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Tamoxifen-induced reduction in mammographic density and breast cancer risk reduction : A nested case-control study

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Cuzick, Jack, Warwick, Jane, Pinney, Elizabeth, Duffy, Stephen W., Cawthorn, Simon, Howell, Anthony, Forbes, John F. and Warren, R. M. L. (2011) Tamoxifen-induced reduction in mammographic density and breast cancer risk reduction : A nested case-control study. Journal National Cancer Institute, Volume 103 (Number 9). pp. 744-752. doi:10.1093/jnci/djr079

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Official URL: http://dx.doi.org/10.1093/jnci/djr079

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Abstract

Background: Mammographic breast density is a strong risk factor for breast cancer. Tamoxifen, which reduces the risk of breast cancer in women at high risk, also reduces mammographic breast density. However, it is not known if tamoxifen-induced reductions in breast density can be used to identify women who will benefit the most from prophylactic treatment with this drug.

Methods: We conducted a nested case–control study within the first International Breast Cancer Intervention Study, a randomized prevention trial of tamoxifen vs placebo. Mammographic breast density was assessed visually and expressed as a percentage of the total breast area in 5% increments. Case subjects were 123 women diagnosed with breast cancer at or after their first follow-up mammogram, which took place 12–18 months after trial entry, and control subjects were 942 women without breast cancer. Multivariable logistic regression was used to adjust for other risk factors. All statistical tests were two-sided.

Results: In the tamoxifen arm, 46% of women had a 10% or greater reduction in breast density at their 12- to 18-month mammogram. Compared with all women in the placebo group, women in the tamoxifen group who experienced a 10% or greater reduction in breast density had 63% reduction in breast cancer risk (odds ratio = 0.37, 95% confidence interval = 0.20 to 0.69, P = .002), whereas those who took tamoxifen but experienced less than a 10% reduction in breast density had no risk reduction (odds ratio = 1.13, 95% confidence interval = 0.72 to 1.77, P = .60). In the placebo arm, there was no statistically significant difference in breast cancer risk between subjects who experienced less than a 10% reduction in mammographic density and subjects who experienced a greater reduction.

Conclusion: The 12- to 18-month change in mammographic breast density is an excellent predictor of response to tamoxifen in the preventive setting.

Item Type: Journal Article
Alternative Title:
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Journal or Publication Title: Journal National Cancer Institute
Publisher: Oxford University Press
ISSN: 1460-2105
Official Date: 2011
Dates:
DateEvent
2011Published
Volume: Volume 103
Number: Number 9
Page Range: pp. 744-752
DOI: 10.1093/jnci/djr079
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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