ERß expression predicts breast cancer risk in hyperplasia
Dr Tina Hieken - Mayo Clinic, Rochester, USA
Part of what I do focusses on breast cancer research and so I had the opportunity to speak about some of our work on risk prediction for breast cancer.
What did you find?
In this study we looked at oestrogen receptor beta, the other oestrogen receptor, and we saw that women who had high levels of ERß, who had atypical hyperplasia of the breast which is associated with a high risk of future breast cancer, these women who had this ERß function expressed did very well in terms of future breast cancer and had much lower than expected incidence of breast cancer subsequent to their benign breast biopsy.
What are the clinical implications of this?
We’re hoping that women who have atypical hyperplasia of the breast, have a high risk of future breast cancer, high enough to justify taking medicine like tamoxifen to lower that risk or to even consider having surgery to remove the breast to lower risk, but we’re finding that within this group there appears to be some women who have a fairly low 25 year risk of breast cancer and some who have a much higher risk of being diagnosed with breast cancer at 25 years. So this may help sort that so that they can think a little bit, have better guidance for their choice of risk reduction, whether it’s surgery or medication.
What other activity is your lab involved in?
This is part of the Mayo Clinic Benign Breast Disease Program, it’s a unique cohort of patients, more than 13,000 patients, who over time with follow-up of nearly twenty years have developed more than 1,200 breast cancers. This provides us with this really amazing platform to learn about breast cancer risk and to hopefully now move more toward biomarker discovery for better understanding of risk.
What technology do you use?
Our group is using all the different technologies that you’ve heard described at this meeting, looking at DNA, RNA, protein expression, multi-omics, looking at microbiome, metabolism, inflammation as well as things such as breast density and tumour histology, things that we’ve known about for some time.
What would you like to see in the next ten years?
I’d like to see some really getting much closer towards preventing breast cancer because I think the best way to improve outcomes from breast cancer would be to prevent it from happening in the first place. As a stepping stone to that to have much better ways of stratifying risk so we can sort out women who are very unlikely to ever develop breast cancer in their lifetime from those who have a high likelihood of having breast cancer in the next ten or twenty years.
What do current prevention efforts look like?
Most of the prevention and early detection efforts are focussed on screening women who are at the highest risk, using different technologies to screen women who are at higher risk, and then in terms of prevention most of it steers around things that block the effect of oestrogen on breast tissue. So there are things that are very effective, such as the medicine tamoxifen, in lowering breast cancer risk but many, many women are very reluctant to take this medication because of concern regarding the side effects or potential side effects.