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

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    Authors
    Brentnall, A. R.
    Warren, R.
    Harkness, E. F.
    Astley, Susan
    Wiseman, J.
    Fox, J.
    Fox, L.
    Eriksson, M.
    Hall, P.
    Cuzick, J.
    Evans, D Gareth R
    Howell, Anthony
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    Affiliation
    Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London,
    Issue Date
    2020
    
    Metadata
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    Abstract
    Background: A 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. Methods: Mammographic 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. Results: Analysis 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. Conclusions: All 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.
    Citation
    Brentnall AR, Warren R, Harkness EF, Astley SM, Wiseman J, Fox J, et al. Mammographic density change in a cohort of premenopausal women receiving tamoxifen for breast cancer prevention over 5 years. Breast Cancer Res. 2020;22(1):101.
    Journal
    Breast Cancer Research
    URI
    http://hdl.handle.net/10541/623358
    DOI
    10.1186/s13058-020-01340-4
    PubMed ID
    32993747
    Additional Links
    https://dx.doi.org/10.1186/s13058-020-01340-4
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1186/s13058-020-01340-4
    Scopus Count
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