Breast Cancer Risk by Breast Density, Menopause, and Postmenopausal Hormone Therapy Use

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, and Diana L. Miglioretti

J Clin Oncol 28:3830-3837, 2010
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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

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes

Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes
Marie L. De Bruin, Judith Sparidans, Mars B. van't Veer, Evert M. Noordijk, Marieke W.J. Louwman, Josée M. Zijlstra, Hendrik van den Berg, Nicola S. Russell, Annegien Broeks, Margreet H.A. Baaijens, Berthe M.P. Aleman, Flora E. van Leeuwen
Journal of Clinical Oncology, Vol 27, No 26 (September 10), 2009: pp. 4239-4246

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Reduction of radiation volume appears to decrease the risk for BC after HL. In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for BC

Assessment of the Accuracy of the Gail Model in Women With Atypical Hyperplasia

Assessment of the Accuracy of the Gail Model in Women With Atypical Hyperplasia
V. Shane Pankratz, Lynn C. Hartmann, Amy C. Degnim, Robert A. Vierkant, Karthik Ghosh, Celine M. Vachon, Marlene H. Frost, Shaun D. Maloney, Carol Reynolds, and Judy C. Boughey
J Clin Oncol 26:5374-5379, 2008

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The Gail model significantly underestimates the risk of breast cancer in women with atypia. Its ability to discriminate women with atypia into those who did and did not develop breast cancer is limited. Health care professionals should be cautious when using the Gail model to counsel individual patients with atypia