The Steroid Metabolome and Breast Cancer Risk in Women with a Family History of Breast Cancer: The Novel Role of Adrenal Androgens and Glucocorticoids

Cancer Epidemiol Biomarkers Prev. 2021 Jan;30(1):89-96. doi: 10.1158/1055-9965.EPI-20-0471. Epub 2020 Sep 30.


Background: No study has comprehensively examined how the steroid metabolome is associated with breast cancer risk in women with familial risk.

Methods: We examined 36 steroid metabolites across the spectrum of familial risk (5-year risk ranged from 0.14% to 23.8%) in pre- and postmenopausal women participating in the New York site of the Breast Cancer Family Registry (BCFR). We conducted a nested case-control study with 62 cases/124 controls individually matched on menopausal status, age, and race. We measured metabolites using GC-MS in urine samples collected at baseline before the onset of prospectively ascertained cases. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) per doubling in hormone levels.

Results: The average proportion of total steroid metabolites in the study sample were glucocorticoids (61%), androgens (26%), progestogens (11%), and estrogens (2%). A doubling in glucocorticoids (aOR = 2.7; 95% CI = 1.3-5.3) and androgens (aOR = 1.6; 95% CI = 1.0-2.7) was associated with increased breast cancer risk. Specific glucocorticoids (THE, THF αTHF, 6β-OH-F, THA, and α-THB) were associated with 49% to 161% increased risk. Two androgen metabolites (AN and 11-OH-AN) were associated with 70% (aOR = 1.7; 95% CI = 1.1-2.7) and 90% (aOR = 1.9; 95% CI = 1.2-3.1) increased risk, respectively. One intermediate metabolite of a cortisol precursor (THS) was associated with 65% (OR = 1.65; 95% CI = 1.0-2.7) increased risk. E1 and E2 estrogens were associated with 20% and 27% decreased risk, respectively.

Conclusions: Results suggest that glucocorticoids and 11-oxygenated androgens are positively associated with breast cancer risk across the familial risk spectrum.

Impact: If replicated, our findings suggest great potential of including steroids into existing breast cancer risk assessment tools.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Androgens / metabolism
  • Androgens / urine*
  • Biomarkers / urine
  • Breast Neoplasms / urine*
  • Case-Control Studies
  • Female
  • Glucocorticoids / metabolism
  • Glucocorticoids / urine*
  • Humans
  • Metabolome*
  • Middle Aged
  • Prospective Studies
  • Registries
  • Risk Assessment
  • Single-Blind Method


  • Androgens
  • Biomarkers
  • Glucocorticoids

Supplementary concepts

  • Breast Cancer, Familial