Longitudinal changes in volumetric breast density with tamoxifen and aromatase inhibitors

Natalie J. Engmann, Christopher G. Scott, Matthew R. Jensen, Lin Ma, Kathleen R. Brandt, Amir Pasha Mahmoudzadeh, Serghei Malkov, Dana H. Whaley, Carrie B. Hruska, Fang Fang Wu, Stacey J. Winham, Diana L. Miglioretti, Aaron D. Norman, John J. Heine, John Shepherd, V. Shane Pankratz, Celine M. Vachon, Karla Kerlikowske

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Reductions in breast density with tamoxifen and aromatase inhibitors may be an intermediate marker of treatment response. We compare changes in volumetric breast density among breast cancer cases using tamoxifen or aromatase inhibitors (AI) to untreated women without breast cancer. Methods: Breast cancer cases with a digital mammogram prior to diagnosis and after initiation of tamoxifen (n= 366) or AI (n= 403) and a sample of controls (n=2170) were identified from the Mayo Clinic Mammography Practice and San Francisco Mammography Registry. Volumetric percent density (VPD) and dense breast volume (DV) were measured using Volpara (Matakina Technology) and Quantra (Hologic) software. Linear regression estimated the effect of treatment on annualized changes in density. Results: Premenopausal women using tamoxifen experienced annualized declines in VPD of 1.17% to 1.70% compared with 0.30% to 0.56% for controls and declines in DV of 7.43 to 15.13 cm3 compared with 0.28 to 0.63 cm3 in controls, for Volpara and Quantra, respectively. The greatest reductions were observed among women with 10% baseline density. Postmenopausal AI users had greater declines in VPD than controls (Volpara P = 0.02; Quantra P = 0.03), and reductions were greatest among women with 10% baseline density. Declines in VPD among postmenopausal women using tamoxifen were only statistically greater than controls when measured with Quantra. Conclusions: Automated software can detect volumetric breast density changes among women on tamoxifen and AI. Impact: If declines in volumetric density predict breast cancer outcomes, these measures may be used as interim prognostic indicators.

Original languageEnglish (US)
Pages (from-to)930-937
Number of pages8
JournalCancer Epidemiology Biomarkers and Prevention
Issue number6
StatePublished - Jun 1 2017

ASJC Scopus subject areas

  • General Medicine


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