The menstrual cycle is an under-appreciated factor in premenopausal breast cancer diagnosis and treatment

Bernhardt, Sarah M.; Dasari, Pallave; Walsh, David; Raymond, Wendy A.; Hull, Louise; Townsend, Amanda; Price, Timothy; Ingman, Wendy V.

doi:10.1016/j.coemr.2020.11.001

Cited by 3 publications

(1 citation statement)

References 54 publications

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“…26 In premenopausal women, the RS result might vary according to timing of tumor acquisition in the menstrual cycle, as can other biomarkers. 27,28 The MammaPrint assay, which provides prognostic information in early-stage breast cancer, [29][30][31] was evaluated in the MINDACT trial. 32 Participants with breast cancer and zero to three positive lymph nodes were assigned a clinical risk using Adjuvant!…”

Section: Practical Applicationsmentioning

confidence: 99%

Challenges in Adjuvant Therapy for Premenopausal Women Diagnosed With Luminal Breast Cancers

Vaz-Luís

Francis

Meglio

et al. 2021

American Society of Clinical Oncology Educational Book

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More than 90% of women with newly diagnosed breast cancer present with stage I to III disease and, with optimal multidisciplinary therapy, are likely to survive their disease. Of these patients, 70% are hormone receptor–positive and candidates for adjuvant endocrine therapy. The adoption of cumulatively better adjuvant treatments contributed to improved outcomes in patients with hormone receptor–positive, early-stage breast cancer. Premenopausal women with hormone receptor–positive breast cancer often present with complex disease and have inferior survival outcomes compared with their postmenopausal counterparts. Risk stratification strategies, including classic clinicopathologic features and newer gene expression assays, can assist in treatment decisions, including adjuvant chemotherapy use and type or duration of endocrine therapy. Gene expression assays may help identify patients who can safely forgo chemotherapy, although to a lesser extent among premenopausal patients, in whom they may play a role only in node-negative disease. Patients at lower risk of recurrence can be adequately treated with tamoxifen alone, whereas higher-risk patients benefit from ovarian function suppression with tamoxifen or an aromatase inhibitor. The role of adding newer therapies such as CDK4/6 inhibitors to adjuvant endocrine therapy is not yet clear. Breast cancer treatments are associated with several side effects, with major impact on patients’ quality of life and treatment adherence, particularly in premenopausal women for whom these side effects may be more prominent as the result of the abrupt decrease in estrogen concentrations. Personalized management of treatment side effects, addressing patients' concerns, and health promotion should be an integral part of the care of premenopausal women diagnosed with luminal breast cancers.

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Section: Practical Applicationsmentioning

confidence: 99%

Challenges in Adjuvant Therapy for Premenopausal Women Diagnosed With Luminal Breast Cancers

Vaz-Luís

Francis

Meglio

et al. 2021

American Society of Clinical Oncology Educational Book

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Comparison of hormone-induced mRNA and protein biomarker expression changes in breast cancer cells

Bernhardt

Dasari

Glynn

et al. 2021

Breast Cancer Res Treat

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Ovarian cycle stage critically affects 21-gene recurrence scores in Mmtv-Pymt mouse mammary tumours

et al. 2021

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Background The Oncotype DX 21-gene Recurrence Score is predictive of adjuvant chemotherapy benefit for women with early-stage, estrogen receptor (ER)-positive, HER2-negative breast cancer. In premenopausal women, fluctuations in estrogen and progesterone during the menstrual cycle impact gene expression in hormone-responsive cancers. However, the extent to which menstrual cycling affects the Oncotype DX 21-gene signature remains unclear. Here, we investigate the impact of ovarian cycle stage on the 21-gene signature using a naturally cycling mouse model of breast cancer. Methods ER-positive mammary tumours were dissected from naturally cycling Mmtv-Pymt mice at either the estrus or diestrus phase of the ovarian cycle. The Oncotype DX 21-gene signature was assessed through quantitative real time-PCR, and a 21-gene experimental recurrence score analogous to the Oncotype DX Recurrence Score was calculated. Results Tumours collected at diestrus exhibited significant differences in expression of 6 Oncotype DX signature genes (Ki67, Ccnb1, Esr1, Erbb2, Grb7, Bag1; p ≤ 0.05) and a significant increase in 21-gene recurrence score (21.8 ± 2.4; mean ± SEM) compared to tumours dissected at estrus (15.5 ± 1.9; p = 0.03). Clustering analysis revealed a subgroup of tumours collected at diestrus characterised by increased expression of proliferation- (p < 0.001) and invasion-group (p = 0.01) genes, and increased 21-gene recurrence score (p = 0.01). No correlation between ER, PR, HER2, and KI67 protein abundance measured by Western blot and abundance of mRNA for the corresponding gene was observed, suggesting that gene expression is more susceptible to hormone-induced fluctuation compared to protein expression. Conclusions Ovarian cycle stage at the time of tissue collection critically affects the 21-gene signature in Mmtv-Pymt murine mammary tumours. Further studies are required to determine whether Oncotype DX Recurrence Scores in women are similarly affected by menstrual cycle stage.

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The menstrual cycle is an under-appreciated factor in premenopausal breast cancer diagnosis and treatment

Cited by 3 publications

References 54 publications

Challenges in Adjuvant Therapy for Premenopausal Women Diagnosed With Luminal Breast Cancers

Challenges in Adjuvant Therapy for Premenopausal Women Diagnosed With Luminal Breast Cancers

Comparison of hormone-induced mRNA and protein biomarker expression changes in breast cancer cells

Ovarian cycle stage critically affects 21-gene recurrence scores in Mmtv-Pymt mouse mammary tumours

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