title: Prognostic significance of estrogen receptor Beta in epithelial hyperplasia of usual type with known outcome.
abstract: The prognostic significance of ER-alpha expression in benign proliferative breast disease has been confirmed in epithelial hyperplasia of usual type (HUT). However, little is known about the role of ER-beta in these lesions. Therefore, this study was performed to test the hypothesis that, in HUT lesions, the ratio of ER-alpha:ER-beta is an accurate determinant of breast cancer risk and of predicting subsequent progression to invasive breast cancer. This case-control study analyzed a cohort of benign proliferative breast lesions and foci of ductal HUT in 117 patients with long follow-up (20 years). These foci were analyzed by morphometric image analysis together with immunohistochemistry using monoclonal antibodies to ER-beta1 and to ER-alpha. The data were compared with ER-beta expression in all breast carcinomas that subsequently developed in the same patients as well as to ER-alpha expression in the corresponding tissues. In cases that progressed to carcinoma, the ratio of ER-alpha to ER-beta in HUT was significantly higher (P < 0.001) than in those that did not progress. None of the HUT foci from patients who progressed to breast cancer were simultaneously ER-alpha negative and ER-beta positive. Using both ER-beta and ER-alpha in a logistic model demonstrated a 75% correct classification rate for the cohort studied. These findings confirm the diagnostic and prognostic value of defining the ER-alpha and ER-beta status of HUT lesions identified morphologically. The data support the hypothesis that high ER-alpha:ER-beta levels characterize those cases within HUT likely to progress to breast cancer. The data also reveal that a reduced level of ER-beta relative to ER-alpha is an accurate predictor of individual cases of HUT likely to progress to invasive breast carcinoma, thus supporting the concept that ER-alpha transcriptional activity is directly modulated by ER-beta.
authors.affiliation: Departments of Cellular and Molecular Pathology, University of Liverpool, Liverpool, UK.
authors.forename: Abeer M
authors.initials: AM
authors.lastname: Shaaban
authors.forename: Christine
authors.initials: C
authors.lastname: Jarvis
authors.forename: Fil
authors.initials: F
authors.lastname: Moore
authors.forename: Christopher
authors.initials: C
authors.lastname: West
authors.forename: Andrew
authors.initials: A
authors.lastname: Dodson
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Foster
mesh_terms: D001940:Breast / Q000378:metabolism* / Q000473:pathology*; D001943:Breast Neoplasms / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D018450:Disease Progression; D047628:Estrogen Receptor alpha / Q000378:metabolism; D047629:Estrogen Receptor beta / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000378:metabolism; D016015:Logistic Models; D008137:Longitudinal Studies; D011230:Precancerous Conditions / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D012307:Risk Factors
chemical_list: D047628:Estrogen Receptor alpha; D047629:Estrogen Receptor beta