Prognostic significance of mammographic density change after initiation of tamoxifen for ER-positive breast cancer

Sarah J. Nyante, Mark E. Sherman, Ruth M. Pfeiffer, Amy Berrington De Gonzalez, Louise A. Brinton, Erin J. Aiello Bowles, Robert N. Hoover, Andrew Glass, Gretchen L. Gierach

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: A prior analysis of postmenopausal breast cancer patients linked a decline in mammographic density (MD) following the initiation of tamoxifen treatment with improved survival, but excluded premenopausal women, for whom tamoxifen is the primary anti-endocrine therapy. Therefore, we evaluated change in MD after tamoxifen and breast cancer death among patients age 32 to 87 years. Methods: This case-control study included 349 estrogen receptor (ER)-positive breast cancer patients who were treated with tamoxifen at Kaiser Permanente Northwest (1990-2008): 97 who died from breast cancer (case patients) and 252 who did not (control patients), matched on age and year at diagnosis and disease stage. Percent MD in the unaffected breast was measured at baseline (mean six months before tamoxifen initiation) and follow-up (mean 12 months after initiation). Associations between change in MD and breast cancer death were estimated using conditional logistic regression. Results: Patients in the highest tertile of MD decline had a lower risk of breast cancer death when compared with women in the lowest tertile (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.22 to 0.88); results were similar after adjustment for baseline MD (OR = 0.49, 95% CI = 0.23 to 1.02). Reductions in death were observed only among patients in the middle and upper tertiles of baseline MD. Associations did not differ by age, tamoxifen use duration, estrogen and/or progestin use, body mass index, or receipt of chemotherapy or radiotherapy. Conclusion: These data suggest that younger and older ER-positive breast cancer patients who experience large reductions in MD following tamoxifen initiation have an improved prognosis.

Original languageEnglish (US)
Article numberdju425
JournalJournal of the National Cancer Institute
Volume107
Issue number3
DOIs
StatePublished - Mar 1 2015

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Tamoxifen
Estrogen Receptors
Breast Neoplasms
Odds Ratio
Confidence Intervals
Breast Density
Progestins
Case-Control Studies
Estrogens
Breast
Body Mass Index
Radiotherapy
Logistic Models
Drug Therapy
Survival
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Cancer Research

Cite this

Nyante, S. J., Sherman, M. E., Pfeiffer, R. M., Berrington De Gonzalez, A., Brinton, L. A., Aiello Bowles, E. J., ... Gierach, G. L. (2015). Prognostic significance of mammographic density change after initiation of tamoxifen for ER-positive breast cancer. Journal of the National Cancer Institute, 107(3), [dju425]. https://doi.org/10.1093/jnci/dju425

Prognostic significance of mammographic density change after initiation of tamoxifen for ER-positive breast cancer. / Nyante, Sarah J.; Sherman, Mark E.; Pfeiffer, Ruth M.; Berrington De Gonzalez, Amy; Brinton, Louise A.; Aiello Bowles, Erin J.; Hoover, Robert N.; Glass, Andrew; Gierach, Gretchen L.

In: Journal of the National Cancer Institute, Vol. 107, No. 3, dju425, 01.03.2015.

Research output: Contribution to journalArticle

Nyante, SJ, Sherman, ME, Pfeiffer, RM, Berrington De Gonzalez, A, Brinton, LA, Aiello Bowles, EJ, Hoover, RN, Glass, A & Gierach, GL 2015, 'Prognostic significance of mammographic density change after initiation of tamoxifen for ER-positive breast cancer', Journal of the National Cancer Institute, vol. 107, no. 3, dju425. https://doi.org/10.1093/jnci/dju425
Nyante, Sarah J. ; Sherman, Mark E. ; Pfeiffer, Ruth M. ; Berrington De Gonzalez, Amy ; Brinton, Louise A. ; Aiello Bowles, Erin J. ; Hoover, Robert N. ; Glass, Andrew ; Gierach, Gretchen L. / Prognostic significance of mammographic density change after initiation of tamoxifen for ER-positive breast cancer. In: Journal of the National Cancer Institute. 2015 ; Vol. 107, No. 3.
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abstract = "Background: A prior analysis of postmenopausal breast cancer patients linked a decline in mammographic density (MD) following the initiation of tamoxifen treatment with improved survival, but excluded premenopausal women, for whom tamoxifen is the primary anti-endocrine therapy. Therefore, we evaluated change in MD after tamoxifen and breast cancer death among patients age 32 to 87 years. Methods: This case-control study included 349 estrogen receptor (ER)-positive breast cancer patients who were treated with tamoxifen at Kaiser Permanente Northwest (1990-2008): 97 who died from breast cancer (case patients) and 252 who did not (control patients), matched on age and year at diagnosis and disease stage. Percent MD in the unaffected breast was measured at baseline (mean six months before tamoxifen initiation) and follow-up (mean 12 months after initiation). Associations between change in MD and breast cancer death were estimated using conditional logistic regression. Results: Patients in the highest tertile of MD decline had a lower risk of breast cancer death when compared with women in the lowest tertile (odds ratio [OR] = 0.44, 95{\%} confidence interval [CI] = 0.22 to 0.88); results were similar after adjustment for baseline MD (OR = 0.49, 95{\%} CI = 0.23 to 1.02). Reductions in death were observed only among patients in the middle and upper tertiles of baseline MD. Associations did not differ by age, tamoxifen use duration, estrogen and/or progestin use, body mass index, or receipt of chemotherapy or radiotherapy. Conclusion: These data suggest that younger and older ER-positive breast cancer patients who experience large reductions in MD following tamoxifen initiation have an improved prognosis.",
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AU - Brinton, Louise A.

AU - Aiello Bowles, Erin J.

AU - Hoover, Robert N.

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