Abstract
The role of progestins (or progestagens) on the breast tissue remains controversial.
However, according to the molecule and the duration of application, cell differentiation
and apoptosis may predominate over proliferation. Progestins are also used as second-line
agents for the treatment of metastatic breast cancer. In young women with benign breast
disease, long-term treatment with 19-nortestosterone progestins had a trend to decrease
breast cancer risk contrarily to what was observed in postmenopausal women receiving
estrogens.
Several compounds with progestational activity have been used for HRT. Small differences
in the structure of the molecules may lead to pronounced differences in activities,
some progestins exerting androgenic effects and some exerting estrogenic or glucocorticoid
like activities. While most progestins do not bind to the estrogen receptors, it has
been shown that some androgenic progestins stimulate MCF7 cells proliferation while
progestins derived from progesterone did not induce cell multiplication in the same
cell lines. Therefore, different progestins may induce different effects on the breast
cells. Whether the progestins available to date are able to bind specifically to the
progesterone receptors PR-A or PR-B and whether this is of clinical relevance to breast
cell proliferation is still unclear.
Although the relationship between progestin use and breast cancer risk is still the
subject of debate and controversy, the data reported to date suggest that 5 years
of treatment carry a low risk but further duration of use increases the risk. Further
studies are still needed, randomised long-term prospective studies as well as from
the laboratory, especially to determine whether a sequential or continuous regimen
would be preferable as far as breast-cell response and apoptosis are concerned, and
what are the effects of the various molecules used for HRT.
Keywords
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Article info
Publication history
Accepted:
June 10,
2004
Received in revised form:
April 23,
2004
Received:
December 16,
2003
Identification
Copyright
© 2004 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
