Effect of Raloxifene on Mammographic Density and Breast Magnetic Resonance Imaging in Premenopausal Women at Increased Risk for Breast Cancer

Eng‐Wong, Jennifer; Orzano-Birgani, Jennifer; Chow, Catherine; Venzon, David; Yao, Jianhua; Galbo, Claudia; Zujewski, Jo Anne; Prindiville, Sheila A.

doi:10.1158/1055-9965.epi-07-2752

Cited by 61 publications

(67 citation statements)

References 28 publications

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“…One possibility is that raloxifene reduced mammographic density to a greater degree than did tamoxifen resulting in differential "unmasking" of in situ cancers among the women taking raloxifene as compared with those taking tamoxifen. Published literature speaks against this possibility, however, showing little effect on mammographic density by raloxifene (13,14) and variable effects with tamoxifen (15,16).…”

Section: Discussionmentioning

confidence: 99%

Carcinoma In Situ Outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials

Vogel

Costantino²,

Wickerham³

et al. 2010

JNCI Monographs

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Selective estrogen receptor modulators (SERMs) are established in the treatment of estrogen receptor (ER)-positive breast cancer, and four decades of basic and preclinical research have shown them to be ideal agents for the reduction of the risk of breast cancer in highrisk pre-and postmenopausal women. The National Surgical Adjuvant Breast and Bowel Project (NSABP) has conducted many clinical trials that used SERMs for the treatment and prevention of breast cancer. The trials were designed to assess a number of clinical and pathological outcomes including both invasive and in situ breast carcinomas. Here, we summarize the previously published data from two of those trials and also highlight the most recent data related to in situ events in the Study of Tamoxifen and Raloxifene (STAR) NSABP breast cancer risk reduction trial using tamoxifen.In 1992, The National Cancer Institute and the NSABP launched the Breast Cancer Prevention Trial (BCPT, P-l) (1,2). The primary aim of this trial was to determine whether tamoxifen prevented invasive breast cancer in women at increased risk. Women eligible for the trial were 60 years or older, were 35-59 years of age with a 5-year predicted risk of breast cancer of at least 1.66%, or had a history of lobular carcinoma in situ (LCIS). Risk was estimated using the model developed by Gail et al. (3,4). During 5 years of recruitment, 13 388 women entered the trial and were randomly assigned to receive tamoxifen (20 mg daily) or placebo therapy.The trial was stopped when statistical significance was achieved in a number of study endpoints after a median follow-up time of 54.6 months. Among the 13 175 women with evaluable endpoints, 368 invasive and noninvasive breast cancers occurred. There was a 49% reduction in overall risk of invasive breast cancer with tamoxifen: there were 175 cases of invasive breast cancer in the placebo group compared with 89 in the tamoxifen group (risk ratio [RR] = 0.51, 95% confidence interval [CI] = 0.39 to 0.66; P < .0001). The annual event rate for invasive breast cancer among women taking tamoxifen was 3.4 per 1000 women compared with 6.8 per 1000 women taking placebo.For the purposes of this evaluation (and in the original publication), both ductal carcinoma in situ (DCIS) and LCIS-both

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Section: Discussionmentioning

confidence: 99%

Carcinoma In Situ Outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials

Vogel

Costantino²,

Wickerham³

et al. 2010

JNCI Monographs

View full text Add to dashboard Cite

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“…Where possible, hormone replacement therapy should be discontinued 4-6 weeks before performing breast MRI. Anti-oestrogen medication may suppress these enhancements, as shown in some trials including those involving non-menopausal females with risk factors or premenstrual mastalgia [16,17]. At the time of writing, because of the adverse effects involved, we do not recommend administration of anti-oestrogen treatment only to reduce physiological breast enhancement.…”

Section: Recognising Normal Enhancing Structuresmentioning

confidence: 99%

Pearls and pitfalls in breast MRI

Millet¹,

Pagès²,

Hoa³

et al. 2012

BJR

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ABSTRACT. At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.

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“…These deficiencies may limit the use of mammographic breast density information as biomarker for monitoring the effect of breast cancer preventive interventions. 97,98 Consequently, quantitative methodologies have been designed for mammographic breast density assessment in the clinical setting.…”

Section: The History Of Qualitative Breast Density Classificationmentioning

confidence: 99%

“…Therefore, area-based techniques may not be able to show change in breast density following intervention. 97,98 These limitations have necessitated the introduction of volumetric methodologies for mammographic breast density assessment. Quantra TM (Hologic Inc.) uses a physical physics principle to calculate volumetric breast density.…”

Section: Categorisation Of Breast Composition Using "Quantitative Arementioning

confidence: 99%

Breast composition: Measurement and clinical use

Ekpo¹,

Hogg²,

Highnam³

et al. 2015

Radiography

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Breast density is a measure of the extent of radiodense fibroglandular tissue in the breast. The risk of developing breast cancer and the risk of missing cancer at screening rise with higher breast density. In this paper, the historical background to breast density measurement is outlined and current evidence based practice is explained. The relevance of breast density knowledge to mammographic practice and image interpretation is considered in the light of clinical assessment and notification of mammographic breast density (MBD). The current work also discusses risk stratification for decisionmaking regarding screening frequency and better modalities for earlier detection of breast cancer in the dense breast. Automated volumetric approaches are explained while ultrasound, digital breast tomosynthesis, molecular breast imaging, and magnetic resonance imaging are introduced as valuable adjuncts to digital mammography for imaging the dense breast. The work concludes on the important note that screened women should be notified of their breast density, and such notification should be accompanied with clear and adequate information about breast density and cancer risk, strategies associated with lower MBD, as well as best screening intervals and pathways for women with dense breasts. Adoption of these strategies may be crucial to early detection and treatment of cancer and improving survival from the disease.

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Effect of Raloxifene on Mammographic Density and Breast Magnetic Resonance Imaging in Premenopausal Women at Increased Risk for Breast Cancer

Cited by 61 publications

References 28 publications

Carcinoma In Situ Outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials

Carcinoma In Situ Outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials

Pearls and pitfalls in breast MRI

Breast composition: Measurement and clinical use

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