menopauze en borst menopauze oestrogenen oestrogenenstimulatie ter hoogte van borst klierweefsel en...
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Menopauze en borst
Menopauze oestrogenen oestrogenenstimulatie ter hoogte van
borst
klierweefsel
en
steunweefsel
en
vetweefsel
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Hormonen en borst (zie fig. 21.2)
oestrogenen
cortisol ductale groei
groeihormoon
prolactine lobulaire en alveolaire
groei
oestrogenen
progesterone volwassen borstont-
prolactine wikkeling
groeihormoon
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HRT en borst
HRT borstinvolutie
toename aantal ducti
interlobulair steunweefsel
nieuwe lobulivorming
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Mammografische screening
Borstkanker mortaliteit
HRT mammografische densiteit
sensitiviteit RX screening specificiteit RX screening
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Mammographic density and breast cancer
• May obscure a small malignant lesion
• can be itself one of the signs of malignancy
(high-density mammographic pattern is an independent risk factor for breast cancer)
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Mammographic Density Assessment (Tabar-Dean)
• I - normal fibroglandular tissue with partial fatty replacement
• II - entirely fatty breast• III - retroareolar periductal fibrosis• IV - nodular structures with increased amount of
periductal tissue• V - homogenous fibrosis with unstructured
ground-gloss appearance
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Mammographic Density Assessment (Wolfe)
• N1 - normal breast tissue composed primarily of fat• P1 - prominent ductal pattern in up to 25 % of
breast volume• P2 - prominent ductal pattern in > 25 % of breast
volume• DY - extremely dense parenchyma denoting
possible connective tissue hyperplasia
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Mammographic Density Assessment (Nottingham)
• Normal
• glandular
• dysplasia (light, moderate, severe)
• prominent ducts
• indeterminate
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Mammografische densiteit (screeningsmammo in België)
• Type 1 : diffuus helder lipomateus weefsel• type 2 : < 25 % dens weefsel• type 3 : 25 - 60 % dens weefsel• type 4 : > 60 % dens weefsel
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Mammographic density increase in women receiving different hormone replacement regimens.C.T. Ezel et al. Maturitas 40 (2001) 151 - 157
Increase in mammographic density :
continuous combined HRT
ERT
cyclic combined HRT
tibolone(retrospective comparative study in 100 women during 4 years)
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Effects of different types of HRT on mammographic density
N. Colacurci et al. Maturitas 40 (2001) 159 - 164
Increase in mammographic density :
43 % continuous combined HRT
35 % cyclic combined HRT
21 % ERT
10 % Tibolone
0 % controlegroep
(100 patients with 1 year follow-up)
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Maximale mitotische activiteit
• Endometrium : late follicularie fase (dd. 12-14)• borst : late luteale fase (dd. 25) : maximale
progesteronemie
hypothese : progesterone in combinatie met de luteale fase oestradiol peak kan de mitotische activiteit ter hoogte van borstklierweefsel stimuleren en het borstkankerrisico doen toenemen (?)
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Oestrogen and progesterone both stimulate breast cell division. However, the mitotic rate of breast cells is higher during the luteal phase of the menstrual cycle than during the follicular phase, suggesting that progesterone and estrogen together induce more mitoses than estrogen alone. Stromal edema is also greatest in the second half of the cycle, indicating the progesterone effect.
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Cave : recent evidence suggests that progesterone is mitogenic in the breast, but the effects of progesteron may differ according to
dosage, duration of exposure, and the estrogenic environment
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Effects of tibolone and continuous combined HRT on mammographic breast density
E. Lundström et al. Am J Obstet Gynecol 186 (2002) 717 - 722
Increase in mammographic density :
48 % continuous combined HRT (estradiol 2 mg/ Neta 1 mg)
4 % tibolone (2.5 mg)
0 % controlegroep (placebo)
(166 patients with 6 months follow-up)
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Tibolone and breast
= no stimulation of breast tissue
= in cell cultures of normal and transformed breast epitelial cells, tibolone inhibits proliferation and stimulates apoptosis.
= tibolone inhibits local sulfatase activity within the breast and may hereby reduce the formation of biologically active estrogenic compounds.
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Tibolone and breast cancer risk
= no human studies about this association
= tibolone markedly inhibits breast all proliferation in both human and animal tissue studies
= tibolone safe alternative for HRT in women with a high risk of breast cancer ??
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Estrogen Replacement Therapy for menopausal women with a history of breast carcinoma.
Results of a 5-year, prospective study
Cancer 2002 ; 95 : 1817 - 26
ERT did not compromise disease free survival in select
patients who were treated previously for localized breast
carcinoma. Larger scale randomized trials are needed to
confirm these findings.
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Fyto-oestrogenen en de borst
- mogelijks gunstig effect op de preventie of
het verloop van borstkanker
- werkingsmechanisme : onbekend
- 2003 : nog geen definitieve uitspraak
hieromtrent
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Mammographic breast density as a biomarker of effects of isoflavones on the female breast.
Breast Cancer Res 2002, 4 : 1 - 4
= Serms : breast density
= Isoflavones : breast density = or (??? more studies !)
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Phytoestrogens and Breast cancer risk
= phytooestrogens =natural plant substances
= three main classes : - isoflavones (genistein, daidzein,…)
- coumestans
- lignans
= anticarcinogenic potential ?
= significant estrogenic properties
= no protective effect on breast cancer risk (prospective studies)
= exception : phytoestrogens at adolescence
phytoestrogens at very high doses
= few prospective studies