative cancers account for approximately 15% of breast cancers. Triple negative breast cancer more often occurs in African-American women younger than 40, or women who have an inherited mutation in BRCA1 gene, which normally is a tumor suppressor gene, which suppresses cell growth.
Hormone Receptors & Receptor Tests
All breast cancers are examined under a microscope for biomarkers of estrogen and progesterone receptors. About 70% of breast cancers are hormone receptor-positive.
Your hormone receptor status should appear on your pathology report after biopsy or surgery. Receptors will be retested if you ever have a recurrence or metastases as well, as your status can change.
Hormones and receptors go together kind of like a lock and key. Receptors are proteins on the surface of breast cells, and when hormones bind to them, the receptors tell the cells to grow and divide. All breast cells have receptors, but they are found in much greater numbers on breast cancer cells that are considered positive.
A goal of treatment is to block the signal created when the hormones attach to receptors. Doing that requires one of two things:
Most of the time, breast cancers tend to be positive or negative for both estrogen and progesterone receptors. Now and then, one will be positive for estrogen but not progesterone. The treatment is the same either way.
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What Is The Survival Rate For Hr Positive Breast Cancers
The survival rate for breast cancers are excellent if the cancer is detected early, and in general HR positive cancers grow slower and have a better prognosis. Overall, breast cancers that are both HR positive and HER2 negative have the best outcomes.
According to recent National Cancer Institute data, the four-year survival rate for combined stages of cancer, based on HR and HER2 status are:
- HR positive/HER2 negative: 92.5%
What Does It Mean To Have Her2
When you were diagnosed with breast cancer, the tissue taken during your biopsy was likely tested for several biologic markers. Those results helped your doctor tailor your treatment. If the tissue was diagnosed as HER2-positive, that means that your cancer produced too much of a growth-promoting protein. About 15% of the 268,000 women living in the U.S. diagnosed with breast cancer each year fall into this group.
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Common Types Of Breast Cancer
There are many types of breast cancer, but the most common ones are:
- Ductal carcinoma in situ
- Invasive ductal carcinoma
- Invasive lobular carcinoma
Lobular or ductal describes whether the cancer originated in the lobules or the ducts of the breast. An in situ cancer is located within the ducts or lobules and has not invaded into the breast tissue. An invasive cancer has invaded normal tissue within or beyond the breast.
Phytoestrogens And Soy: The Debate
Phytoestrogens are compounds that have a mild estrogenic effect and are found in whole grains, nuts and seeds, and many other botanicals, fruits and vegetables. These foods are associated with a reduced risk of breast cancer as well as reduced cancer reoccurrence.
The controversy becomes heated in the debate over soy-containing foods. This issue is complex, with some studies showing that eating soy early in life can reduce breast cancer risk. On the other hand, the consumption of concentrated soy extracts showed increased proliferation of breast cancer cells. Finally, other studies show a protective or neutral effect from whole soy foods.
My recommendation for soy is to eat whole soy foods in moderation no more than several servings per week, preferably fermented soy foods such as miso or tempeh. Avoid soy protein isolates and supplements containing concentrated soy isoflavones.
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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.
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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Hormone Receptor Status And Hormone Therapy
Hormone receptor-positive breast cancers can be treated with hormone therapy drugs. These include tamoxifen and the aromatase inhibitors, anastrozole , letrozole and exemestane . Ovarian suppression, with surgery or drug therapies, is also a hormone therapy.
Hormone receptor-negative breast cancers are not treated with hormone therapies because they dont have hormone receptors.
Learn about hormone therapy for the treatment of metastatic breast cancers.
Dos And Donts For Estrogen
Breast cancer is not just one disease it comes in many variations.
One of the primary factors in determining the type of breast cancer is the sensitivity of the tumor cells to estrogen. If a breast tumor is hormone-sensitive or estrogen receptor-positive, it means there are specific estrogen receptors on the tumor cells, and when estrogen binds with these receptors, it transfers a message to the cancer cells. Like a lock and key effect, the breast tumor cells are stimulated by estrogen to grow and reproduce. Therefore, one of the main goals of therapy or intervention with hormone-positive cancer is to reduce hormonal stimulation as much as possible.
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What Do The Test Results Mean
The results of HER2 testing will guide you and your cancer care team in making the best treatment decisions.
It is not clear if one test is more accurate than the other, but FISH is more expensive and takes longer to get the results. Often the IHC test is done first.
- If the IHC result is 0 or 1+, the cancer is considered HER2-negative. These cancers do not respond to treatment with drugs that target HER2.
- If the IHC result is 3+, the cancer is HER2-positive. These cancers are usually treated with drugs that target HER2.
- If the IHC result is 2+, the HER2 status of the tumor is not clear and is called “equivocal.” This means that the HER2 status needs to be tested with FISH to clarify the result.
Triple-negative breast tumors dont have too much HER2 and also dont have estrogen or progesterone receptors. They are HER2-, ER-, and PR-negative. Hormone therapy and drugs that target HER2 are not helpful in treating these cancers. See Triple-negative Breast Cancer to learn more.
Triple-positive breast tumorsare HER2-, ER-, and PR-positive. These cancers are treated with hormone drugs as well as drugs that target HER2.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Last Revised: September 20, 2019
Why Your Hormone Status Matters
Breast cancers that are estrogen receptor-positive and/or progesterone receptor-positive are “fueled” by hormones. They’re different from breast cancers that are HER2-positive, in which tumor growth is driven by growth factors that bind to HER2 receptors on the cancer cells. Breast cancers that don’t have any of these receptors are called triple-negative.
Some breast cancers are both hormone receptor-positive and HER2-positive, meaning that estrogen, progesterone, and growth factors can stimulate cell growth. These cancers are often referred to as triple-positive breast cancers.
An ER+ or PR+ score means that hormones are causing your tumor to grow and hormone suppression treatments are likely to work well.If the score is negative , then your tumor is not driven by hormones and your results will need to be evaluated along with other tests, such as your HER2 status, to determine the most effective treatment.
If the only information you’re given is that your hormone status tests are negative, it’s good to ask your healthcare provider for a number that indicates the actual score. Even if the number is a low one, the tumor may effectively be treated with hormone therapy.
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How Does Hormone Therapy Work
Our bodies make a variety of hormones to help control how certain cells work.
Estrogen and progesterone are hormones that are mainly produced in the ovaries of premenopausal women. But theyre also produced in other tissues, so postmenopausal women and men have some estrogen and progesterone, too.
These hormones, however, can promote the growth of some breast cancers.
Treatments like surgery and radiation target specific areas of the body, such as the tumor site or lymph nodes. Because they focus on very specific areas, theyre considered localized treatments.
Hormone therapies, on the other hand, are considered systemic treatments because they target hormones throughout the body.
There are several types of hormone therapy, each with its own mechanism of action. They may help stop or slow growth or prevent recurrence by blocking:
- ovarian function
There are several types of hormone therapy to treat breast cancer, including:
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:
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