Caitlin Whyte (Host): There are so many kinds of breast cancer out there. And today we'll be discussing hormone positive breast cancer with oncologist Dr. Paige Ganem. This is Flourish, a podcast brought to you by PRISMA Health. I'm Caitlin Whyte.

Well, thank you for joining us once again today, Doctor. First question is, how is hormone positive breast cancer different from other breast cancers?

Paige Ganem, DO: Hormone positive breast cancer means that your breast cancer cell, your specific breast cancer tumor, expresses receptors for estrogen or progesterone. Those are our two hormone markers on breast cancer cells. It makes it different than something such as a HER2 breast cancer, which also can express hormones.

However, something like triple negative breast cancer doesn't express any receptors, including hormones, and so it makes talking about this breast cancer specific to treatments we have and just in general, thoughts about how it spreads, how aggressive it is, and, and it's a big factor into kind of the whole picture of a breast cancer.

Host: Well then, what causes hormone positive breast cancer?

Paige Ganem, DO: That is the age old question, and I wish I had a single answer that was very obvious, but, it's not exactly clear, though there are a lot of factors that we think increase your risk. So I think rather than say what causes it, we can talk about things that increase your risk of breast cancer. And this is a bit in general to breast cancer, though some can be whittled down to hormone positive breast cancer. By far, your biggest risk factor for getting breast cancer is having a genetic mutation that is passed through your family or can happen, what we call de novo, where it can unfortunately just happen in your DNA that increases your risk of breast cancer.

And there's a handful of those that make your risk of breast cancer much higher than the general population. That includes hormone positive breast cancer, as well as other types. Outside of genetic risk factors, lifestyle things such as smoking, alcohol, and obesity are known to increase your risk of breast cancer.

 And then hormone positive breast cancer specifically, you know, there seems to be a lot of questions around hormone replacement therapy, such as taking birth control pills, taking estrogen in the menopause phase of life. And, those all seem to increase risks in different levels and different ways.

But in general, estrogen exposure over time is known to increase your risk. So, we ask women questions about when they first had their you know, menstrual cycle, when they first got pregnant, if they breastfed, at what age they go through menopause, because different periods of time in your life change your estrogen exposure in your body.

And so it is not one thing that makes you get breast cancer, though there are a variety of things that to put it in some phrase such as the perfect storm happens, you know, it's a combination of what we say nature versus nurture, so your body's genetic makeup plus things that you do, so some of these are controllable and some are not.

Host: Well, can you dive into more than how is hormone positive breast cancer diagnosed?

Paige Ganem, DO: So hormone positive breast cancer is diagnosed like any other breast cancer, really one of two ways. Women have a screening mammogram because it is time for you to have your mammogram and we find a spot that is of concern. Or you develop a symptom, whether that is a lump that you feel, swelling in your breast, nipple discharge, skin discoloration.

I mean, there can be a variety of different symptoms that lead you to undergo an imaging. And so, most women have an a mammogram. This is often followed by ultrasound or MRI to kind of better detail what we're looking at, and then you get a biopsy, and that is a way that we take a sample of tissue, and then that tissue is taken to the pathology lab, and it is analyzed for the type of tumor that it is, the breast cancer markers, so hormone markers, HER2 markers, we kind of talked about that a little bit earlier. And based on that, a hormone positive breast cancer is diagnosed based on its expression of estrogen and progesterone.

Host: So once we have that diagnosis, how is it then treated?

Paige Ganem, DO: That depends on many different factors. So it depends on the stage that your cancer is at the time of diagnosis. So an early stage cancer is treated very differently than a metastatic or late stage cancer. So generally, hormone positive breast cancers that are small and early go to surgery first, so they are removed, and then on the back end, we have some calculators and tools and tests that are done to help us determine if chemotherapy is necessary, but it's actually a pretty interesting tumor type because in many cases we don't use chemotherapy at all.

We use pill therapies that block the estrogen pathway in the body to kind of prevent the stimulation of these receptors that we know are on the breast cancer cells. So not everybody with hormone positive breast cancer gets chemotherapy. But pretty much all women with early stage disease will have surgery and may or may not have radiation as what we consider local therapy.

So treatment to the breast and then systemic therapy is what we refer to when we discuss medications that we use. And so by and far, we are using less chemotherapy and more targeted therapy on these hormone pathways, which makes a very interesting treatment field for breast cancer.

Host: Mm. Of course. Well, with all of this information, is hormone positive breast cancer considered aggressive?

Paige Ganem, DO: I think in general, hormone positive breast cancer makes up about 70 to 80 percent of the cancers that we see, and they tend to be less aggressive than some of the other forms of breast cancer. But again, every, every case is specific and has its own kind of behaviors, but to make a general statement, it is a less aggressive form of breast cancer. Within the hormone positive breast cancer world, there are a couple of other different things we look at that play into us saying this is more aggressive or less aggressive, but in general, compared to the HER2 or compared to the triple negative, yes, I would feel comfortable saying this is less aggressive than that. But it is still cancer. It still needs to be taken seriously. And I don't want to make light of it being a cancer.

Host: Well, is hormone positive breast cancer hereditary?

Paige Ganem, DO: It can be. It is not always and not generally, I will say. Though if you have certain genetic mutations makes you at higher risk of breast cancer; some of those breast cancers can be hormone positive breast cancers, but unlike some of our other breast cancer forms, there's not as much of a indication to automatically get genetic testing because it is not as well known to be associated with hereditary factors.

Host: Well, Doctor, wrapping up here today, can you be tested to check your risk for developing hormone positive breast cancer at all?

Paige Ganem, DO: That's an interesting question. can't necessarily be checked for your risk of developing hormone positive breast cancer specifically, though there are multiple risk models that exist that you can speak with your primary care about. We have high risk clinics if you have a strong family history of cancer and you wish to discuss if you should have increased screening compared to the general population.

 So there are factors that weigh into us recommending more testing. And I should say more screening tests, not necessarily any biopsies or lab tests that monitor things, but there is a subset of the population that are at higher risk than others, just based on factors such as multiple family members with breast cancer, et cetera. And they qualify and should be covered by insurance a lot of the time for more screening, and more frequent screening than some other people.

Host: Well, once again, Doctor, thank you for all the work that you do and for being on the show. For more information and other podcasts, just like this one, head on over to Prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I'm Caitlin Whyte. Thank you for listening.