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  • Title: A biological marker, strongly associated with early oral contraceptive use, for the selection of a high risk group for premenopausal breast cancer.
    Author: Olsson H, Borg A, Ewers SB, Fernö M, Möller T, Ranstam J.
    Journal: Med Oncol Tumor Pharmacother; 1986; 3(2):77-81. PubMed ID: 3747639.
    Abstract:
    In a population-based group of women, consecutively diagnosed, with premenopausal breast cancer there was a significant correlation between tumour size and plasma prolactin (r = 0.30; P less than 0.004). The concentration of estrogen receptor was negatively correlated to tumour size (r = 0.17; P less than 0.09). There were no substantial correlations between tumour size and progesterone receptor, plasma progesterone or estradiol. Adjustments for menstrual cycle day and age did not alter the above findings. The ratio of plasma prolactin and estrogen receptor was significantly greater (P less than 0.037) for the group of the patients that had started using oral contraceptives before the age of 20 as compared with the other patients. Consequently, the tumour size was significantly greater in the group of early users (P less than 0.003). The findings indicate that breast tumours developing in previous early users of oral contraceptives have a low estrogen receptor concentration, while these patients have higher plasma prolactin. The tumour size is greater in early users indicating a poorer prognosis than other women with breast cancer. As early use of oral contraceptives increases breast cancer risk and a high ratio of plasma prolactin and estrogen receptor concentration of the primary tumour characterize early oral contraceptive users the ratio may be a valuable marker for the breast cancer risk. 75 patients with breast cancer born in 1935 or later and who were referred to the Department of Oncology, University Hospital, Lund from the Southern Health Care Region of Sweden from June 1984 to June 1985 participated in this study designed to compare the tumor size with the level of the plasma hormones -- prolactin, progesterone, estradiol, and estrogen and progesterone receptors (ER and PGR) from the primary tumor. Early oral contraceptive (OC) use also was considered. All tumors wereverified histopathologically. The patients with both stage I after conservative surgery and stage II breast cancer were given postoperative radiation therapy. The study patients represent 74% of all in this age group diagnosed in the region during the same time. Statistical analyses included adjustments for the menstrual cycle and age. Both univariate and multivariate tests were used. In 12 of 75 women hormone receptors were not analyzed either because of inadequate handling of specimens or because no tumor tissue had been sent to the receptor laboratry. There was a significant univariate correlation betwee the level of plasma prolactin and the tumor size. The correlation continued after adjustment for age in a multivariate analysis. Including the ratio between plasma prolactin and ER of the primary tumor in the multivariate model added highly significant information on tumor size. The correlation between tumor size and ER alone was weak. The correlations between tumor size and plasma estradiol, plasma progesterone, and PGR of the Primary tumor were all negligible. Also negligible were the correlations between the patient's menstrual cycle phase at the time of blood collection and the level of prolactin, the hormone receptor levels, and the phase of the menstrual cycle at which the operation was performed. The ratio of prolactin and ER was significantly greater for those patients who had started OC use before age 20 (10 patients) as compared with the rest of the patients (53 patients). The tumor size was greater for the early OC users. These findings could not be explained by smoking habits, use of hormones, or antipsychotic drugs at the time of diagnosis. Plasma estradiol and progesterone did not significantly relate to hormonal receptor concentrations or OC use. There was no strong correlation between porlactin and ER, and ER or prolactin was not significantly correlated with early OC use.
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