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Hunt JT, Kamat R, Yao M, Sharma N, Batur P. Effect of contraceptive hormonal therapy on mammographic breast density: A longitudinal cohort study. Clin Imaging 2023; 97:62-67. [PMID: 36893493 DOI: 10.1016/j.clinimag.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Evaluate the longitudinal relationship between mammographic density and hormonal contraceptive use in late reproductive-aged women. METHODS Patients aged 35-50 years old who underwent 5 or more screening mammograms within a 7.5-year period between 2004 and 2019 in a single urban tertiary care center were randomly selected. Patients were categorized into four cohorts based on hormonal contraceptive exposure during a 2-year lead-in period and a 7.5-year study period: 1) never exposed, 2) always exposed, 3) interval hormonal contraceptive start, and 4) interval hormonal contraceptive stop. The primary outcome was difference in BI-RADS breast density category between initial and final mammograms. RESULTS Of the 708 patients included, long-term use of combined oral contraceptives or a levonorgestrel intrauterine device were not associated with an increase in breast density category over the 7.5-year study period, compared to those with no hormonal contraceptive exposure. Initiation of combined oral contraceptives was associated with an increase in breast density category (β = 0.31, P = 0.045); however, no difference in initial density category was noted between those exposed and those never exposed to combined oral contraceptives during the 2-year lead-in period, and discontinuation was not associated with a decrease in breast density category when compared to those with continuous exposure. CONCLUSION(S) Long-term use of combined oral contraceptives or a levonorgestrel intrauterine device was not associated with an increase in BI-RADS breast density category. Initiation of a combined oral contraceptive was associated with an increase in breast density category, although this may be a transient effect.
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Affiliation(s)
- Jonathan T Hunt
- Department of Obstetrics & Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| | - Rachel Kamat
- Department of Obstetrics & Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Meng Yao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Nidhi Sharma
- Austin Radiological Association Women's Imaging Center, Suite 100, 1600 West 38(th) Street, Austin, TX 78731, United States
| | - Pelin Batur
- Department of Obstetrics & Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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Effect of neoadjuvant chemotherapy on breast tissue composition: a longitudinal mammographic study with automated volumetric measurement. Eur Radiol 2020; 30:4785-4794. [PMID: 32314056 DOI: 10.1007/s00330-020-06830-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/05/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the effect of neoadjuvant chemotherapy (NAC) on breast tissue composition with mammographic automated volumetric measurement. METHODS This retrospective study included 168 breast cancer patients who were treated with NAC and underwent serial mammography (pre-treatment, mid-treatment, and post-treatment) between January 2015 and October 2018. Automated volumetric measurements of the contralateral breast volume (BV), fibroglandular volume (FGV), and breast density (BD) were performed using Volpara software. BD grades were divided into 4 groups by Volpara density grade (VDG). The longitudinal changes in BV, FGV, BD, and their associated factors were evaluated. RESULTS Repeated-measures analysis of variance demonstrated a significant reduction in BV, FGV, and BD over time (p < 0.001, p < 0.001, and p = 0.002, respectively). BV showed a greater reduction in the second half than in the first half (- 28.6 cm3 vs. - 15.2 cm3), BD showed a greater reduction in the first half than in the second half (- 0.8% vs. - 0.1%), and FGV steadily decreased (- 4.6 cm3 and - 3.9 cm3 in the first and second halves). On multivariable linear regression analysis, chemotherapy regimen was associated with BV change between pre- and post-treatment (p = 0.002); age (p = 0.024) and VDG (p = 0.027) were associated with FGV change; age (p = 0.037), VDG (p = 0.002), and chemotherapy regimen (p = 0.003) were associated with BD change. CONCLUSIONS NAC affects breast tissue composition, reflected as reductions in BV, FGV, and BD. Mammography with automated volumetric measurement can capture quantitative changes in these breast tissue parameters during NAC. KEY POINTS • Neoadjuvant chemotherapy (NAC) affects breast tissue composition with different patterns of reduction in breast volume, fibroglandular volume, and breast density. • Age, Volpara density grades, and NAC regimen were independent factors associated with breast density change between pre-treatment and post-treatment. • Mammography with automated volumetric measurement enables identification of longitudinal changes in breast tissue composition.
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Mammographic density: intersection of advocacy, science, and clinical practice. CURRENT BREAST CANCER REPORTS 2019; 11:100-110. [PMID: 33312342 DOI: 10.1007/s12609-019-00316-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose Here we aim to review the association between mammographic density, collagen structure and breast cancer risk. Findings While mammographic density is a strong predictor of breast cancer risk in populations, studies by Boyd show that mammographic density does not predict breast cancer risk in individuals. Mammographic density is affected by age, parity, menopausal status, race/ethnicity, and body mass index (BMI).New studies normalize mammographic density to BMI may provide a more accurate way to compare mammographic density in women of diverse race and ethnicity. Preclinical and tissue-based studies have investigated the role collagen composition and structure in predicting breast cancer risk. There is emerging evidence that collagen structure may activate signaling pathways associated with aggressive breast cancer biology. Summary Measurement of film mammographic density does not adequately capture the complex signaling that occurs in women with at-risk collagen. New ways to measure at-risk collagen potentially can provide a more accurate view of risk.
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Mammographic density changes following discontinuation of tamoxifen in premenopausal women with oestrogen receptor-positive breast cancer. Eur Radiol 2018; 28:3176-3184. [PMID: 29626240 DOI: 10.1007/s00330-017-5293-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/10/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate the changes in mammographic density after tamoxifen discontinuation in premenopausal women with oestrogen receptor-positive breast cancers and the underlying factors METHODS: A total of 213 consecutive premenopausal women with breast cancer who received tamoxifen treatment after curative surgery and underwent three mammograms (baseline, after tamoxifen treatment, after tamoxifen discontinuation) were included. Changes in mammographic density after tamoxifen discontinuation were assessed qualitatively (decrease, no change, or increase) by two readers and measured quantitatively by semi-automated software. The association between % density change and clinicopathological factors was evaluated using univariate and multivariate regression analyses. RESULTS After tamoxifen discontinuation, a mammographic density increase was observed in 31.9% (68/213, reader 1) to 22.1% (47/213, reader 2) by qualitative assessment, with a mean density increase of 1.8% by quantitative assessment compared to density before tamoxifen discontinuation. In multivariate analysis, younger age (≤ 39 years) and greater % density decline after tamoxifen treatment (≥ 17.0%) were independent factors associated with density change after tamoxifen discontinuation (p < .001 and p = .003, respectively). CONCLUSIONS Tamoxifen discontinuation was associated with mammographic density change with a mean density increase of 1.8%, which was associated with younger age and greater density change after tamoxifen treatment. KEY POINTS • Increased mammographic density after tamoxifen discontinuation can occur in premenopausal women. • Mean density increase after tamoxifen discontinuation was 1.8%. • Density increase is associated with age and density decrease after tamoxifen.
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Brooks JD, Sung JS, Pike MC, Orlow I, Stanczyk FZ, Bernstein JL, Morris EA. MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer 2018. [PMID: 29524207 PMCID: PMC6041161 DOI: 10.1002/ijc.31370] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background parenchymal enhancement (BPE) is the degree to which normal breast tissue enhances on contrast-enhanced magnetic resonance imaging (MRI). MRI-density is a volumetric measure of breast density that is highly correlated with mammographic density, an established breast cancer risk factor. Endogenous estrogen concentrations are positively associated with postmenopausal breast cancer risk and BPE has been shown to be sensitive to hormonal exposures. The objective of our study was to examine the relationship between BPE and MRI-density and serum hormone concentrations in postmenopausal women. This was a study of cancer-free postmenopausal women undergoing contrast-enhanced breast MRI (N = 118). At the time of MRI all women completed a self-administered questionnaire and blood samples were collected for hormone analyses. Serum concentrations of estrone (E1), estradiol (E2) and bioavailable E2 were examined by category of BPE and MRI-density. Compared to women with "minimal" BPE, those who had "marked" BPE had significantly higher serum concentrations of E1, E2 and bioavailable E2 (90% increase, ptrend across all categories = 0.001; 150% increase, ptrend = 0.001; and 158% increase, ptrend = 0.001, respectively). These associations were only affected to a minor extent by adjustment for BMI and other variables. After adjustment for BMI, no significant associations between MRI-density and serum E1, E2 and bioavailable E2 were observed. Serum estrogen concentrations were significantly positively associated with BPE. Our study provides further evidence of the hormone-sensitive nature of BPE, indicating a potential role for BPE as an imaging marker of endogenous and exogenous hormonal exposures in the breast.
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Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Byrne C, Ursin G, Martin CF, Peck JD, Cole EB, Zeng D, Kim E, Yaffe MD, Boyd NF, Heiss G, McTiernan A, Chlebowski RT, Lane DS, Manson JE, Wactawski-Wende J, Pisano ED. Mammographic Density Change With Estrogen and Progestin Therapy and Breast Cancer Risk. J Natl Cancer Inst 2017; 109:3064857. [PMID: 28376149 DOI: 10.1093/jnci/djx001] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/06/2017] [Indexed: 02/04/2023] Open
Abstract
Background Estrogen plus progestin therapy increases both mammographic density and breast cancer incidence. Whether mammographic density change associated with estrogen plus progestin initiation predicts breast cancer risk is unknown. Methods We conducted an ancillary nested case-control study within the Women's Health Initiative trial that randomly assigned postmenopausal women to daily conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 2.5 mg or placebo. Mammographic density was assessed from mammograms taken prior to and one year after random assignment for 174 women who later developed breast cancer (cases) and 733 healthy women (controls). Logistic regression analyses included adjustment for confounders and baseline mammographic density when appropriate. Results Among women in the estrogen plus progestin arm (97 cases/378 controls), each 1% positive change in percent mammographic density increased breast cancer risk 3% (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01 to 1.06). For women in the highest quintile of mammographic density change (>19.3% increase), breast cancer risk increased 3.6-fold (95% CI = 1.52 to 8.56). The effect of estrogen plus progestin use on breast cancer risk (OR = 1.28, 95% CI = 0.90 to 1.82) was eliminated in this study, after adjusting for change in mammographic density (OR = 1.00, 95% CI = 0.66 to 1.51). Conclusions We found the one-year change in mammographic density after estrogen plus progestin initiation predicted subsequent increase in breast cancer risk. All of the increased risk from estrogen plus progestin use was mediated through mammographic density change. Doctors should evaluate changes in mammographic density with women who initiate estrogen plus progestin therapy and discuss the breast cancer risk implications.
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Affiliation(s)
- Celia Byrne
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Giske Ursin
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway and Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jennifer D Peck
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elodia B Cole
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Donglin Zeng
- University of North Carolina, Chapel Hill, NC, USA
| | - Eunhee Kim
- National Institutes of Health, Bethesda, MD, USA
| | - Martin D Yaffe
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Anne McTiernan
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Etta D Pisano
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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Hansen NL, Kuhl CK, Barabasch A, Strobel K, Schrading S. Does MRI Breast “Density” (Degree of Background Enhancement) Correlate With Mammographic Breast Density? J Magn Reson Imaging 2014; 40:483-9. [DOI: 10.1002/jmri.24495] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/31/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nienke L. Hansen
- Department of Diagnostic and Interventional Radiology; RWTH Aachen University Hospital; Aachen Germany
| | - Christiane K. Kuhl
- Department of Diagnostic and Interventional Radiology; RWTH Aachen University Hospital; Aachen Germany
| | - Alexandra Barabasch
- Department of Diagnostic and Interventional Radiology; RWTH Aachen University Hospital; Aachen Germany
| | - Kevin Strobel
- Department of Diagnostic and Interventional Radiology; RWTH Aachen University Hospital; Aachen Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology; RWTH Aachen University Hospital; Aachen Germany
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Carmona-Sánchez E, Cuadros López JL, Cuadros Celorrio ÁM, Pérez-Roncero G, González Ramírez AR, Fernández Alonso AM. Assessment of mammographic density in postmenopausal women during long term hormone replacement therapy. Gynecol Endocrinol 2013; 29:1067-70. [PMID: 24004297 DOI: 10.3109/09513590.2013.831831] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess long-term effects of different hormone replacement therapy (HRT) regimens on mammographic density. METHODS One hundred sixty-five postmenopausal women were treated with the same HRT during 5 years: 38 received transdermal estradiol, 78 cyclic combined therapy and 49 continuous combined therapy. Mammograms were obtained at baseline, at 1-year and 5-year treatment. Breast density changes were categorized as slight focal increased density, considerable focal increased density, slight diffuse increased density and considerable diffuse increased density. RESULTS Mammographic density increased in 7.9% of women receiving estrogen alone versus 25.2% of women receiving combined therapy (p < 0.022) during 1 year, and in 7.9% of women versus 28.3% of women (p < 0.009) after 5 years of therapy, respectively. There were significant statistical differences in women treated with estrogen alone versus those treated with combined HRT after 1 and 5 years. After 5 years of HRT, breast density increased 21.8% in women receiving cyclic combined therapy versus 38.8% in those under continuous combined therapy (p < 0.039). CONCLUSION An increase in breast density is significantly more frequent in women receiving combined estrogen-progestin therapy than in women receiving estrogen alone. There are differences between cyclic and continuous combined therapy at 5 years of treatment.
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Hollenbeck S, Keely P, Seewaldt V. Mammographic density: intersection of science, the law, and clinical practice. Am Soc Clin Oncol Educ Book 2013:0011300063. [PMID: 23714458 DOI: 10.14694/edbook_am.2013.33.e63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
High mammographic density is associated with a two- to sixfold increased risk of breast cancer. Mammographic density can be altered by endogenous and exogenous hormonal factors and generally declines with age. Mammographic density is affected by confounding factors such as age, parity, menopausal status, and body mass index (BMI), thus making interpretation of mammographic density challenging. None of the established means of measuring mammographic density are entirely satisfactory because they are time consuming and/or subjective. Although mammographic density has been shown to predict breast cancer risk, the role of mammographic density in precisely assessing a woman's breast cancer risk over her lifetime and evaluating response to risk-reduction strategies cannot be fully realized until we have a better understanding of the biology that links mammographic density to breast cancer risk.
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Affiliation(s)
- Scott Hollenbeck
- From Duke University, Durham, NC; University of Wisconsin, Madison, WI
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Skippage P, Wilkinson L, Allen S, Roche N, Dowsett M, a'Hern R. Correlation of Age and HRT Use with Breast Density as Assessed by Quantra™. Breast J 2012; 19:79-86. [PMID: 23230974 DOI: 10.1111/tbj.12046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Philippa Skippage
- Department of Radiology; Frimley Park Hospital NHS Foundation Trust; Surrey United Kingdom
| | | | - Steven Allen
- Department of Radiology; Royal Marsden Hospital; Surrey United Kingdom
| | - Nicola Roche
- Department of Surgery; Royal Marsden Hospital; London United Kingdom
| | | | - Roger a'Hern
- Institute of Cancer Research; London United Kingdom
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Tesic V, Kolaric B, Znaor A, Kuna SK, Brkljacic B. Mammographic density and estimation of breast cancer risk in intermediate risk population. Breast J 2012; 19:71-8. [PMID: 23173778 DOI: 10.1111/tbj.12051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is not clear to what extent mammographic density represents a risk factor for breast cancer among women with moderate risk for disease. We conducted a population-based study to estimate the independent effect of breast density on breast cancer risk and to evaluate the potential of breast density as a marker of risk in an intermediate risk population. From November 2006 to April 2009, data that included American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) breast density categories and risk information were collected on 52,752 women aged 50-69 years without previously diagnosed breast cancer who underwent screening mammography examination. A total of 257 screen-detected breast cancers were identified. Logistic regression was used to assess the effect of breast density on breast carcinoma risk and to control for other risk factors. The risk increased with density and the odds ratio for breast cancer among women with dense breast (heterogeneously and extremely dense breast), was 1.9 (95% confidence interval, 1.3-2.8) compared with women with almost entirely fat breasts, after adjustment for age, body mass index, age at menarche, age at menopause, age at first childbirth, number of live births, use of oral contraceptive, family history of breast cancer, prior breast procedures, and hormone replacement therapy use that were all significantly related to breast density (p < 0.001). In multivariate model, breast cancer risk increased with age, body mass index, family history of breast cancer, prior breast procedure and breast density and decreased with number of live births. Our finding that mammographic density is an independent risk factor for breast cancer indicates the importance of breast density measurements for breast cancer risk assessment also in moderate risk populations.
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Affiliation(s)
- Vanja Tesic
- Department of Epidemiology, Dr. Andrija Stampar Institute of Public Health, Zagreb, Croatia.
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Vachon CM, Li J, Scott CG, Hall P, Czene K, Wang X, Liu J, Fredericksen ZS, Rider DN, Wu FF, Olson JE, Cunningham JM, Stevens KN, Sellers TA, Pankratz SV, Couch FJ. No evidence for association of inherited variation in genes involved in mitosis and percent mammographic density. Breast Cancer Res 2012; 14:R7. [PMID: 22226020 PMCID: PMC3496122 DOI: 10.1186/bcr3088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 12/01/2011] [Accepted: 01/07/2012] [Indexed: 01/18/2023] Open
Abstract
Introduction Increased mammographic breast density is one of the strongest risk factors for breast cancer. While two-thirds of the variation in mammographic density appears to be genetically influenced, few variants have been identified. We examined the association of inherited variation in genes from pathways that mediate cell division with percent mammographic density (PMD) adjusted for age, body mass index (BMI) and postmenopausal hormones, in two studies of healthy postmenopausal women. Methods We investigated 2,058 single nucleotide polymorphisms (SNPs) in 378 genes involved in regulation of mitosis for associations with adjusted PMD among 484 unaffected postmenopausal controls (without breast cancer) from the Mayo Clinic Breast Cancer Study (MCBCS) and replicated the findings in postmenopausal controls (n = 726) from the Singapore and Sweden Breast Cancer Study (SASBAC) study. PMD was assessed in both studies by a computer-thresholding method (Cumulus) and linear regression approaches were used to assess the association of SNPs and PMD, adjusted for age, BMI and postmenopausal hormones. A P-value threshold of 4.2 × 10-5 based on a Bonferroni correction of effective number of independent tests was used for statistical significance. Further, a pathway-level analysis was conducted of all 378 genes using the self-contained gene-set analysis method GLOSSI. Results A variant in PRPF4, rs10733604, was significantly associated with adjusted PMD in the MCBCS (P = 2.7 × 10-7), otherwise, no single SNP was associated with PMD. Additionally, the pathway analysis provided no evidence of enrichment in the number of associations observed between SNPs in the mitotic genes and PMD (P = 0.60). We evaluated rs10733604 (PRPF4), and 73 other SNPs at P < 0.05 from 51 genes in the SASBAC study. There was no evidence of an association of rs10733604 (PRPF4) with adjusted PMD in SASBAC (P = 0.23). There were, however, consistent associations (P < 0.05) of variants at the putative locus, LOC375190, Aurora B kinase (AURKB), and Mini-chromosome maintenance complex component 3 (MCM3) with adjusted PMD, although these were not statistically significant. Conclusions Our findings do not support a role of inherited variation in genes involved in regulation of cell division and adjusted percent mammographic density in postmenopausal women.
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Affiliation(s)
- Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Tehranifar P, Reynolds D, Flom J, Fulton L, Liao Y, Kudadjie-Gyamfi E, Terry MB. Reproductive and menstrual factors and mammographic density in African American, Caribbean, and white women. Cancer Causes Control 2011; 22:599-610. [PMID: 21327938 DOI: 10.1007/s10552-011-9733-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/17/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We investigated the associations between reproductive and menstrual risk factors for breast cancer and mammographic density, a strong risk factor for breast cancer, in a predominantly ethnic minority and immigrant sample. METHODS We interviewed women (42% African American, 22% African Caribbean, 22% White, 9% Hispanic Caribbean, 5% other) without a history of breast cancer during their mammography appointment (n = 191, mean age = 50). We used a computer-assisted method to measure the area and percentage of dense breast tissue from cranio-caudal mammograms. We used multivariable linear regression analyses to estimate the associations between reproductive and menstrual risk factors and mammographic density. RESULTS Age was inversely associated with percent density and dense area, and body mass index (BMI) was inversely associated with percent density. Adjusting for age, BMI, ethnicity and menopausal status, later age at menarche (e.g., β = -7.37, 95% CI: -12.29, -2.46 for age ≥ 13 years vs. ≤ 11 years), and any use of hormonal birth control (HBC) methods (β = -5.10, 95% CI: -9.37, -0.84) were associated with reduced dense area. Ethnicity and nativity (foreign- vs. US-born) were not directly associated with density despite variations in the distribution of several risk factors across ethnic and nativity groups. CONCLUSIONS The mean level of mammographic density did not differ across ethnic and nativity groups, but several risk factors for breast cancer were associated with density in ethnic minority and immigrant women.
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Affiliation(s)
- Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA.
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Factors That Influence Changes in Mammographic Density With Postmenopausal Hormone Therapy. Taiwan J Obstet Gynecol 2010; 49:413-8. [DOI: 10.1016/s1028-4559(10)60091-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2009] [Indexed: 11/21/2022] Open
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Soares PM, Cabello C, Magna LA, Tinois E, Benetti-Pinto CL. Breast density in women with premature ovarian failure or postmenopausal women using hormone therapy: analytical cross-sectional study. SAO PAULO MED J 2010; 128:211-4. [PMID: 21120432 PMCID: PMC10938997 DOI: 10.1590/s1516-31802010000400007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 06/17/2010] [Accepted: 06/23/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Studies on postmenopausal women have reported increased risk of breast cancer relating to the type and duration of hormone therapy (HT) used. Women with premature ovarian failure (POF) represent a challenge, since they require prolonged HT. Little is known about the impact of prolonged HT use on these women's breasts. This study aimed to evaluate the effects of one type of HT on the breast density of women with POF, compared with postmenopausal women. DESIGN AND SETTING Cross-sectional study at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS 31 women with POF and 31 postmenopausal women, all using HT consisting of conjugated equine estrogen combined with medroxyprogesterone acetate, and matched according to HT duration, were studied. Mammography was performed on all subjects and was analyzed by means of digitization or Wolfe's classification, stratified into two categories: non-dense (N1 and P1 patterns) and dense (P2 and Dy). RESULTS No significant difference in breast density was found between the two groups through digitization or Wolfe's classification. From digitization, the mean breast density was 24.1% ± 14.6 and 18.1% ± 17.2 in the POF and postmenopausal groups, respectively (P = 0.15). Wolfe's classification identified dense breasts in 51.6% and 29.0%, respectively (P = 0.171). CONCLUSION There was no difference in breast density between the women with POF and postmenopausal women, who had used HT for the same length of time. These results may help towards compliance with HT use among women with POF.
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Affiliation(s)
- Patrícia Magda Soares
- MD, Postgraduate student, Department of Obstetrics and Gynecology, School of Medical Sciences, Universidade Estadual de São Paulo (Unicamp), Campinas, São Paulo, Brazil.
| | - César Cabello
- MD, PhD. Associate professor, Department of Obstetrics and Gynecology, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Luis Alberto Magna
- MD, PhD. Titular professor, Department of Medical Genetics, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Eduardo Tinois
- Physicist and engineer, Biomedical Engineering Center, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Cristina Laguna Benetti-Pinto
- Physicist and engineer, Biomedical Engineering Center, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
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Chiu SYH, Duffy S, Yen AMF, Tabár L, Smith RA, Chen HH. Effect of Baseline Breast Density on Breast Cancer Incidence, Stage, Mortality, and Screening Parameters: 25-Year Follow-up of a Swedish Mammographic Screening. Cancer Epidemiol Biomarkers Prev 2010; 19:1219-28. [DOI: 10.1158/1055-9965.epi-09-1028] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Harvey J, Scheurer C, Kawakami FT, Quebe-Fehling E, de Palacios PI, Ragavan VV. Hormone replacement therapy and breast density changes. Climacteric 2010; 8:185-92. [PMID: 16096175 DOI: 10.1080/13697130500103458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare the incidence of increased breast density and tenderness in postmenopausal women associated with transdermal (Estalis/Combipatch), Novartis, Basel, Switzerland) and oral (Kliogest), Schering AG, Berlin, Germany) hormone replacement therapy (HRT). METHODS A total of 202 postmenopausal women were randomized to transdermal or oral HRT. Mammograms obtained at study entry and after 1 year of treatment were assessed for percent breast density by means of the digital segmentation and thresholding technique. Breast tenderness was assessed at each study visit. RESULTS The mean breast density by ANCOVA after adjusting for screening value at study end was significantly lower for women using Estalis (38.4%, standard error 0.9%) compared with Kliogest (46.9%, standard error 1.5%) (p<0.0001). Significantly fewer women using transdermal HRT had an increase in mammographic breast density or breast tenderness compared to oral HRT. Of the women using transdermal HRT, 39.1% had no change in breast density compared to 15.7% for women using oral HRT. Only 4% of women using transdermal HRT had a marked increase in density (>25%) compared to 15.7% of women using oral HRT. Overall, 36.0% of patients in the transdermal group reported breast tenderness at some point during the 1-year study, compared with 57.6% in the oral HRT group (p=0.0002). CONCLUSION Transdermal HRT use is associated with a significantly lower incidence of increased mammographic breast density and breast tenderness compared with oral HRT.
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Affiliation(s)
- J Harvey
- University of Virginia Health System, Charlottesville, VA, USA
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18
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Mavi A, Cermik TF, Urhan M, Puskulcu H, Basu S, Cucchiara AJ, Yu JQ, Alavi A. The effect of age, menopausal state, and breast density on (18)F-FDG uptake in normal glandular breast tissue. J Nucl Med 2010; 51:347-52. [PMID: 20150253 DOI: 10.2967/jnumed.109.068718] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Theoretically, the degree of (18)F-FDG uptake in the glandular tissues of the normal breast can affect the detection of breast cancer. The aim of this prospective study was to investigate relationships among age, menopausal state, and breast density and determine whether they affect (18)F-FDG uptake in normal glandular breast tissue. METHODS Among 250 newly diagnosed breast cancer patients, 149 patients (mean age +/- SD, 50.9 +/- 9.70 y; range, 32-77 y) were analyzed because they had normal contralateral breasts confirmed by MRI, mammography, and (18)F-FDG PET examinations. PET images were acquired 60 +/- 2 min after the administration of (18)F-FDG (5.2 MBq/kg of body weight). The maximum and average standardized uptake value (SUVmax and SUVavg, respectively) of (18)F-FDG were calculated in the normal breast. Patients were divided into groups according to qualitative breast density and menopausal state. Descriptive statistics and 2-factorial analysis of covariance were used to assess the effects of qualitative breast density, menopausal state, and age on SUVmax and SUVavg. Pearson chi(2) was used to test the relationship between menopausal state and qualitative breast density. RESULTS The average age of patients with nondense breasts was significantly higher than that of patients with dense breasts (P < 0.01). Also, breast density related to menopausal state (P < 0.05). Dense breasts had an average SUVmax of 1.243 and mean SUVavg of 0.694, whereas nondense breasts had a mean SUVmax of 0.997 and mean SUVavg of 0.592. Analysis of covariance indicated that density and the linear effect of age were significant with regard to both SUVmax and SUVavg. After removing the linear effect of age, menopausal state had no effect on SUVmax and SUVavg. CONCLUSION (18)F-FDG uptake significantly decreases as age increases and breast density decreases. Age and qualitative breast density are independent factors and significantly affect (18)F-FDG uptake for both SUVmax and SUVavg. Menopausal state had no effect on SUVmax and SUVavg.
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Affiliation(s)
- Ayse Mavi
- Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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19
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Can mammographic assessments lead to consider density as a risk factor for breast cancer? Eur J Radiol 2010; 82:404-11. [PMID: 20133095 DOI: 10.1016/j.ejrad.2010.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/09/2010] [Accepted: 01/11/2010] [Indexed: 11/22/2022]
Abstract
Admitting that mammographic breast density is an important independent risk factor for breast cancer in the general population, has a crucial economical health care impact, since it might lead to increasing screening frequency or reinforcing additional modalities. Thus, the impact of density as a risk factor has to be carefully investigated and might be debated. Some authors suggested that high density would be either a weak factor or confused with a masking effect. Others concluded that most of the studies have methodological biases in basic physics to quantify percentage of breast density, as well as in mammographic acquisition parameters. The purpose of this review is to evaluate mammographic procedures and density assessments in published studies regarding density as a breast cancer risk. No standardization was found in breast density assessments and compared density categories. High density definitions varied widely from 25 to 75% of dense tissues on mammograms. Some studies showed an insufficient follow-up to reveal masking effect related to mammographic false negatives. Evaluating breast density impact needs thorough studies with consensual mammographic procedures, methods of density measurement, breast density classification as well as a standardized definition of high breast density. Digital mammography, more effective in dense breasts, should help to re-evaluate the issue of density as a risk factor for breast cancer.
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20
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Stuedal A, Ma H, Bjørndal H, Ursin G. Postmenopausal hormone therapy with estradiol and norethisterone acetate and mammographic density: findings from a cross-sectional study among Norwegian women. Climacteric 2009; 12:248-58. [DOI: 10.1080/13697130802638458] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Schneider HPG. Menopause World Congress in Berlin. Climacteric 2009. [DOI: 10.1080/cmt.5.1.90.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Panoulis C, Lambrinoudaki I, Vourtsi A, Augoulea A, Kaparos G, Aravantinos L, Christodoulakos G, Creatsas G. Progestin may modify the effect of low-dose hormone therapy on mammographic breast density. Climacteric 2009; 12:240-7. [DOI: 10.1080/13697130802684601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Terry MB, Buist DSM, Trentham-Dietz A, James-Todd TM, Liao Y. Nonsteroidal anti-inflammatory drugs and change in mammographic density: a cohort study using pharmacy records on over 29,000 postmenopausal women. Cancer Epidemiol Biomarkers Prev 2008; 17:1088-95. [PMID: 18483330 DOI: 10.1158/1055-9965.epi-07-2836] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Use of nonsteroidal anti-inflammatory drugs (NSAID) has been associated with a decrease in breast cancer risk, but it is unknown if they also reduce mammographic density, a strong intermediate marker of breast cancer risk. METHODS We investigated NSAID use and mammographic density in 29,284 postmenopausal women who had two screening mammograms at Group Health in Seattle. We used pharmacy records to classify women as NSAID nonusers, continuers, initiators, or discontinuers based on use between the two mammograms and nine separate prescription and nonprescription NSAID classes. Using unordered polytomous logistic regression methods, we modeled the odds ratio (OR) of staying not dense, decreasing density, or increasing density relative to remaining dense based on Breast Imaging Reporting Data System classification of density. RESULTS There was no association with density change from initiation or continuation of NSAIDs. However, both initiators and continuers of any NSAIDs were more likely to stay not dense than stay dense [OR, 1.12; 95% confidence interval (95% CI), 1.04-1.20; OR, 1.25; 95% CI, 1.05-1.49, respectively]. This association with staying not dense for initiators and continuers of any NSAID use was observed primarily among women ages <65 years at first mammogram (OR, 1.24; 95% CI, 1.12-1.36; OR, 1.48; 95% CI, 1.14-1.93, respectively). CONCLUSIONS Initiation of NSAID use did not reduce mammographic density over the short term. Continuers of NSAID use were more likely to stay not dense compared with nonusers, suggesting that it is plausible that longer-term use of NSAIDs may be needed to reduce density.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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24
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Weaver K, Kataoka M, Murray J, Muir B, Anderson E, Warren R, Warsi I, Highnam R, Glasier A. Does a short cessation of HRT decrease mammographic density? Maturitas 2008; 59:315-22. [DOI: 10.1016/j.maturitas.2008.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 12/30/2007] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
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25
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Hur MH, Lee HK, Kang WN, Yoon CS, Ko SS, Lee YJ, Lee KS, Cho BJ, Kang SS. Breast Cancer Screening: A Medical Audit of the Screening Mammography Performed at One Institution for 10 Years. J Breast Cancer 2008. [DOI: 10.4048/jbc.2008.11.4.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Min Hee Hur
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Hae Kyung Lee
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Wan Nam Kang
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Chan Seok Yoon
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Seung Sang Ko
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Yu-Jin Lee
- Department of Radiology, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Kyung Sang Lee
- Department of Radiology, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Byung Jae Cho
- Department of Radiology, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
| | - Sung Soo Kang
- Department of Surgery, Kwandong University, College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea
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26
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Benetti-Pinto CL, Soares PM, Magna LA, Petta CA, Dos Santos CC. Breast density in women with premature ovarian failure using hormone therapy. Gynecol Endocrinol 2008; 24:40-3. [PMID: 18224543 DOI: 10.1080/09637480701690543] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Women with premature ovarian failure (POF) are treated with estrogen-progestin therapy; however, doubts remain regarding the effect of this therapy on the breasts of women with POF. OBJECTIVE To evaluate the breast density of women with POF using estrogen-progestin therapy compared with normally menstruating women. METHODS A cross-sectional study was performed in 31 women with POF using conjugated equine estrogens and medroxyprogesterone acetate and a control group of 31 normally menstruating women, paired by age. All underwent mammography, analyzed by digitization and Wolfe's classification, the latter defined as non-dense (N1 and P1) or dense (P2 and Dy). Parity, breastfeeding and body mass index were evaluated, as well as duration of hormone use and ovarian failure in the POF group. RESULTS Digitization revealed no difference in mean breast density between the groups: 24.1+/-14.6% and 21.8+/-11.3% for POF and control groups, respectively. The Wolfe classification also failed to detect any significant difference between the groups, dense breasts being detected in 51.6% and 35.5% of cases in the POF and control groups, respectively. CONCLUSION Periods of hypoestrogenism followed by hormone therapy resulted in no changes in breast density in women with POF, compared with normally menstruating women of the same age.
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Affiliation(s)
- Cristina Laguna Benetti-Pinto
- Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas, Campinas, Sao Paulo, Brazil.
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27
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Hwang ES, Miglioretti DL, Ballard-Barbash R, Weaver DL, Kerlikowske K. Association between Breast Density and Subsequent Breast Cancer Following Treatment for Ductal Carcinoma In situ. Cancer Epidemiol Biomarkers Prev 2007; 16:2587-93. [DOI: 10.1158/1055-9965.epi-07-0458] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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28
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Parikh J, Einstein A. Medical directors of breast imaging centers: beyond films. J Am Coll Radiol 2007; 3:135-41. [PMID: 17412024 DOI: 10.1016/j.jacr.2005.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Indexed: 11/27/2022]
Abstract
Over the past decade, breast radiologists have been increasingly asked to fulfill a new dynamic role as medical directors of breast imaging centers. To our knowledge, there are no standardized job descriptions nor defined roles and responsibilities for this position. Job descriptions are usually crafted to fit unique institutional and individual situations. To be an effective medical director of a breast imaging center, breast imagers must be more than just film readers. In this article, the authors describe the diverse roles of contemporary medical directors of breast imaging centers.
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Affiliation(s)
- Jay Parikh
- Women's Diagnostic Imaging Center Swedish Cancer Institute, Seattle, WA 98104, USA.
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29
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Porter GJR, Evans AJ, Cornford EJ, Burrell HC, James JJ, Lee AHS, Chakrabarti J. Influence of mammographic parenchymal pattern in screening-detected and interval invasive breast cancers on pathologic features, mammographic features, and patient survival. AJR Am J Roentgenol 2007; 188:676-83. [PMID: 17312053 DOI: 10.2214/ajr.05.1950] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of our study was to assess the effect of mammographic parenchymal pattern on patient survival, mammographic features, and pathologic features of breast cancer in a screened population. MATERIALS AND METHODS We classified the parenchymal pattern (according to BI-RADS) of 759 screened women who presented with a screening-detected (n = 455) or interval (n = 304) invasive breast cancer. Pathologic details (tumor size, histologic grade, lymph node stage, vascular invasion, and histologic type) and mammographic appearances were recorded. Breast cancer-specific survival was ascertained, with a median follow-up of 9.0 years. RESULTS An excess of interval cancers was seen in women with dense breasts (p < 0.0001). Screening-detected (but not interval) tumors were significantly smaller in fatty breasts (p = 0.014). Tumor grade, lymph node stage, vascular invasion, and histologic type did not vary significantly with mammographic parenchymal pattern in screening-detected or interval cancers. Screening-detected cancers in fatty breasts were more likely to appear as indistinct (p = 0.003) or spiculated (p = 0.002) masses in contrast to cancers in dense breasts, which more commonly appeared as architectural distortions (p < 0.0001). No significant breast cancer-specific survival difference was seen by mammographic parenchymal pattern for screening-detected cancers (p = 0.75), interval cancers (p = 0.82), or both groups combined (p = 0.12). CONCLUSION The prognosis of screened women presenting with breast cancer is unrelated to dense mammographic parenchymal pattern despite an excess of interval cancers and larger screening-detected tumors in this group. These data support the mammographic screening of women with dense parenchymal patterns.
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Affiliation(s)
- Gareth J R Porter
- Nottingham Breast Institute, City Hospital, Hucknall Rd., Nottingham, England, NG5 1PB.
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30
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Vachon CM, Ingle JN, Suman VJ, Scott CG, Gottardt H, Olson JE, Goss PE. Pilot study of the impact of letrozole vs. placebo on breast density in women completing 5 years of tamoxifen. Breast 2007; 16:204-10. [PMID: 17145182 DOI: 10.1016/j.breast.2006.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 10/18/2006] [Indexed: 10/23/2022] Open
Abstract
Breast density, a strong risk factor for breast cancer, is reduced by the anti-estrogen, tamoxifen (TAM). We examined whether aromatase inhibitor (AI) therapy results in further reductions in breast density among women completing 5 years of TAM. Among a sample of women with early-onset breast cancer who were randomized to letrozole (LET)(n=56) or placebo (PLAC)(n=48) after 5 years of TAM, we examine the change in percent density at 9-15 months as well as a per-year change in PD by treatment group. There was no difference in the adjusted mean change (-1.0%, LET; -0.3%, PLAC (P=0.58)) or the percentage change (-2.7%, LET; -3.0%, PLAC (P=0.96)) in PD between treatment groups at 9-15 months. Results were similar for longitudinal change (-0.68% per year, LET; -0.12% per year, PLAC (P=0.23)). Breast density does not appear to be a clinically relevant biomarker in women who already have low PD following 5 years of TAM.
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Affiliation(s)
- C M Vachon
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
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31
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Breast density and polymorphisms in genes coding for CYP1A2 and COMT: the Multiethnic Cohort. BMC Cancer 2007; 7:30. [PMID: 17295924 PMCID: PMC1800856 DOI: 10.1186/1471-2407-7-30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 02/12/2007] [Indexed: 11/22/2022] Open
Abstract
Background Mammographic density is a strong predictor of breast cancer risk and is increased by hormone replacement therapy (HRT). Some associations with genetic polymorphisms in enzymes involved in estrogen metabolism have been described. This cross-sectional analysis examined the relation between mammographic density and the CYP1A2*1F and COMT Val58 Met polymorphisms among 332 breast cancer cases and 254 controls in the Hawaii component of the Multiethnic Cohort. Methods Mammographic density, before diagnosis in cases, was quantified by using a validated computer-assisted method. Blood samples were genotyped by standard PCR/RFLP methods. Adjusted mean percent density was calculated by genotype using mixed models with the unstructured covariance option. Results A positive association between the C allele in the CYP1A2*1F gene and percent density, but not the dense area, was suggested (p = 0.11). The relation was limited to controls (p = 0.045), postmenopausal women not using HRT (p = 0.08), and normal weight subjects (p = 0.046). We did not observe any relation between the COMT Val58 Met polymorphism and breast density. Conclusion The lack of an association between the CYP1A2 genotype and the size of the dense areas suggests an effect on the non-dense, i.e., fatty breast tissue. The discrepancies among studies may be due to differential susceptibility; changes in enzyme activity as a result of the CYP1A2*1F polymorphism may influence breast tissue differently depending on hormonal status. Larger studies with the ability to look at interactions would be useful to elucidate the influence of genetic variation in CYP1A2 and COMT on the risk of developing breast cancer.
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Aiello EJ, Buist DSM, White E. Do breast cancer risk factors modify the association between hormone therapy and mammographic breast density? (United States). Cancer Causes Control 2006; 17:1227-35. [PMID: 17111253 DOI: 10.1007/s10552-006-0073-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 05/04/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether the association between hormone therapy (HT) and breast density differs by levels of breast cancer risk factors. METHODS We evaluated 80,867 screening mammograms from 39,296 postmenopausal women from Washington State. We estimated odds ratios and 95% confidence intervals for dense breasts (Breast Imaging Reporting and Data System categories 3 "heterogeneously dense" and 4 "extremely dense") compared to fatty breasts (categories 1 "almost entirely fat" and 2 "scattered fibroglandular") among HT users compared to never users. We separately examined former HT use and current HT use by type (estrogen plus progestin therapy (EPT) and estrogen-only therapy (ET)). We stratified the associations by age, BMI, race, family history, and reproductive and menopausal factors. RESULTS Current EPT users had a 98% (1.87-2.09) greater odds of having dense breasts and current ET users had a 71% (1.56-1.87) greater odds compared to never users. Current HT users were more likely to have dense breasts if they were older, had more children, or younger at first birth compared to never users; these associations were stronger among EPT users than ET users. CONCLUSIONS HT, particularly EPT, may reduce protective effects of older age, parity, and younger age at first birth on mammographic density.
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Affiliation(s)
- Erin J Aiello
- Group Health Center for Health Studies, Suite 1600, Seattle, WA 98101, USA.
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Martin KE, Helvie MA, Zhou C, Roubidoux MA, Bailey JE, Paramagul C, Blane CE, Klein KA, Sonnad SS, Chan HP. Mammographic Density Measured with Quantitative Computer-aided Method: Comparison with Radiologists' Estimates and BI-RADS Categories. Radiology 2006; 240:656-65. [PMID: 16857974 DOI: 10.1148/radiol.2402041947] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively compare computer-aided mammographic density estimation (MDEST) with radiologist estimates of percentage density and Breast Imaging Reporting and Data System (BI-RADS) density classification. MATERIALS AND METHODS Institutional Review Board approval was obtained for this HIPAA-compliant study; patient informed consent requirements were waived. A fully automated MDEST computer program was used to measure breast density on digitized mammograms in 65 women (mean age, 53 years; range, 24-89 years). Pixel gray levels in detected breast borders were analyzed, and dense areas were segmented. Percentage density was calculated by dividing the number of dense pixels by the total number of pixels within the borders. Seven breast radiologists (five trained with MDEST, two not trained) prospectively assigned qualitative BI-RADS density categories and visually estimated percentage density on 260 mammograms. Qualitative BI-RADS assessments were compared with new quantitative BI-RADS standards. The reference standard density for this study was established by allowing the five trained radiologists to manipulate the MDEST gray-level thresholds, which segmented mammograms into dense and nondense areas. Statistical tests performed include Pearson correlation coefficients, Bland-Altman agreement method, kappa statistics, and unpaired t tests. RESULTS There was a close correlation between the reference standard and radiologist-estimated density (R = 0.90-0.95) and MDEST density (R = 0.89). Untrained radiologists overestimated percentage density by an average of 37%, versus 6% for trained radiologists (P < .001). MDEST showed better agreement with the reference standard (average overestimate, 1%; range, -15% to +18%). MDEST correlated better with percentage density than with qualitative BI-RADS categories. There were large overlaps and ranges of percentage density in qualitative BI-RADS categories 2-4. Qualitative BI-RADS categories correlated poorly with new quantitative BI-RADS categories, and 16 (6%) of 260 views were erroneously classified by MDEST. CONCLUSION MDEST compared favorably with radiologist estimates of percentage density and is more reproducible than radiologist estimates when qualitative BI-RADS density categories are used. Qualitative and quantitative BI-RADS density assessments differed markedly.
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Topal NB, Ayhan S, Topal U, Bilgin T. Effects of hormone replacement therapy regimens on mammographic breast density: The role of progestins. J Obstet Gynaecol Res 2006; 32:305-8. [PMID: 16764621 DOI: 10.1111/j.1447-0756.2006.00402.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the effects of different regimens of hormone replacement therapy (HRT) on mammographic breast density. METHODS Mammograms of 113 healthy postmenopausal women who were on different HRT regimens were evaluated retrospectively. All women had a baseline mammography and at least one mammogram after at least 12 months of HRT. Four parenchymal patterns were considered mammographically. Quantification of density changes that occurred on follow-up mammograms was done qualitatively and with reference to densities on baseline mammograms. RESULTS Sixty women were treated with a continuous estrogen-progestin combination; 16 with a cyclic estrogen-progestin combination and 37 were with estrogen only. Twenty-six women had increased mammographic density after HRT. Mammographic density increase was detected in 23 women (38.3%) of the continuous estrogen-progestin combination group, two women (12.5%) of the cyclic estrogen-progestin combination group and one woman (2.7%) of the estrogen-only group. Mammographic density increase was more common among women in the continuous estrogen-progestin combination group than the other groups and this difference was found to be statistically significant (P < 0.001). Breast density increase was observed in 18 of 30 women (60%) with higher doses of progestin compared to 5 of 30 women (16.7%) with lower dose (P < 0.05). CONCLUSIONS Postmenopausal HRT may increase mammographic breast density. Breast density appears to be mostly affected by higher doses and continuous administration of progestin.
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Affiliation(s)
- Naile Bolca Topal
- Department of Radiology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Maskarinec G, Pagano I, Lurie G, Kolonel LN. A Longitudinal Investigation of Mammographic Density: The Multiethnic Cohort. Cancer Epidemiol Biomarkers Prev 2006; 15:732-9. [PMID: 16614116 DOI: 10.1158/1055-9965.epi-05-0798] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mammographic densities are hypothesized to reflect the cumulative exposure to risk factors that influence breast cancer incidence. This report analyzed percent densities over time and explored predictors of density change in relation to age. The study population consisted of 607 breast cancer cases and 667 frequency matched controls with 1,956 and 1,619 mammographic readings, respectively. Mammograms done over >20 years and before a diagnosis of breast cancer were assessed for densities using a computer-assisted method. Using multilevel modeling to allow for repeated measurements, we estimated the effect of ethnicity, case status, reproductive characteristics, hormonal therapy, body mass index, and soy intake on initial status and longitudinal change. After integrating the area under the percent density curve, cumulative percent density was compared with age-specific breast cancer rates in Hawaii. Percent densities decreased approximately 5.6% per 10 years but a nonlinear effect indicated a faster decline earlier in life. Cumulative percent densities and age-specific breast cancer rates increased at very similar rates; both standardized regression coefficients were >0.9. Japanese ancestry, overweight, estrogen/progestin treatment, and, to a lesser degree, estrogen-only therapy predicted a slower decline in densities with age. Case status and adult soy intake were related to higher densities whereas overweight and having any child were associated with lower densities at initial status. Risk factors that influence the decline in mammographic densities over time may be important for breast cancer prevention because cumulative percent densities may reflect the age-related increase in breast cancer risk.
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Christodoulakos GE, Lambrinoudaki IV, Vourtsi AD, Vlachou S, Creatsa M, Panoulis KPC, Botsis D. The effect of low dose hormone therapy on mammographic breast density. Maturitas 2006; 54:78-85. [PMID: 16198519 DOI: 10.1016/j.maturitas.2005.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 08/29/2005] [Accepted: 08/30/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the effect of two standard and one low dose continuous hormone therapy regimens on mammography. METHODS One hundred and thirty-two non-hysterectomized postmenopausal women were randomly allocated either to conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA, n=38), 17beta-estradiol 2 mg plus norethisterone acetate 1 mg (E2/NETA, n=44) or 17beta-estradiol 1 mg plus norethisterone acetate 0.5 mg (low E2/NETA, n=50). Treatment was continuous and the study period lasted 12 months. Main outcome measures were the changes according to Wolfe classification between baseline and 12-month mammograms. RESULTS Five (13.2%) women in the CEE/MPA group showed an increase in breast density. Fourteen (31.8%) women on E2/NETA and 6 (12.2%) on low E2/NETA treatment revealed an increase in breast density. No woman exhibited an involution of fibroglandular tissue. CONCLUSIONS Different hormone therapy regimens have a variable impact on breast density probably depending on the steroid used. Low dose hormone therapy associates with significantly lesser increase in breast density.
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Affiliation(s)
- George E Christodoulakos
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, 27, Themistokleous Street, Dionysos, GR-14578 Athens, Greece
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Noh JJ, Maskarinec G, Pagano I, Cheung LWK, Stanczyk FZ. Mammographic densities and circulating hormones: A cross-sectional study in premenopausal women. Breast 2006; 15:20-8. [PMID: 16000251 DOI: 10.1016/j.breast.2005.04.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 03/10/2005] [Accepted: 04/13/2005] [Indexed: 11/19/2022] Open
Abstract
Progestogens appear to influence breast density more than estrogens in postmenopausal women taking hormone replacement therapy (HRT), but little is known about the effect of circulating hormones on mammographic density among premenopausal women. This cross-sectional study explores the relationship of body weight and sex steroids with breast density. Luteal serum samples were analyzed for progesterone, estrone, estradiol, and sex hormone-binding globulin (SHBG). Mammograms were assessed for density using a computer-assisted method. We performed mediation tests using multiple linear regression models. Significant associations of SHBG and estradiol with percentage density disappeared after adjustment for body weight and other covariates, whereas the relationship between progesterone and breast density remained borderline significant. The mediation tests indicated that progesterone has a direct and an indirect effect on mammographic density. Our finding that progesterone shows a stronger association with percentage of mammographic density than estrogen agrees with clinical reports describing denser mammographic patterns among women taking HRT, although these women differ in menopausal status.
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Affiliation(s)
- Jihae J Noh
- Cancer Research Center of Hawaii, 1236 Lauhala Street, Honolulu, HI 96813, USA
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Boudreau DM, Buist DSM, Rutter CM, Fishman PA, Beverly KR, Taplin S. Impact of hormone therapy on false-positive recall and costs among women undergoing screening mammography. Med Care 2006; 44:62-9. [PMID: 16365614 DOI: 10.1097/01.mlr.0000188969.83608.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to evaluate the effects of hormone therapy (HT) on false-positive (FP) recall for additional breast evaluation and costs. DESIGN We undertook an observational cohort study of women ages 40-80 years with 2 mammography screenings in an integrated delivery system. MEASURES FP recall, defined as mammograms resulting in a radiologist's recommendation for additional imaging, ultrasound, or invasive procedures among disease-free women, was compared for nonusers, initiators, discontinuers, and continuers of HT. Differences in health care costs by HT were assessed for total, primary care, specialty, laboratory, radiology, inpatient, mental health, and pharmacy. RESULTS There was no association between HT and FP recall among women ages 40-49 years. Among women 50 years or older, current HT users, ie, initiators and continuers, had increased odds of FP recall (odds ratio; 95% confidence interval) compared with nonusers (1.2; 1.0-1.4 for women 50-59 years; 1.8; 1.5-2.2 for women 60-69; and 1.7; 1.4-2.0 for women 70-80 years). Among women 50-59 years, the odds of FP recall were attributed to opposed HT (ie, estrogen+progestin). Increases in FP recall among HT users 60 years and older was maintained for initiators, continuers, opposed, and unopposed (estrogen only). Increases in FP recall among HT users were for imaging and ultrasound but not invasive procedures. Costs for current HT users during the 12 months after screening were not higher than nonusers, except for pharmacy and outpatient mental health. CONCLUSION The relationship between HT use and FP recall is greatest among older women and does not result in a differential use of invasive procedures.
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Affiliation(s)
- Denise M Boudreau
- Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101-1448, USA.
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Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis MG, Wilson M, Patnick J. Hormone replacement therapy and false positive recall in the Million Women Study: patterns of use, hormonal constituents and consistency of effect. Breast Cancer Res 2005; 8:R8. [PMID: 16417651 PMCID: PMC1413983 DOI: 10.1186/bcr1364] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Revised: 11/02/2005] [Accepted: 11/08/2005] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Current and recent users of hormone replacement therapy (HRT) have an increased risk of being recalled to assessment at mammography without breast cancer being diagnosed ('false positive recall'), but there is limited information on the effects of different patterns of HRT use on this. The aim of this study is to investigate in detail the relationship between patterns of use of HRT and false positive recall. METHODS A total of 87,967 postmenopausal women aged 50 to 64 years attending routine breast cancer screening at 10 UK National Health Service Breast Screening Units from 1996 to 1998 joined the Million Women Study by completing a questionnaire before screening and were followed for their screening outcome. RESULTS Overall, 399 (0.5%) participants were diagnosed with breast cancer and 2,629 (3.0%) had false positive recall. Compared to never users of HRT, the adjusted relative risk (95% CI) of false positive recall was: 1.62 (1.43-1.83), 1.80 (1.62-2.01) and 0.76 (0.52-1.10) in current users of oestrogen-only HRT, oestrogen-progestagen HRT and tibolone, respectively (p (heterogeneity) < 0.0001); 1.65 (1.43-1.91), 1.49 (1.22-1.81) and 2.11 (1.45-3.07) for current HRT used orally, transdermally or via an implant, respectively (p (heterogeneity) = 0.2); and 1.84 (1.67-2.04) and 1.75 (1.49-2.06) for sequential and continuous oestrogen-progestagen HRT, respectively (p (heterogeneity) = 0.6). The relative risk of false positive recall among current users appeared to increase with increasing time since menopause, but did not vary significantly according to any other factors examined, including duration of use, hormonal constituents, dose, whether single- or two-view screening was used, or the woman's personal characteristics. CONCLUSION Current use of oestrogen-only and oestrogen-progestagen HRT, but not tibolone, increases the risk of false positive recall at screening.
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Affiliation(s)
- Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia
| | - Gillian Reeves
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Valerie Beral
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Diana Bull
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Barbara Crossley
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Moya Simmonds
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Elizabeth Hilton
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Stephen Bailey
- Breast Screening Service, Princess of Wales Community Hospital, Stourbridge Road, Bromsgrove B61 0BB, UK
| | - Nigel Barrett
- West of London Breast Screening Service, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Peter Briers
- Gloucestershire Breast Screening Service, Linton House, Thirlestaine Road, Cheltenham, Glos GL53 7AS, UK
| | - Ruth English
- The Breast Care Unit, Oxford Radcliffe Hospital NHS Trust, The Churchill Hospital, Old Road, Headington, Oxford OX3 7JH, UK
| | - Alan Jackson
- Patricia Massey Breast Screening Unit, Queen Alexandra Hospital, Cosham, Portsmouth, Hants PO6 3LY, UK
| | - Elizabeth Kutt
- Avon Breast Screening, Central Health Clinic, Tower Hill, Bristol BS2 0JD, UK
| | - Janet Lavelle
- North Lancashire Breast Screening Service, Royal Lancaster Infirmary, Ashton Court, Lancaster LA1 4GG, UK
| | - Linda Rockall
- The West Sussex Breast Screening Service, Worthing Hospital, Park Avenue, Worthing, West Sussex BN11 2DH, UK
| | - Matthew G Wallis
- Breast Screening Unit, Coventry and Warwick Hospital, Stoney Stanton Road, Coventry CV1 4FH, UK
| | - Mary Wilson
- Greater Manchester Breast Screening Service, The Nightingale Centre, Withington Hospital, Nell Lane, Manchester M20 0PT, UK
| | - Julietta Patnick
- National Health Service Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
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Dite GS, Wark JD, Giles GG, English DR, McCredie MRE, Hopper JL. Is there overlap between the genetic determinants of mammographic density and bone mineral density? Cancer Epidemiol Biomarkers Prev 2005; 14:2266-8. [PMID: 16172242 DOI: 10.1158/1055-9965.epi-05-0279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mammographic density and bone mineral density, risk factors for breast cancer and osteoporotic fractures, respectively, are both thought to reflect cumulative exposure to estrogen and are highly heritable. We asked if there was overlap between the genes that explain their variances. We studied 63 monozygous and 71 dizygous female twin pairs ages 38 to 71 years (mean, 50 years). Absolute and percent mammographic densities were measured by a computer-assisted method, and bone mineral density was measured at the lumbar spine, femoral neck, and forearm by dual energy X-ray absorptiometry. After adjusting for age, height, and weight, the within-person and cross-trait cross-twin correlations between the mammographic density and bone mineral density measures were between -0.09 and 0.16 (SEs, 0.07-0.09) and independent of zygosity (all P > 0.05). We conclude that there is little, if any, overlap between the genetic or environmental determinants of disease risk associated with these traits.
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Affiliation(s)
- Gillian S Dite
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Carlton, VIC, Australia
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McTiernan A, Martin CF, Peck JD, Aragaki AK, Chlebowski RT, Pisano ED, Wang CY, Brunner RL, Johnson KC, Manson JE, Lewis CE, Kotchen JM, Hulka BS. Estrogen-plus-progestin use and mammographic density in postmenopausal women: Women's Health Initiative randomized trial. J Natl Cancer Inst 2005; 97:1366-76. [PMID: 16174858 DOI: 10.1093/jnci/dji279] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased mammographic density reduces the sensitivity of screening mammography, is associated with increased breast cancer risk, and may be hormone related. We assessed the effect of estrogen-plus-progestin therapy on mammographic density. METHODS In a racially and ethnically diverse ancillary study of the Women's Health Initiative, we examined data from 413 postmenopausal women who had been randomly assigned to receive daily combined conjugated equine estrogens (0.625 mg) plus medroxyprogesterone acetate (i.e., progestin; 2.5 mg) (n = 202) or daily placebo (n = 211). We assessed the effect of estrogen plus progestin on measured mammographic percent density and abnormal findings over a 1-year and 2-year period. All tests of statistical significance were two-sided and were based on F tests or t tests from mixed-effects models. RESULTS Mean mammographic percent density increased by 6.0% at year 1, compared with baseline, in the estrogen-plus-progestin group but decreased by 0.9% in the placebo group (difference = 6.9%, 95% confidence interval [CI] = 5.3% to 8.5%; P < .001). The mean changes in mammographic density persisted but were attenuated slightly after 2 years, with an absolute increase of 4.9% in the estrogen-plus-progestin group and a decrease of 0.8% in the placebo group (difference = 5.7%, 95% CI = 4.3% to 7.3%; P < .001). These effects were consistent across racial/ethnic groups but were higher among women aged 70-79 years in the estrogen-plus-progestin group (mean increase at year 1 = 11.6%) than in the placebo group (mean decrease at year 1 = 0.1%) (difference of the means = 11.7%, 95% CI = 8.2% to 15.4%; P < .001, comparing across age groups). At year 1, women who were adherent to treatment in the estrogen-plus-progestin group had a mean increase in density of 7.7% (95% CI = 5.9% to 9.5%), and women in the placebo group had a mean decrease in density of 1.1% (95% CI = 0.3% to 1.9%). Use of estrogen plus progestin was associated with an increased risk of having an abnormal mammogram at year 1 (relative risk = 3.9, 95% CI = 1.5 to 10.2; P = .003), compared with placebo, that was not explained by an increase in density. CONCLUSIONS Use of up to 2 years of estrogen plus progestin was associated with increases in mammographic density.
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Affiliation(s)
- Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98019, USA.
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Aiello EJ, Tworoger SS, Yasui Y, Stanczyk FZ, Potter J, Ulrich CM, Irwin M, McTiernan A. Associations among circulating sex hormones, insulin-like growth factor, lipids, and mammographic density in postmenopausal women. Cancer Epidemiol Biomarkers Prev 2005; 14:1411-7. [PMID: 15941949 DOI: 10.1158/1055-9965.epi-04-0920] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Hormone therapy use has been positively associated with mammographic density in several studies. However, few studies have examined the association between endogenous hormone levels and mammographic density. Therefore, we evaluated the relationship of endogenous sex hormones, insulin-like growth factor (IGF), and lipids with mammographic density in 88 overweight, postmenopausal women not taking hormone therapy. METHODS Percent density and dense area were evaluated as continuous measures using a computer-assisted program. We used multiple linear regression to evaluate the associations of sex hormones, IGF, and cholesterol with mammographic density, adjusting for confounders, including adiposity. We evaluated stratification by history of hormone therapy use (former versus never) and hormone therapy latency (<5 versus > or = 5 years). RESULTS Among former hormone therapy users, mammographic density was inversely associated with circulating levels of estrone (P = 0.01), estradiol (P = 0.003), free estradiol (P = 0.004), testosterone (P = 0.04), free testosterone (P = 0.02), androstenedione (P < 0.001), dehydroepiandrosterone (P = 0.01), and the ratio of IGF-I to its binding protein (IGF-I/IGFBP-3; P = 0.04). We found similar associations when we limited the analyses to women who had used hormone therapy within the past 5 years. We also noted positive associations of mammographic density with total cholesterol (P = 0.03) and low-density lipoprotein (P = 0.03) among former hormone therapy users. No associations were noted among women who had never used hormone therapy. CONCLUSIONS These results suggest that there is an inverse relationship between endogenous sex hormones and mammographic density in postmenopausal women among former users of hormone therapy. This is not consistent with the hormone therapy literature and should be confirmed in larger studies.
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Affiliation(s)
- Erin J Aiello
- Center for Health Studies, Group Health Cooperative, Seattle, Washington, USA
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Harvey JA, Bovbjerg VE, Smolkin ME, Williams MB, Petroni GR. Evaluating hormone therapy-associated increases in breast density comparison between reported and simultaneous assignment of BI-RADS categories, visual assessment, and quantitative analysis. Acad Radiol 2005; 12:853-62. [PMID: 16039539 DOI: 10.1016/j.acra.2005.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 04/04/2005] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Changes in breast density, which are commonly associated with hormone replacement therapy (HRT) use, may imply changes in breast cancer risk. This study explores the ability of different methods to detect hormone replacement therapy (HRT)-associated increases in breast density. MATERIALS AND METHODS Between 1997 and 2001, 51 postmenopausal women were reported to have HRT-associated increases in breast density at our institution. Twenty postmenopausal women not reported to have an increase in density during the same period were selected as controls. Mammograms from date of report and earlier comparison were used. Breast Imaging Reporting and Data System (BI-RADS) density categories from both dates were obtained from the mammography report. Mammograms were reviewed at separate time points and density changes evaluated by assigning BI-RADS density categories, visual assessment, and computer-assisted quantitative analysis. RESULTS Mammogram reports were not available for two patients. The remaining 49 women with reported HRT increases in density were included. Reported BI-RADS categories resulted in detection of 57%, simultaneous BI-RADS assignment in 61%, visual assessment in 100%, and quantitative assessment in 94% of women with HRT-associated increases in density. Reported BI-RADS category change was the only method that resulted in false-positive increases in density for control patients. Minimal HRT associated increases in density were the most difficult to detect, with 90% of these 21 cases not detected by simultaneous BI-RADS category assignment and 3 cases not detected by quantitative methods when defined as an increase of at least 5%. CONCLUSION Visual and quantitative assessment best identified women with HRT-associated increases in density, including those with minimal increases. Simultaneous assignment of BI-RADS categories was considerably better than use of reported BI-RADS categories. This information may be helpful in guiding research design of studies evaluating changes in density from the HRT use.
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Affiliation(s)
- Jennifer A Harvey
- Department of Radiology, Box 800170, University of Virginia, Charlottesville, VA, USA.
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Barnabei VM, Cochrane BB, Aragaki AK, Nygaard I, Williams RS, McGovern PG, Young RL, Wells EC, O'Sullivan MJ, Chen B, Schenken R, Johnson SR. Menopausal Symptoms and Treatment-Related Effects of Estrogen and Progestin in the Womenʼs Health Initiative. Obstet Gynecol 2005; 105:1063-73. [PMID: 15863546 DOI: 10.1097/01.aog.0000158120.47542.18] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the effects of estrogen plus progestin (E+P) therapy on menopausal symptoms, vaginal bleeding, gynecologic surgery rates, and treatment-related adverse effects in postmenopausal women. METHODS Randomized, double-blind, placebo-controlled trial of 16,608 postmenopausal women, ages 50-79 (mean +/- standard deviation 63.3 +/- 7.1) years, with intact uterus, randomized to one tablet per day containing 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (n = 8,506) or placebo (n = 8,102), and followed for a mean of 5.6 years. Change in symptoms and treatment-related effects were analyzed at year 1 in all participants. Bleeding and gynecologic surgery rates were analyzed through study close-out. RESULTS Baseline symptoms did not differ between the treatment groups. More women assigned to E+P than placebo reported relief of hot flushes (85.7% versus 57.7%, respectively; odds ratio 4.40; 95% confidence interval 3.40-5.71), night sweats (77.6% versus 57.4%; 2.58; 2.04-3.26), vaginal or genital dryness (74.1% versus 54.6%; 2.40; 1.90-3.02), joint pain or stiffness (47.1% versus 38.4%; 1.43; 1.24-1.64), and general aches or pains (49.3% versus 43.7%; 1.25; 1.08-1.44). Women asymptomatic at baseline who were assigned to E+P more often developed breast tenderness (9.3% versus 2.4%, respectively; 4.26; 3.59-5.04), vaginal or genital discharge (4.1% versus 1.0%; 4.47; 3.44-5.81), vaginal or genital irritation (4.2% versus 2.8%; 1.52; 1.27-1.81), and headaches (5.8% versus 4.7%; 1.26; 1.08-1.46) than women on placebo. Estrogen plus progestin treatment prevented the onset of new musculoskeletal symptoms. Vaginal bleeding was reported by 51% of women on E+P and 5% of women on placebo at 6 months; most bleeding was reported as spotting. Gynecologic surgeries (hysterectomy and dilation and curettage) were performed more frequently in women assigned to E+P (3.1% versus 2.5% for hysterectomy, hazard ratio = 1.23, P = .026; 5.4% versus 2.4% for dilation and curettage, hazard ratio = 2.23, P < .001). CONCLUSION Estrogen plus progestin relieved some menopausal symptoms, such as vasomotor symptoms and vaginal or genital dryness, but contributed to treatment-related effects, such as bleeding, breast tenderness, and an increased likelihood of gynecologic surgery.
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Affiliation(s)
- Vanessa M Barnabei
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Lord SJ, Mack WJ, Van Den Berg D, Pike MC, Ingles SA, Haiman CA, Wang W, Parisky YR, Hodis HN, Ursin G. Polymorphisms in genes involved in estrogen and progesterone metabolism and mammographic density changes in women randomized to postmenopausal hormone therapy: results from a pilot study. Breast Cancer Res 2005; 7:R336-44. [PMID: 15987428 PMCID: PMC1143576 DOI: 10.1186/bcr999] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Revised: 12/06/2004] [Accepted: 01/13/2005] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Mammographic density is a strong independent risk factor for breast cancer, and can be modified by hormonal exposures. Identifying genetic variants that determine increases in mammographic density in hormone users may be important in understanding hormonal carcinogenesis of the breast. METHODS We obtained mammograms and DNA from 232 postmenopausal women aged 45 to 75 years who had participated in one of two randomized, double-blind clinical trials with estrogen therapy (104 women, taking 1 mg/day of micronized 17beta-estradiol, E2), combined estrogen and progestin therapy (34 women, taking 17beta-estradiol and 5 mg/day of medroxyprogesterone acetate for 12 days/month) or matching placebos (94 women). Mammographic percentage density (MPD) was measured on baseline and 12-month mammograms with a validated computer-assisted method. We evaluated polymorphisms in genes involved in estrogen metabolism (catechol-O-methyltransferase (COMT (Val158Met)), cytochrome P450 1B1 (CYP1B1 (Val432Leu)), UDP-glucuronosyltransferase 1A1 (UGT1A1 (<7/>or= 7 TA repeats))) and progesterone metabolism (aldo-keto reductase 1C4 (AKR1C4 (Leu311Val))) with changes in MPD. RESULTS The adjusted mean change in MPD was +4.6% in the estrogen therapy arm and +7.2% in the combined estrogen and progestin therapy arm, compared with +0.02% in the placebo arm (P = 0.0001). None of the genetic variants predicted mammographic density changes in women using estrogen therapy. Both the AKR1C4 and the CYP1B1 polymorphisms predicted mammographic density change in the combined estrogen and progestin therapy group (P < 0.05). In particular, the eight women carrying one or two low-activity AKR1C4 Val alleles showed a significantly greater increase in MPD (16.7% and 29.3%) than women homozygous for the Leu allele (4.0%). CONCLUSION Although based on small numbers, these findings suggest that the magnitude of the increase in mammographic density in women using combined estrogen and progestin therapy may be greater in those with genetically determined lower activity of enzymes that metabolize estrogen and progesterone.
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Affiliation(s)
- Sarah J Lord
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Malcolm C Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sue A Ingles
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wei Wang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yuri R Parisky
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Howard N Hodis
- Atherosclerosis Research Unit, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giske Ursin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Nutrition, University of Oslo, Norway
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Habel LA, Dignam JJ, Land SR, Salane M, Capra AM, Julian TB. Mammographic density and breast cancer after ductal carcinoma in situ. J Natl Cancer Inst 2004; 96:1467-72. [PMID: 15467036 PMCID: PMC2935469 DOI: 10.1093/jnci/djh260] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Women with ductal carcinoma in situ (DCIS) are at substantially increased risk for a second breast cancer, but few strong predictors for these subsequent tumors have been identified. We used Cox regression modeling to examine the association between mammographic density at diagnosis of DCIS of 504 women from the National Surgical Adjuvant Breast and Bowel Project B-17 trial and risk of subsequent breast cancer events. In this group of patients, mostly 50 years old or older, approximately 6.6% had breasts categorized as highly dense (i.e., > or =75% of the breast occupied by dense tissue). After adjusting for treatment with radiotherapy, age, and body mass index, women with highly dense breasts had 2.8 (95% confidence interval [CI] = 1.3 to 6.1) times the risk of subsequent breast cancer (DCIS or invasive), 3.2 (95% CI = 1.2 to 8.5) times the risk of invasive breast cancer, and 3.0 (95% CI = 1.2 to 7.5) times the risk of any ipsilateral breast cancer, compared with women with less than 25% of the breast occupied by dense tissue. Our results provide initial evidence that the risk of second breast cancers may be increased among DCIS patients with highly dense breasts.
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MESH Headings
- Adult
- Aged
- Breast/pathology
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Confounding Factors, Epidemiologic
- Female
- Humans
- Incidence
- Mammography
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Proportional Hazards Models
- Randomized Controlled Trials as Topic
- Risk Assessment
- Risk Factors
- Single-Blind Method
- United States/epidemiology
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Affiliation(s)
- Laurel A Habel
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA.
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Abstract
The main risks and other adverse consequences from screening mammography include discomfort from breast compression, patient recall for additional imaging, and false positive biopsies. Although these risks affect a larger number of women than those who benefit from screening, the risks are less consequential than the life-sparing benefits from early detection. Radiation risk, even for multiple screenings, is negligible at current mammography doses. Anxiety before screening or resulting from supplementary imaging work-up, short-term follow-up, cyst aspiration, and biopsy has not dampened the enthusiasm of most women for the value of early detection.
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Affiliation(s)
- Stephen A Feig
- Department of Radiology, The Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA.
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Kutlu T, Fiçicioğlu C, Başaran T, Başaran E, Topaloğlu T. Mammographic breast density changes after 1 year of tibolone use. Maturitas 2004; 48:133-6. [PMID: 15172087 DOI: 10.1016/j.maturitas.2003.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2002] [Revised: 06/29/2003] [Accepted: 08/07/2003] [Indexed: 11/19/2022]
Abstract
UNLABELLED Hormone replacement therapy (HRT) is widely used with a large variety of regimens and medications. For each of these regimens the goal is the same but there is always a fear about side effects, especially on breast. Mammographic screening is a standard tool for all women receiving hormone replacement therapy. Breast density is very important, because it interferes with the sensitivity of the evaluation and it is also a predictor of malignity. OBJECTIVE We planned a study to investigate the effects of tibolone on mammographic breast density. DESIGN AND METHODS We studied 70 postmenopausal women who started tibolone therapy (2.5 mg per day) after initial mammography and blood samples taken for biochemical examinations. None of the women used any hormone replacement therapy before. Eleven of them either discontinued the therapy or lost contact. After 1 year, we evaluated 59 women by mammographic status, using Wolfe classification. Mammographies were analyzed by two independent radiologists. RESULTS Mammographies of 59 women were compared with the initial ones. While in the low density patterns, there was a slight increase (15%; P < 0.05); in the higher density groups, there was a decrease of 25% as observed by one radiologist, and 16% according to the other (P < 0.05). None of the women had a diffuse, high density pattern. There was no statistically significant inter-observer variation between two radiologists (P < 0.05). CONCLUSIONS Wolfe classification allows easy interpretation of mammographic evaluation and the results are reproducible. Tibolone, as a tissue-specific steroid, does not have an estrogenic effect on breast cells. We found that it might limit, even reverse breast density increase, especially in postmenopausal women with high breast density.
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Affiliation(s)
- Tayfun Kutlu
- Zeynep Kamil Hospital, Istanbul, Selimiye, Kavak Iskele Cad 16/7 Usküdar, Turkey.
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49
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Boutet G, Boisserie-Lacroix M, Trillaud H. Thérapeutiques hormonales de la ménopause : impact sur la densité mammographique. ACTA ACUST UNITED AC 2004; 85:1673-86. [PMID: 15669560 DOI: 10.1016/s0221-0363(04)97731-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Whether qualitative-classified or quantitative-measured, mammographic density, which changes according to physiological variations, is nowadays commonly recognized as a factor increasing the relative risk of breast cancer. The present review aims at clarifying the impact of menopausal hormonal therapies on mammographic density. Neither Tibolone nor Raloxifene seem to have any negative impact on mammographic density. In some instances, oestrogens-progestin hormonal replacement therapies may increase mammographic density and thus reduce sensitivity and specificity of screening mammograms. Shorter intervals between mammographies combined with additional physical examination and breast ultrasonography appear to be the best way to reduce interval cancers.
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Affiliation(s)
- G Boutet
- Cabinet de Gynécologie, 28 rue de Norvège 17000 La Rochelle
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Warren R. Hormones and mammographic breast density. Maturitas 2004; 49:67-78. [PMID: 15351098 DOI: 10.1016/j.maturitas.2004.06.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Revised: 04/25/2004] [Accepted: 06/10/2004] [Indexed: 11/17/2022]
Abstract
Mammographic density reveals information about the hormonal environment along with the heritability in which breast cancer develops. This is made possible by the widespread use of population screening by mammography. Increasingly this is an important observation not just for population studies, which reveal disease determinants, but also for the individual. Density reveals the effect of the intrinsic hormonal environment and its background genetics, and also the effect of pharmaceuticals--agents used for disease control and prevention and hormone replacement therapy (HRT) used for well-being around the menopause. Increasingly this focus on the individual will need methods of measurement of density that can be monitored with greater accuracy than the widely used BI-RADS 4 categories. For this purpose studies are under way to measure volume of dense tissue as a continuous variable. In due course, measurement of density will be used as a biomarker of risk, employed in risk models and to monitor interventions. Before this can happen more knowledge will be needed of the change occurring naturally through the menopause and the differences between individuals. This will need specific study backed up with detailed information about the patient on large numbers of women and their mammograms. Currently the widespread use of HRT has increased the prevalence of the dense patterns and potentially may adversely affect the effectiveness of mammographic screening programmes. There is a large literature recording this from which we see that combined continuous preparations of oestrogen progestin are more likely to cause increased density than oestrogen alone or tibolone. Breast density, measured more accurately, has the potential to be an important adjunct to risk estimation and to monitor interventions for breast cancer prevention with pharmaceuticals (such as SERMS) and by change in lifestyle behaviours.
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Affiliation(s)
- Ruth Warren
- Department of Radiology, Addenbrooke's Hospital, Cambridge Breast Unit, Box 97, Cambridge CB22QQ, UK.
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