PITTSBURGH, February 15, 1999 — Results of a study published in the February 16 issue of the Annals of Internal Medicine suggest that in the near future a simple blood test to detect levels of sex hormones could predict which women are at the highest risk of developing breast cancer. With this information, physicians could determine who would be good candidates for medications that can reduce the risk of the disease.
Jane A. Cauley, Dr.P.H., associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH), led the multi-center, federally funded study.
"In our study of older women, we found those with the highest levels of either serum estradiol or testosterone were three times more likely than expected to develop breast cancer," said Dr. Cauley. "This magnitude of risk is much higher than that observed for other breast cancer risk factors."
She explained, "Each year more than 180,000 women are diagnosed with breast cancer in the United States. Although well-established risk factors exist for breast cancer, more than 90 percent of all women have at least one of these factors and, individually, each factor only modestly increases a woman’s risk of developing the disease."
The research involved participants from the Study of Osteoporotic Fractures and included 97 women who developed breast cancer and 244 randomly selected controls. All women were white, 65 years of age or older and not receiving estrogen. The estimated incidence of breast cancer was lowest (4 per 10,000 women/year) in women with the lowest blood levels of estradiol and testosterone. Conversely, the incidence of breast cancer was highest (65 per 10,000 women/year) in women with the highest concentrations of both hormones.
This research strengthens previous reports indicating that hormone levels influence the risk of breast cancer, according to Dr. Cauley. "This type of information could help clinicians direct high-risk women to consider chemoprevention for breast cancer," said Dr. Cauley. "Results from the Breast Cancer Prevention Trial and the Multiple Outcomes of Raloxifene Evaluation Trial have shown that certain medications can reduce the incidence of breast cancer."
Unlike previous reports, results of this study showed that testosterone and estradiol independently contributed to breast cancer risk. For many years, researchers have known that estradiol, a metabolic product of estrogen, fuels the growth of some breast cancers. The way that testosterone may contribute to breast cancer growth is unclear at this time, according to Dr. Cauley.
Studies are currently underway to determine whether selective estrogen receptor modifiers, or SERMS, can reduce the incidence of breast cancer in women who have high baseline measurements of estradiol. In addition, studies like the Women’s Health Trial have shown that dietary modifications can reduce blood levels of estradiol in post-menopausal women. In another study, the Women’s Health Initiative, investigators are waiting to see whether reduced dietary fat will translate into a decrease in the number of breast cancer cases.
Because absolute levels of hormones in older women are low, the study employed extremely sensitive, accurate assays to measure differences among levels in study participants. These sensitive assays are not yet clinically available, according to Dr. Cauley.