In the beginning … 

You may have noticed that the American actress Angelina Jolie, who is now employed as a  Special Envoy  for the  United Nations High Commissioner for Refugees, has re-surfaced in the pages of the science media. She first hit the nerdy headlines by announcing in The New York Times that she had had a preventive double mastectomy (in 2013) and a preventive oophorectomy (in 2015).

We described the molecular biology that prompted her actions in A Taxing Inheritance. The essential facts were that she had a family history of breast and ovarian cancer: genetic testing revealed that she carried a mutation in the BRCA1 gene giving her a 87% risk of breast cancer and a 50% chance of getting ovarian cancer.

A star returns

BRCA1 and breast cancer are back in the news as a result of a paper by Jane Visvader, Geoffrey Lindeman and colleagues in Melbourne that asked a very simple question: which type of cell is driven to proliferate abnormally and give rise to a tumour by mutant BRCA1 protein? That is, pre-cancerous breast tissue contains a mixture of cell types: does cancer develop from one in particular –  and, if you blocked proliferation of that type of cell, could you prevent tumours forming?

Simple question but their paper summarises about 10 years of work to come up with a clear answer.

And the villain is …

The mature mammary gland is made up of lots of small sacs (alveoli) lined with cells that produce milk – called luminal cells. Groups of alveoli are known as lobules, linked by ducts that carry milk to the nipple. Most breast cancers start in the lobular or duct cells.

Breast fig copy

Left: Normal breast lobule showing alveoli lined with milk-producing luminal cells connected to duct leading to the nipple. Right: Normal milk sac, non-invasive cancer, invasive cancer.

Things are complicated by there being more than one type of progenitor cell but the Melbourne group were able to show that, in mice carrying mutated BRCA1, one subtype stood out in terms of its cancerous potential. These cells carried a protein on their surface called RANK (which is member of the tumour necrosis factor family). They had gross defects in their DNA repair systems (so they can’t fix genetic damage) and they’re highly proliferative. Luminal progenitors that don’t express RANK behave normally.

Slide1 copy

Scheme representing normal and abnormal cell development. The basic idea is that different types of cells evolve from a common ancestor. The Australian work identified one type of luminal progenitor cell that carries a protein called RANK on its surface (pink cell) as being a prime source of tumours. RANK+ cells have defective DNA repair systems so they accumulate mutations (red cells) more rapidly than normal cells, a feature of tumour cells.

In mice with mutant BRCA1 a monoclonal antibody (denosumab) that blocks RANK signalling markedly slowed tumour development. In a small pilot study blockade of RANK inhibited cell proliferation in breast tissue from human BRCA1-mutation carriers.


How effective blocking the activation of RANK signalling will be in preventing breast cancer is anyone’s guess but the idea behind the work of the Australian group cannot be faulted. Being able to prevent the ‘starter’ cells from launching themselves on the pathway to cancer driven by mutation in BRCA1 would mean that women in Angelina Jolie’s position would not have to contemplate the drastic course of surgery. The question is: will the preliminary mouse results lead to something that works in humans and, moreover, does so with high efficiency. As ever in cancer, watch this space – but don’t hold your breath!


Nolan, E. et al. (2016). RANK ligand as a potential target for breast cancer prevention in BRCA1-mutation carriers.