Hormones and Breast Cancer

Question 1

List some risk factors for breast cancer.

Answer 1

early menarche, late menopause, alcohol consumption, postmenopausal obesity, HRT.

Question 2

List some protective factors for breast cancer.

Answer 2

pregnancy at a young age, young age at first delivery, prolonged lactation, exercise and general fitness.

Question 3

Why does free oestradiol raise as BMI increases in postmenopausal women?

Answer 3

As the aromatase system can convert androgens into oestrogens.

Question 4

List some of the predictors to response of endocrine therapy in metastatic breast cancer.

Answer 4

ER+, PR+, long disease free interval, metastases site (bone>soft tissue>visceral tissue) as bone most likely to respond to hormonal stimuli, whereas unlikely that visceral metastases will.

Question 5

List some different types of endocrine therapies used in the treatment of metastatic breast cancer and their mechanism of action.

Answer 5

Antioestrogen/oestrogen antagonists (pre- and post- menopausal) - work by binding to oestrogen receptor to prevent oestrogen stimulus. E.g. Tamoxifen, fulvestrant.
Aromatase inhibitors (postmenopausal women) - reduces peripheral conversion of testosterone to oesradiol. E.g. anastrozole, letrosome, exemestane.
LHRH agonists (premenopausal women) - switch off ovarian function as luteinising hormone releasing factor agonists, thereby lack of ovarian function equals less hormones.

Question 6

What is everolimus?

Answer 6

An MTOR inhibitor (mammalian target of rapamycin), one of the pathways involved in endocrine release.

Question 7

What is fulvestrant?

Answer 7

A pure antioestrogen.

Unlike tamoxifen which has some oestrogen agonist function in bone and endometrium.