MedicalResearch.com Interview with:
Natalie Engmann, MSc
PhD Candidate, Epidemiology and Translational Science
Department of Epidemiology & Biostatistics
University of California, San Francisco
MedicalResearch.com: What is the background for this study?
Response: Breast density is well-established as a strong risk factor for breast cancer. Our study looked at what proportion of breast cancer cases in the entire population can be attributed to risk factors routinely collected in clinical practice, including breast density, measured using the clinical Breast Imaging and Reporting Scale (BI-RADS) categories.
MedicalResearch.com: What are the main findings?
Response: Our main finding is that clinically collected risk factors routinely used in breast cancer risk prediction models account for over 50% of breast cancer cases, and that a substantial proportion of premenopausal (39.3%) and postmenopausal (26.2%) breast cancers in the population could potentially be averted if all women reduced their breast density to BI-RADS category ‘b’ of scattered fibroglandular densities.
We found that roughly 13% of breast cancers could be averted if all women reduced their breast density by more modest reductions of a single BI-RADS category. Breast density had the largest attributable risk of any of the clinical risk factors included in our study, each of which accounted for <10% of breast cancer cases in the population.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Breast density is a strong and very common risk factor, therefore reducing breast density has the potential to dramatically reduce breast cancer cases in the population. Currently there is no population-level intervention to reduce breast density. Tamoxifen is the only known therapy that effectively reduces breast density, but can have serious side effects and is generally not recommended or acceptable for most women, except those at very high breast cancer risk with guidance from their physician. This study highlights the need for better interventions to reduce breast density, and thus breast cancer risk, that are acceptable for use by the entire population of women, not only those at very high breast cancer risk.
MedicalResearch.com: Is there anything else you would like to add?
Response: In addition to new research evaluating interventions to modify breast density, it would be useful to look at the population attributable risk of breast density and other modifiable factors for different molecular subtypes of breast cancer. Breast cancer is a heterogenous disease, and some subtypes are more aggressive than others. If we can identify modifiable risk factors that could prevent a substantial proportion of the most aggressive cancers, we could prioritize interventions to reduce subtypes of breast cancer with the worst survival outcomes.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Engmann NJ, Golmakani MK, Miglioretti DL, Sprague BL, Kerlikowske K, for the Breast Cancer Surveillance Consortium. Population-Attributable Risk Proportion of Clinical Risk Factors for Breast Cancer. JAMA Oncol. Published online February 02, 2017. doi:10.1001/jamaoncol.2016.6326
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