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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, Adam R.; orcid: 0000-0001-6327-4357
    Warren, Ruth
    Harkness, Elaine F.
    Astley, Susan M.
    Wiseman, Julia
    Fox, Jill
    Fox, Lynne
    Eriksson, Mikael
    Hall, Per
    Cuzick, Jack
    Evans, D. Gareth
    Howell, Anthony; email: Anthony.Howell@manchester.ac.uk
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    Publication Date
    2020-09-29
    Submitted date
    2020-02-17
    
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    Abstract
    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
    Breast Cancer Research, volume 22, issue 1, page 101
    Publisher
    BioMed Central
    URI
    http://hdl.handle.net/10034/625984
    Type
    article
    Description
    From Springer Nature via Jisc Publications Router
    History: received 2020-02-17, accepted 2020-09-10, registration 2020-09-11, pub-electronic 2020-09-29, online 2020-09-29, collection 2020-12
    Publication status: Published
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