The saved breast

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

More posts by Christiane Fux All content is checked by medical journalists.

Getting your healthy breasts amputated is a drastic step. Nevertheless, some women decide to do it - because they carry a highly dangerous breast cancer gene. Now there is hope of countering the high cancer risk with a drug instead of the scalpel.

A sword of Damocles hovers over women with a certain variant of the BRCA1 gene. Because the gene that is supposed to repair disastrous changes in breast tissue is not working properly. There is an 80 percent probability that its carriers will develop an aggressive form of hereditary breast cancer. And their risk of ovarian cancer is also significantly higher.

Many see their mothers, aunts, and sisters die. Some then make an extreme decision. As a precaution, you have your breasts removed - and often your ovaries too. Artificial breasts, premature menopause, and sometimes childlessness are the price they are willing to pay for their improved chances of survival.

Bone drug for cancer

The decision to take action before the cancer breaks out could become a lot easier in the future. Because there may soon be an alternative to the drastic step of an operation: an active ingredient that significantly reduces the risk of illness. Better still: a drug that has already been approved - albeit for completely different diseases. The active ingredient is called denosumab. An antibody that is currently prescribed primarily against bone loss.

An anti-osteoporosis drug for breast cancer? "That's not so absurd," says Verena Sigl from the Vienna Institute for Molecular Biotechnology in an interview with The young scientist worked on the latest publication on the topic as a doctoral student. As the Austrian researchers had previously found out, breast tissue and bone substance have an unexpected commonality. Both respond to the same messenger substance: RANKL.

Unimagined connection between bones and breasts

RANKL docks precisely to the surface of bone tissue cells, but also breast cells. Both are equipped with certain surface proteins, so-called receptors, which are called RANK. If RANKL docks on bone cells, this triggers the command to break down the bone. Because bone substance is constantly being built up and broken down in the human body - a process that ideally is in dynamic equilibrium.

In the breast tissue, RANKL triggers another chain reaction: It sends the breast cells a signal that stimulates them to grow. “Biologically, that's very clever,” says Sigl. Because women need a lot of calcium to produce milk. Among other things, it comes from the bones. Progesterone - "the pregnancy hormone par excellence", as Sigl says, increases the release of RANKL by a factor of 2000. The increased breakdown of bones provides a lot of calcium that benefits the child. At the same time, it stimulates the breast tissue to grow and adjust to milk production.

Uncontrolled cell growth

Especially women with problematic BRCA1 variants, however, this ingenious biological double effect is fatal. "If the RANKL signal is too strong, the breast cells can start to proliferate in an uncontrolled manner," explains Sigl.

This was first indicated by animal experiments. The researcher examined mice that carried a mutation in the BRCA1 gene. Cancer tumors and numerous precursors to cancer developed in the breast tissue of animals in which RANKL was active. However, in mice in which the researchers had genetically blocked the docking sites for RANKL, i.e. the RANK receptors, they did not discover any carcinomas in any of the animals - and precursors of cancer were also significantly less common.

Growth brake in the Petri dish

In another experiment, the scientists checked whether these results could be transferred to humans: They tested the effect of the RANK / RANKL blocker denosumab on cell cultures obtained from the tissue of women with an altered BRCA1 gene. "As soon as we added the drug, the growth of the breast cancer cells was drastically reduced," says Sigl. However, the researchers cannot yet say why this is happening: “We don't yet know the exact relationships,” says Sigl.

How effective and sustainable denosumab or a similar active ingredient could actually protect against cancer in women with a BRCA1 gene cannot yet be estimated. “But I put a lot of hope in it. By blocking RANK or RANKL, you switch off a very central link in the signal chain. "

Prevention without a scalpel

Around one in 300 women carry the fateful inherited breast cancer genes. Perhaps the best-known of them is the American actress Angelina Jolie: Oscar winner, UN special envoy, mother of six - a woman who is counted among the most beautiful in the world.

She also had her breasts removed. In 2013, the New York Times published a haunting letter from the then 38-year-old to her co-fate: “My risk of developing breast cancer has fallen from 87 percent to five percent. I can now tell my children that they don't have to be afraid of losing me to breast cancer. "

There is hope that in the not too distant future women will be able to say this phrase without undergoing drastic surgery.

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