Cumulative exposure to the cycling levels of
estrogen (E) and progesterone (P) throughout a woman’s reproductive life
significantly influences the lifetime risk of developing breast cancer, and
women exposed to progestin-containing hormone replacement therapy (HRT) have an
increased breast cancer risk compared to women taking estrogen (E) alone, or no
HRT at all. How exposure to these hormones increases breast cancer risk,
however, is unknown. Despite the pervasive dogma that P in the breast merely
serves as a marker of an active estrogen receptor (ER), and an inhibitor of the
proliferative actions of E, it is now clear that in the normal breast P
increases proliferation independently of E action. Using a 3D culture model of primary
human breast cells to recapitulate the structure of the breast in vivo, as well as a cohort of normal
breast tissue samples, we have shown that the progesterone receptor (PR) is
expressed in different epithelial populations compared with ER in the normal
human breast. In addition, we have shown that PR becomes highly correlated with
ER in breast cancer, supporting
the view that the mechanisms of E and P action are distinct in the normal
breast, but that they converge in breast cancer. Importantly, the findings of
this study were obtained using a combination of transcript and protein data,
multiple sample cohorts, and in vitro,
in vivo and in silico methodologies. The data presented here challenge the
established paradigm that ER and PR are co-expressed in normal breast, and have
significant implications regarding not only our understanding of normal biology
in the human breast, but also regarding diagnosis, prognosis and/or treatment
options in breast cancer patients.