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Differences within breast tumors and between patients are associated with the risk of metastasis and response to endocrine therapy, according to a new doctoral thesis from Karolinska Institutet. The findings also highlight the importance of long-term follow-up in capturing the full benefit of treatment.

In hormone-sensitive breast cancer, the cancer cells have receptors for the hormone estrogen, which can stimulate their growth. Patients can therefore be treated with endocrine therapy, but the treatment does not benefit everyone to the same extent. Tumor cells can also remain dormant in the body and begin growing again 10 to 20 years later.

In his thesis, Oscar Danielsson at the Department of Oncology-Pathology investigated how different types of variation in hormone-sensitive breast cancer are associated with the long-term risk of metastasis and the benefit of endocrine therapy.

"Breast cancer can vary both within the tumor and from one patient to another. Our findings show that these differences may be associated with the risk of metastasis and how much patients benefit from treatment," says Danielsson.

The thesis also examined two common types of hormone-sensitive breast cancer, luminal A and luminal B. Both groups showed long-term benefit from treatment with tamoxifen. For patients with luminal B, much of the benefit was already apparent after five years. For those with luminal A, the benefit was smaller at five years but became greater with longer follow-up.

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