[New concepts on hormone dependence in breast cancer]

The type of hormone dependence in mammary neoplasias is usually defined by the presence or absence of estrogen and progesterone receptors. At present, new advances in the knowledge related to the functionality of these receptors are changing our previous concepts. Estrogen receptors classified as negative by biochemical or immunocytochemical methods because of deletions or mutations in their ligand-binding domain, are still able to regulate the expression of genes related to cellular proliferation. Receptors defined as positive, may present other defective domains with disappearance or distortion of their transcriptional function. As a result, regulation of the cellular proliferative process is distorted and the tumoral growth seems autonomous, as if the receptors were absent. The modular organization of the receptor molecule allows a relative functional independence of the constitutive domains. Functional assays to evaluate receptor behavior under different experimental or clinical situations are necessary. A displacement assay with tamoxifen, for studying the relative binding affinity of tamoxifen and estradiol for the estrogen receptor contributes to a more appropriate use of this antiestrogen in mammary oncology. Conformational changes and mutations in one or several of these genomic molecules may after the transcriptional message with repercussion on cellular proliferation. In this way, antiprogestinic agents can show progestin agonistic effects when combined with cAMP analogues; on the other hand, opposite effects on cellular growth by cAMP analogues can be observed according to the type of hormone dependency (autonomous or dependent) of the tumors. Modulation of steroid receptor transcriptional activity is also achieved through non-transcriptional proteins associated to the receptor molecule. These proteins are then potential targets for the pharmacological regulation of the transcription message. Resistance to antihormone treatments in breast cancer is a dominant feature in the evolution of this malignancy. It cannot be attributed to the presence or absence of steroid receptors when only defined by their quantitative variations.