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 .
All About Er Positive Her2 Negative Breast Cancer
About one in eight women in the United States will develop breast cancer, according to commonly used statistics.
But other reports indicate that breast cancer rates are on the decline, likely because of improved recognition, prevention, and treatment. One advancement is the ability to identify different breast cancer types based on specific molecules found in tumors. The distinction greatly aids in breast cancer treatment selection and helps doctors predict how aggressive cancers will advance.
A crucial step in the process of beast cancer evaluation is testing tumor tissue removed during a biopsy or surgery to determine if it has estrogen and progesterone receptors molecules that the hormones bind to.
Cancerous cells may have none, one, or both receptors. Breast cancers that have estrogen receptors are called ER-positive . Those with progesterone receptors are referred to as PR-positive .
In addition to hormone receptors, some breast cancers have high levels of a growth-promoting protein called HER2/neu. If a tumor has this property, it is called HER2-positive. HER2 positive cancers are more aggressive than HER2 negative cancer.
Knowing breast cancer type, leads doctors to determining best treatments.
HER2 negative cancers will not respond to treatment with drugs that target HER2, such as trastuzumab and lapatinib .
Overall, estrogen receptor-positive breast cancer is treatable, especially when diagnosed early.
What To Look For In Your Pathology Report
When you have a biopsy for a breast tumor, the pathology report tells you a lot more than whether its cancerous or not. It provides crucial information about the makeup of your tumor.
This is important because some types of breast cancer are more aggressive than others, meaning they grow and spread faster. Targeted treatments are available for some types, but not for all.
Each type of breast cancer requires its own approach to treatment. The information in your pathology report will help guide your treatment goals and options.
Two important items on the report will be your HR status and your HER2 status.
Continue reading to learn more about how HR and HER2 status in breast cancer affects your treatment and your outlook.
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Molecular Classification Of Infiltrating Breast Cancer
Infiltrating breast cancer, also called invasive breast cancer, is one that has spread from its original location in the breast to other parts of the body. The most common type is infiltrating ductal carcinoma, which begins in the lining of the milk ducts. Another type is lobular carcinoma, which begins in the milk glands. Invasive ductal carcinoma and lobular carcinoma may be categorized as any of the four molecular subtypes.
About 85 percent of breast cancers are ductal carcinomas, while 11.4 percent are lobular carcinomas, according to a study published in the Annals of Medicine and Surgery. More than three-quarters of lobular carcinomas fall into the luminal A and triple-negative tumor category.
Should I Enroll In A Clinical Trial
Clinical trials are definitely worth considering, according to the Susan G. Komen organization. They offer the chance to try and possibly benefit from new treatments. The best time to join a trial is before starting treatment or, if your provider is considering changing treatments, before you switch to a new treatment. Ask your doctor if there are any trials that would suit your circumstances. You can also search the clinical trial database at ClinicalTrials.gov or use the Susan G. Komen Metastatic Trial Search, a personalized tool to match you with clinical trials.
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Do I Need Genetic Counseling And Testing
Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.
If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.
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Why Is Knowing Hormone Receptor Status Important
Knowing the hormone receptor status of your cancer helps doctors decide how to treat it. If your cancer has one or both of these hormone receptors, hormone therapy drugs can be used to either lower estrogen levels or stop estrogen from acting on breast cancer cells. This kind of treatment is helpful for hormone receptor-positive breast cancers, but it doesnt work on tumors that are hormone receptor-negative .
All invasive breast cancers should be tested for both of these hormone receptors either on the biopsy sample or when the tumor is removed with surgery. About 2 of 3 breast cancers have at least one of these receptors. This percentage is higher in older women than in younger women. DCIS should be checked for hormone receptors, too.
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How Her2 Affects Breast Cancer Stage
There are a number of things that affect the stage of your breast cancer. Whether you are HER2-positive or HER2-negative is one. Others are:
- Size of tumor and if it’s grown into tissue around it
- Whether there’s cancer in your lymph nodes
- Whether cancer has spread beyond the breast
- The tumor’s grade
- Whether cancer cells have receptors for the hormones estrogen and progesterone
It can be hard to figure out your stage because of the number of factors your doctor must consider. Every case is different, but there are general guidelines for each stage, and your HER2 status can make quite a bit of difference. For example, you might have breast cancer with:
- Tumor that is 2 to 5 centimeters
- No cancer cells detected in lymph nodes
If you’re HER2-positive you’re likely at stage IIA. If you’re negative, you’re probably still stage I.
Stage IIB could mean:
- Tumor that is 2 to 5 centimeters
- Cancer cells or clumps up to 2 millimeters in one or more lymph nodes
But even with these signs, you could still be at stage I if you’re HER2-positive
A stage III fast growing tumor that’s bigger than 5 centimeters might still be at stage IIA if you’re positive for:
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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Grade High Vs Low Or Intermediate
To evaluate racial differences within risk subgroups available in routine clinical practice, we also performed stratified analyses by overall tumor grade in the full study population . Grade is strongly associated with high-risk features and serves as a prognostic and predictive marker in the absence of gene profiling assays . We observed early separation of recurrence curves by race among women with high grade tumors . At 5âyears, Black women with high grade tumors had a recurrence risk of 16.6% , compared with 12.0% among White women. By comparison, Black and White women with low grade tumors had similar 5-year recurrence risk .
Standardized risk of recurrence among hormone receptor-positive/HER2â tumors stratified by race and grade. Pairwise log-rank tests were performed with Bonferroni correction for multiple comparisons. Compared with White women with low or intermediate grade, White women with high grade tumors and Black women with high grade tumors were statistically significantly different. Compared with Black women with low or intermediate grade tumors, Black women with high grade tumors were statistically significantly different . No other pairwise comparisons were statistically significant. Risk was standardized for age and stage.
RFD and 95% confidence intervals for treatment history and health insurance status for Black vs White women
|Treatment history and health insurance status .||White, No. nâ=â202 .|
Her2 Status In Breast Cancer
If your cancer appears to be aggressive and fast-growing, you might have higher levels of a protein called human epidermal growth factor receptor 2, or HER2 for short. Some genes, like HER2, and the proteins they make, do more than play a role in the development of breast cancer. They can also influence how your breast cancer behaves as well as how it may respond to specific cancer treatments.
Usually, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself. However, if the HER2 gene doesnt work correctly and produces too many copies of itself, it leads to the uncontrolled growth of breast cancer cells.
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Will I Ever Be Cured
Oncologists dont talk about curing stage 4 breast cancer as much as managing it as you would other chronic diseases, according to Brufsky. Were not likely going to get rid of every single bit of cancer, but were learning that people can live with this disease and be asymptomatic for years and years, he explains. While the mean survival of patients with HR-positive/HER-2-negative metastatic breast cancer is now over five years, its hard to say what the future holds for a woman diagnosed with the disease today. The field is changing so quickly and dramatically that in two or three years, this will be a different conversation.
Advances In Breast Cancer Research
A polyploid giant cancer cell from triple-negative breast cancer.
NCI-funded researchers are working to advance our understanding of how to prevent, detect, and treat breast cancer. They are also looking at how to address disparities and improve quality of life for survivors of the disease.
This page highlights some of the latest research in breast cancer, including clinical advances that may soon translate into improved care, NCI-supported programs that are fueling progress, and research findings from recent studies.
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What Does It Mean To Be Her2
If your breast cancer is HER2-negative, you do not have an excess of the HER2 gene. Tumors such as these will not respond to therapies that specifically target HER2 receptors.
If your breast cancer is HER2-positive, then you have too much HER2 protein or extra copies of the HER2 gene. These breast cancers tend to be fast-growing. HER2-positive breast cancer treatment typically includes targeted therapy drugs that slow the growth and kill these cancer cells. HER2-positive breast cancers account for about 25% of all breast cancer cases.
Knowing your HER2 status will help your WVCI cancer care team create the best treatment plan for you.
Purpose Of This Review
The purpose of this review is to critically evaluate the results of trials of neoadjuvant chemotherapy and neoadjuvant endocrine therapy for different breast cancer subtypes, discuss how neoadjuvant responses can inform adjuvant therapy, and highlight the importance of pathological complete response as a surrogate marker of distant disease-free survival , distant recurrence free survival , and event free survival which is interchangeable with disease-free survival , in the age of adaptive trial design. Notably, in contrast to overall survival , precise definitions of DFS and similar, related endpoints vary somewhat from trial to trial. pCR is generally a composite endpoint of primary tumor and lymph nodes. While pCR correlates with lower risk of recurrence, risk of recurrence still occurs and reduction of this risk remains an important goal. We also highlight functional and genomic predictive biomarkers in NET and their prediction of recurrence free survival , essentially equivalent to EFS.
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Determining Your Her2 Status
A breast biopsy is used to determine HER2 status. The biopsy can be sent for laboratory testing with an immunohistochemistry test. The fluorescence in situ hybridization test looks for the HER2 gene in breast cancer cells.
The results of an immunohistochemistry test show different levels of HER2 positivity. For example, a tumor may be reported as 0, 1+, 2+, or 3+. Tumors with a higher number may be referred to as having an overexpression of HER2.
According to the American Cancer Society, immunohistochemistry test results should be considered as follows:
The impact of being HER2-positive on breast cancer survival is, of course, a top concern. Unfortunately, statistics can be misleading without considering other aspects of your diagnosis, including cancer stage at diagnosis and whether the tumor is also estrogen and/or progesterone receptor-positive.
With this in mind, you may also be tested for progesterone and estrogen receptors. Triple-negative breast cancers are negative for HER2, estrogen, and progesterone, while triple-positive breast cancers are positive for all three.
Time To Recurrence Or Progression To Advanced Breast Cancer
Time to recurrence or progression to advanced breast cancer was most often defined as the time between date of diagnosis of primary breast cancer, and date of diagnosis of first distant metastasis or recurrence. Disease-free interval , metastasis-free interval , and recurrence-free interval are other terminology used to describe this. In Zhao et al,70 it was defined as the date from surgery to first recurrence. Eight studies did not report the definition.36,45,49,,66,71
The relationship between time to recurrence or progression to advanced breast cancer and OS and PFS was evaluated, with a significant association reported in 78% and 80% of studies, respectively.10,29,36,39,45,48,49,,60,66,70,71,91 In 13 studies, shorter time to recurrence or progression to advanced breast cancer was associated with worse survival relative to longer time, except in Jung et al,48 where the 15 years vs < 1 year MFI was associated with worse OS . The 2-year time interval was the most commonly studied cut-off point. Four studies showed a shorter time to recurrence or progression to advanced breast cancer was associated with worse PFS.29,54,60,70 Consistency in evidence and directionality of association was observed for OS and PFS. The overall effect size of the association between time to recurrence or progression to advanced breast cancer and survival endpoints was moderate.
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Hormone Receptor Status And Prognosis
Hormone receptor status is related to the risk of breast cancer recurrence.
Hormone receptor-positive tumors have a slightly lower risk of breast cancer recurrence than hormone receptor-negative tumors in the first 5 years after diagnosis .
After 5 years, this difference begins to decrease and over time, goes away .
For a summary of research studies on hormone receptor status and survival, visit the Breast Cancer Research Studies section.
What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Less common but serious side effects of hormone therapy drugs are listed below.
- Breathing problems, including painful breathing, shortness of breath, and cough
- Loss of appetite
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Treatment Options For Triple Negative Breast Cancer
Since triple negative breast cancer doesnt respond to targeted treatments used for other types of breast cancer, it raises complicated questions about treatment.
For now, experts typically rely on removing as much of the tumor as possible in addition to chemotherapy, according to the Mayo Clinic. Experts are testing immunotherapy options that may attack triple negative breast cancer tumors as well. Ongoing research could lead to new targeted treatments for triple negative breast cancer, Dr. Nanda says. If youre interested in learning more, you might consider speaking to your doctor about participating in a clinical trial, Dr. Mayer says.
No matter the treatment strategy that you and your doctor decide is best, self-care is an essentialand easy to overlookpart of dealing with triple negative breast cancer. Heres how four women with this condition practice self-care. They may give you a few ideas for coping, too.