Tamoxifen-Induced Reduction in Mammographic Density and Breast Cancer Risk Reduction: A Nested Case-Control Study
Tamoxifen-Induced Reduction in Mammographic Density and Breast Cancer Risk Reduction: A Nested Case-Control Study
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DOI：
10.1093/jnci/djr079
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发表时间：
2011-05-01
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影响因子：
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通讯作者：
Warren, Ruth M. L.
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作者：
Cuzick, Jack;Warwick, Jane;Warren, Ruth M. L.
背景 乳房 X 光检查乳腺密度是乳腺癌的一个重要危险因素。他莫昔芬可以降低高危女性患乳腺癌的风险，也可以降低乳房X光检查的乳腺密度。然而，尚不清楚他莫昔芬引起的乳腺密度降低是否可用于确定从该药物预防性治疗中获益最多的女性。 方法 我们在第一项国际乳腺癌干预研究中进行了一项巢式病例对照研究，这是一项他莫昔芬与安慰剂对比的随机预防试验。乳房 X 线摄影乳房密度通过肉眼评估并表示为乳房总面积的百分比，增量为 5%。病例受试者是 123 名在首次随访乳房 X 光检查时或之后被诊断患有乳腺癌的女性，该随访是在试验进入后 12-18 个月进行的，对照受试者是 942 名没有乳腺癌的女性。使用多变量逻辑回归来调整其他风险因素。所有统计检验都是双向的。 结果 在他莫昔芬组中，46% 的女性在 12 至 18 个月的乳房 X 光检查中乳腺密度下降了 10% 或更多。与安慰剂组的所有女性相比，他莫昔芬组中乳腺密度降低 10% 或以上的女性患乳腺癌的风险降低了 63%（比值比 = 0.37，95% 置信区间 = 0.20 至 0.69，P = 0.002），而服用他莫昔芬但乳腺密度降低不到 10% 的女性则没有风险降低（比值比 = 1.13，95% 置信区间 = 0.72 至 1.77，P = .60)。在安慰剂组中，乳腺 X 光密度降低不到 10% 的受试者与降低幅度较大的受试者之间，乳腺癌风险没有统计学上的显着差异。结论 12 至 18 个月的乳腺 X 光密度变化是预防环境中对他莫昔芬反应的极好预测指标。
Background Mammographic breast density is a strong risk factor for breast cancer. Tamoxifen, which reduces the risk of breast cancer in women at high risk, also reduces mammographic breast density. However, it is not known if tamoxifen-induced reductions in breast density can be used to identify women who will benefit the most from prophylactic treatment with this drug.Methods We conducted a nested case-control study within the first International Breast Cancer Intervention Study, a randomized prevention trial of tamoxifen vs placebo. Mammographic breast density was assessed visually and expressed as a percentage of the total breast area in 5% increments. Case subjects were 123 women diagnosed with breast cancer at or after their first follow-up mammogram, which took place 12-18 months after trial entry, and control subjects were 942 women without breast cancer. Multivariable logistic regression was used to adjust for other risk factors. All statistical tests were two-sided.Results In the tamoxifen arm, 46% of women had a 10% or greater reduction in breast density at their 12- to 18-month mammogram. Compared with all women in the placebo group, women in the tamoxifen group who experienced a 10% or greater reduction in breast density had 63% reduction in breast cancer risk (odds ratio = 0.37, 95% confidence interval = 0.20 to 0.69, P = .002), whereas those who took tamoxifen but experienced less than a 10% reduction in breast density had no risk reduction (odds ratio = 1.13, 95% confidence interval = 0.72 to 1.77, P = .60). In the placebo arm, there was no statistically significant difference in breast cancer risk between subjects who experienced less than a 10% reduction in mammographic density and subjects who experienced a greater reduction.Conclusion The 12- to 18-month change in mammographic breast density is an excellent predictor of response to tamoxifen in the preventive setting.