Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use

Karla Kerlikowske, Andrea J. Cook, Diana S M Buist, Steve R. Cummings, Celine Vachon, Pamela Vacek, Diana L Miglioretti

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Purpose: We determined whether the association between breast density and breast cancer risk and cancer severity differs according to menopausal status and postmenopausal hormone therapy (HT) use. Methods: We collected data on 587,369 women who underwent 1,349,027 screening mammography examinations; 14,090 women were diagnosed with breast cancer. We calculated 5-year breast cancer risk from a survival model for subgroups of women classified by their Breast Imaging Reporting and Data System (BIRADS) breast density, age, menopausal status, and current HT use, assuming a body mass index of 25 kg/m2. Odds of advanced (ie, IIb, III, IV) versus early (ie, I, IIa) stage invasive cancer was calculated according to BIRADS density. Results: Breast cancer risk was low among women with low density (BIRADS-1): women age 55 to 59 years, 5-year risk was 0.8% (95% CI, 0.6 to 0.9%) for non-HT users and 0.9% (95% CI, 0.7% to 1.1%) for estrogen and estrogen plus progestin users. Breast cancer risk was high among women with very high density (BIRADS-4), particularly estrogen plus progestin users: women age 55 to 59 years, 5-year risk was 2.4% (95% CI, 2.0% to 2.8%) for non-HT users, 3.0% (95% CI, 2.6% to 3.5%) for estrogen users, and 4.2% (95% CI, 3.7% to 4.6%) for estrogen plus progestin users. Advanced-stage breast cancer risk was increased 1.7-fold for postmenopausal HT users who had very high density (BIRADS-4) compared to those with average density (BIRADS-2). Conclusion: Postmenopausal women with high breast density are at increased risk of breast cancer and should be aware of the added risk of taking HT, especially estrogen plus progestin.

Original languageEnglish (US)
Pages (from-to)3830-3837
Number of pages8
JournalJournal of Clinical Oncology
Volume28
Issue number24
DOIs
StatePublished - Aug 20 2010
Externally publishedYes

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Menopause
Information Systems
Hormones
Breast Neoplasms
Estrogens
Progestins
Therapeutics
Breast
Breast Density
Mammography
Risk-Taking
Neoplasms
Body Mass Index
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use. / Kerlikowske, Karla; Cook, Andrea J.; Buist, Diana S M; Cummings, Steve R.; Vachon, Celine; Vacek, Pamela; Miglioretti, Diana L.

In: Journal of Clinical Oncology, Vol. 28, No. 24, 20.08.2010, p. 3830-3837.

Research output: Contribution to journalArticle

Kerlikowske, K, Cook, AJ, Buist, DSM, Cummings, SR, Vachon, C, Vacek, P & Miglioretti, DL 2010, 'Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use', Journal of Clinical Oncology, vol. 28, no. 24, pp. 3830-3837. https://doi.org/10.1200/JCO.2009.26.4770
Kerlikowske K, Cook AJ, Buist DSM, Cummings SR, Vachon C, Vacek P et al. Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use. Journal of Clinical Oncology. 2010 Aug 20;28(24):3830-3837. https://doi.org/10.1200/JCO.2009.26.4770
Kerlikowske, Karla ; Cook, Andrea J. ; Buist, Diana S M ; Cummings, Steve R. ; Vachon, Celine ; Vacek, Pamela ; Miglioretti, Diana L. / Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 24. pp. 3830-3837.
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abstract = "Purpose: We determined whether the association between breast density and breast cancer risk and cancer severity differs according to menopausal status and postmenopausal hormone therapy (HT) use. Methods: We collected data on 587,369 women who underwent 1,349,027 screening mammography examinations; 14,090 women were diagnosed with breast cancer. We calculated 5-year breast cancer risk from a survival model for subgroups of women classified by their Breast Imaging Reporting and Data System (BIRADS) breast density, age, menopausal status, and current HT use, assuming a body mass index of 25 kg/m2. Odds of advanced (ie, IIb, III, IV) versus early (ie, I, IIa) stage invasive cancer was calculated according to BIRADS density. Results: Breast cancer risk was low among women with low density (BIRADS-1): women age 55 to 59 years, 5-year risk was 0.8{\%} (95{\%} CI, 0.6 to 0.9{\%}) for non-HT users and 0.9{\%} (95{\%} CI, 0.7{\%} to 1.1{\%}) for estrogen and estrogen plus progestin users. Breast cancer risk was high among women with very high density (BIRADS-4), particularly estrogen plus progestin users: women age 55 to 59 years, 5-year risk was 2.4{\%} (95{\%} CI, 2.0{\%} to 2.8{\%}) for non-HT users, 3.0{\%} (95{\%} CI, 2.6{\%} to 3.5{\%}) for estrogen users, and 4.2{\%} (95{\%} CI, 3.7{\%} to 4.6{\%}) for estrogen plus progestin users. Advanced-stage breast cancer risk was increased 1.7-fold for postmenopausal HT users who had very high density (BIRADS-4) compared to those with average density (BIRADS-2). Conclusion: Postmenopausal women with high breast density are at increased risk of breast cancer and should be aware of the added risk of taking HT, especially estrogen plus progestin.",
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