Parallel assessment of the impact of different hormone replacement therapies on breast density by radiologist- and computer-based analyses of mammograms

Pettersen, P.C.; Raundahl, Jakob; Loog, Marco; Nielsen, Mads; Tankó, László B.; Christiansen, Claus

doi:10.1080/13697130801930385

Cited by 14 publications

(11 citation statements)

References 27 publications

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“…Tamoxifen, which reduces the incidence of invasive breast cancer in high-risk women, is known to reduce breast density (14, 27). Postmenopausal hormone replacement therapy, which is associated with an increased incidence of invasive breast cancer, is associated with a modest increase in breast density (10, 11, 28–30). In view of these associations and the reductions in incidence of CLB cancer observed in adjuvant AI trials, we hypothesized that adjuvant anastrozole would reduce CLB density.…”

Section: Discussionmentioning

confidence: 99%

Changes in Breast Density and Circulating Estrogens in Postmenopausal Women Receiving Adjuvant Anastrozole

Prowell

Blackford

Byrne

et al. 2011

Cancer Prevention Research

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Factors associated with an increased risk of breast cancer include prior breast cancer, high circulating estrogens, and increased breast density. Adjuvant aromatase inhibitors are associated with a reduction in incidence of contralateral breast cancer. We conducted a prospective, single-arm, single-institution study to determine whether use of anastrozole is associated with changes in contralateral breast density and circulating estrogens. Eligible patients included postmenopausal women with hormone receptor-positive early-stage breast cancer who had completed local therapy, had an intact contralateral breast, and were recommended an aromatase inhibitor as their only systemic therapy. Participants received anastrozole 1 mg daily for 12 months on study. We assessed contralateral breast density and serum estrogens at baseline, 6, and 12 months. The primary endpoint was change in contralateral percent breast density from baseline to 12 months. Secondary endpoints included change in serum estrone sulfate from baseline to 12 months. Fifty-four patients were accrued. At 12 months, compared with baseline, there was a nonstatistically significant reduction in breast density (mean change: −16%, 95% CI: −30 to 2, P = 0.08) and a significant reduction in estrone sulfate (mean change: −93%, 95% CI: −94 to −91, P < 0.001). Eighteen women achieved 20% or greater relative reduction in contralateral percent density at 12 months compared with baseline; however, no measured patient or disease characteristics distinguished these women from the overall population. Large trials are required to provide additional data on the relationship between aromatase inhibitors and breast density and, more importantly, whether observed changes in breast density correlate with meaningful disease-specific outcomes.

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Section: Discussionmentioning

confidence: 99%

Changes in Breast Density and Circulating Estrogens in Postmenopausal Women Receiving Adjuvant Anastrozole

Prowell

Blackford

Byrne

et al. 2011

Cancer Prevention Research

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“…Of 60 hits, only six articles were suitable for this review [9][10][11][12][13][14] (Table 1). Of those, four were subgroup analyses of the placebo-controlled, randomized-controlled trial (PC-RCT) Postmenopausal Estrogen/Progestin Intervention (PEPI) trial [9][10][11][12] , one was a post-hoc analysis of two PC-RCTs 13 and another one a head-to-head RCT 14 . Sample size ranged from 77 14 to 571 10 postmenopausal women.…”

Section: Breast Densitymentioning

confidence: 99%

“…MHT regimens comprised oral conjugated equine estrogens (CEE) at 0.625 mg/day (o-CEE), o-CEE at 0.625 mg/day combined with oral medroxyprogesterone acetate (o-MPA) at 10 mg/day for 12 days per month (o-CEE þ o-seqMPA), o-CEE at 0.625 mg/day combined with o-MPA at 2.5 mg/day (o-CEE þ o-contMPA), and o-CEE at 0.625 mg/day combined with oral MP (o-MP) at 200 mg/day for 12 days per month (o-CEE þ o-contMP). The post-hoc analysis combined two Danish RCTs 13 comparing placebo to either an oral MHT or nasal-oral MHT regimen. The oral MHT regimen contained oral 17b-estradiol (o-E2) at 1 mg/day combined with trimegestone at 0.125 mg/day (o-E2 þ o-contTrimegestone), whereas the nasal-oral MHT contained either nasal E2 at 150 or 300 mg/day, respectively, combined with o-MP at 200 mg/day for 14 days per month in women with an intact uterus (n-E2 ± o-seqMP).…”

Section: Breast Densitymentioning

confidence: 99%

“…Mammographic density was assessed either categorically, e.g. by Breast Imaging Reporting and Data System (BI-RADS) grades 9,13,14 , or continuously, e.g. by computer-based mammographic percent density [10][11][12][13] .…”

Section: Breast Densitymentioning

confidence: 99%

“…by Breast Imaging Reporting and Data System (BI-RADS) grades 9,13,14 , or continuously, e.g. by computer-based mammographic percent density [10][11][12][13] . After 1 year of MHT within the PEPI trial, mammographic density was significantly increased by all estrogen-progestogen regimens but not by o-CEE or placebo [9][10][11] .…”

Section: Breast Densitymentioning

confidence: 99%

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The impact of micronized progesterone on breast cancer risk: a systematic review

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Postmenopausal women with an intact uterus using estrogen therapy should receive a progestogen for endometrial protection. The debate on bioidentical hormones including micronized progesterone has increased in recent years. Based on a systematic literature review on the impact of menopausal hormone therapy (MHT) containing micronized progesterone on the mammary gland, an international expert panel's recommendations are as follows: (1) estrogens combined with oral (approved) or vaginal (off-label use) micronized progesterone do not increase breast cancer risk for up to 5 years of treatment duration; (2) there is limited evidence that estrogens combined with oral micronized progesterone applied for more than 5 years are associated with an increased breast cancer risk; and (3) counseling on combined MHT should cover breast cancer risk - regardless of the progestogen chosen. Yet, women should also be counseled on other modifiable and non-modifiable breast cancer risk factors in order to balance the impact of combined MHT on the breast.

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Physical activity and mammographic breast density: a systematic review

Yaghjyan

Colditz

Wolin

2012

Breast Cancer Res Treat

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Parallel assessment of the impact of different hormone replacement therapies on breast density by radiologist- and computer-based analyses of mammograms

Cited by 14 publications

References 27 publications

Changes in Breast Density and Circulating Estrogens in Postmenopausal Women Receiving Adjuvant Anastrozole

Changes in Breast Density and Circulating Estrogens in Postmenopausal Women Receiving Adjuvant Anastrozole

The impact of micronized progesterone on breast cancer risk: a systematic review

Physical activity and mammographic breast density: a systematic review

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