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Progestins and cancer.

R Sitruk-Ware1, G Plu-Bureau

  • 1Department of Endocrinology, Hôpital Saint-Antoine, Paris, France. CWare1996@aol.com

Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology
|September 14, 2002
PubMed
Summary

Progestins protect endometrial tissue from estrogen but their role in breast tissue is complex. While some derivatives may stimulate proliferation, others induce cell death, and high doses are used for advanced breast cancer treatment.

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Area of Science:

  • Endocrinology
  • Oncology
  • Pharmacology

Background:

  • The role of progestins in breast tissue is less understood than in the endometrium.
  • In vitro studies show progestins affect estrogen and progesterone receptors and 17beta-estradiol dehydrogenase in breast tissue, similar to endometrial effects.
  • Epidemiologic data suggest progestins prevent endometrial cancer but do not negate estrogen's breast cancer risk increase in hormone-replacement therapy (HRT).

Purpose of the Study:

  • To clarify the complex and sometimes dual effects of progestins on breast tissue.
  • To investigate the differential effects of various progestin derivatives on breast cell proliferation and apoptosis.
  • To evaluate the therapeutic role of progestins in advanced breast cancer and compare international usage patterns.

Main Methods:

  • Review of in vitro and epidemiologic studies on progestin effects in breast and endometrial tissues.
  • Analysis of progestin derivatives (pregnanes, estranes, gonanes) and their mechanisms of action.
  • Comparison of breast cancer rates and progestin usage in France versus the USA.

Main Results:

  • Progestins protect endometrial tissue from estrogen-induced proliferation.
  • Some estrane derivatives can stimulate breast cell multiplication via estrogen receptors, while most pregnanes do not.
  • Certain pregnane derivatives promote apoptosis, and high-dose progestins are effective second-line therapy for advanced breast cancer.

Conclusions:

  • Progestins protect endometrial tissue from estrogen.
  • Progestins do not appear to stimulate breast tissue proliferation and may offer protection.
  • High-dose progestins are valuable in treating advanced breast cancer, and international differences in usage may correlate with breast cancer incidence rates.

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