Progesterone receptor status is a marker for hormone responsiveness and disease prognosis in breast cancer. Progesterone receptor negative tumours have generally been shown to have a poorer prognosis than progesterone receptor positive tumours. The observed loss of progesterone receptor could be through a range of mechanisms, including the generation of alternatively spliced progesterone receptor variants that are not detectable by current screening methods. Many progesterone receptor mRNA variants have been described with deletions of various whole, multiple or partial exons that encode differing protein functional domains. These variants may alter the progestin responsiveness of a tissue and contribute to the abnormal growth associated with breast cancer. Absence of specific functional domains from these spliced variants may also make them undetectable or indistinguishable from full length progesterone receptor by conventional antibodies. A comprehensive investigation into the expression profile and activity of progesterone receptor spliced variants in breast cancer is required to advance our understanding of tumour hormone receptor status. This, in turn, may aid the development of new biomarkers of disease prognosis and improve adjuvant treatment decisions. After menarche, the cyclical release of the steroid hormones oestrogen and progesterone stimulates the primitive ducts of the immature breast to differentiate into terminal end buds, which branch into alveolar buds. During pregnancy, high circulating steroid hormone levels stimulate increased lobular differentiation to the mature secretory gland. Upon withdrawal of sex steroid hormones at menopause, involution to an undifferentiated morphology occurs [2].
IntroductionNormal mammary ducts consist of a layer of luminal epithelial cells, surrounded by a layer of myoepithelial cells, encased in delimiting fibroblasts set in a fatty, collagenous stroma [3]. Most breast carcinomas are of epithelial origin and are either localised to the duct/lobule of origin or capable of invading surrounding stroma [4]. Whilst age is the biggest contributory risk factor for developing breast cancer, use of hormone replacement therapy (HRT) and oral contraceptives have also been implicated, implicating hormone signalling in breast cancer development [1,4]. A further increased risk with combined oestrogen-progesterone HRT compared to oestrogen alone also bears out the significant role of progesterone signalling through progesterone receptor (PR) in breast cancer development [5][6][7]. PR, along with oestrogen receptor (ER), status is routinely measured in breast cancer specimens. PR+ patients are more likely to respond to hormonal therapies and survive disease [8]. Approximately 40% of breast tumours are ER+/PR+ and these patients are considered to have the best prognosis and are most likely to respond to hormonal therapies [4,9]. These cancers are associated with a lower rate of cell proliferation and well differentiated tumours, leading to a better prospect of overall s...