Mammographic density change in a cohort of premenopausal women receiving tamoxifen for breast cancer prevention over 5 years

Breast Cancer Research

Adam R. Brentnall¹  Jack Cuzick¹  Per Hall²  Mikael Eriksson²  Ruth Warren³  Elaine F. Harkness⁴  Susan M. Astley⁵  Lynne Fox⁶  Jill Fox⁶  Julia Wiseman⁶  Anthony Howell⁷  D. Gareth Evans⁸ 

[1] Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, EC1M 6BQ, London, UK;Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;Department of Radiology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK;Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, M23 9LT, Manchester, UK;Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, M23 9LT, Manchester, UK;Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, M20 4BX, Manchester, UK;Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, M23 9LT, Manchester, UK;Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, M23 9LT, Manchester, UK;Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, M20 4BX, Manchester, UK;Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, Manchester, UK;Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, M23 9LT, Manchester, UK;Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, M20 4BX, Manchester, UK;NW Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, M13 9WL, Manchester, UK;Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK;

关键词: Tamoxifen;    Prevention;    Mammographic density;    Breast density change;   

DOI  :  10.1186/s13058-020-01340-4

来源: Springer

【 摘 要 】

BackgroundA decrease in breast density due to tamoxifen preventive therapy might indicate greater benefit from the drug. It is not known whether mammographic density continues to decline after 1 year of therapy, or whether measures of breast density change are sufficiently stable for personalised recommendations.MethodsMammographic density was measured annually over up to 5 years in premenopausal women with no previous diagnosis of breast cancer but at increased risk of breast cancer attending a family-history clinic in Manchester, UK (baseline 2010-2013). Tamoxifen (20 mg/day) for prevention was prescribed for up to 5 years in one group; the other group did not receive tamoxifen and were matched by age. Fully automatic methods were used on mammograms over the 5-year follow-up: three area-based measures (NN-VAS, Stratus, Densitas) and one volumetric (Volpara). Additionally, percentage breast density at baseline and first follow-up mammograms was measured visually. The size of density declines at the first follow-up mammogram and thereafter was estimated using a linear mixed model adjusted for age and body mass index. The stability of density change at 1 year was assessed by evaluating mean squared error loss from predictions based on individual or mean density change at 1 year.ResultsAnalysis used mammograms from 126 healthy premenopausal women before and as they received tamoxifen for prevention (median age 42 years) and 172 matched controls (median age 41 years), with median 3 years follow-up. There was a strong correlation between percentage density measures used on the same mammogram in both the tamoxifen and no tamoxifen groups (all correlation coeficients > 0.8). Tamoxifen reduced mean breast density in year 1 by approximately 17–25% of the inter-quartile range of four automated percentage density measures at baseline, and from year 2, it decreased further by approximately 2–7% per year. Predicting change at 2 years using individual change at 1 year was approximately 60–300% worse than using mean change at 1year.ConclusionsAll measures showed a consistent and large average tamoxifen-induced change in density over the first year, and a continued decline thereafter. However, these measures of density change at 1 year were not stable on an individual basis.

【 授权许可】

CC BY