Epithelial mesenchymal transition initiates precancer states in BRCA1 mutation carriers

Epithelial-to-mesenchymal transition (EMT) is activated to equip cells with the capacity to adapt to and escape hostile conditions. While EMT is required for cancer progression, its role in breast cancer initiation remains elusive. Given the basal-like phenotype of breast cancers arising in female carriers of germline BRCA1 pathogenic variants (BRCA1 carriers), we hypothesized that enhanced EMT susceptibility underlies precancerous initiation in mammary epithelium. Perturbation of patient-derived normal mammary organoids from BRCA1 carriers and non-carriers with inflammatory cytokines induced copy number variations (CNV) and the acquisition of oncogenic mutations in both groups. However, in organoids derived from BRCA1 carriers, cytokine exposure induced morphological, transcriptomic, and functional EMT, accompanied by a transition to basal-like phenotype. Concomitant DNA damage accumulation in organoids from BRCA1-carriers demonstrated PARP inhibitor sensitivity. EMT-primed states were identified in a subpopulation of normal mammary epithelium from BRCA1 carriers. We demonstrate the utility of patient-derived normal BRCA1 heterozygous mammary organoids to reveal a plastic, high-risk epithelial state that is associated with a transient, targetable vulnerability.