Hip bone density predicts breast cancer risk independently of Gail score

Results From the Women's Health Initiative

Authors

  • Zhao Chen PhD, MPH,

    Corresponding author
    1. Division of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, Arizona
    • Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Drachman Hall, Room A230, 1295 N Martin, PO Box 245211, Tucson, AZ 85724-5211
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    • Fax: (520) 626-2767

  • Leslie Arendell MS,

    1. Division of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, Arizona
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  • Mikel Aickin PhD,

    1. Department of Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • Jane Cauley PhD,

    1. Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Cora E. Lewis MD, MSPH,

    1. Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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  • Rowan Chlebowski MD, PhD

    1. Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles Medical Center (LABioMed), Torrance, California
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    • Dr. Chlebowski has acted as a consultant for Astra-Zeneca, Novartis, and Genentech and has received grant support from Amgen.


  • See editorial on pages 890-2, this issue.

  • The following is a short list of The Women's Health Initiative investigators: Program Office (National Heart, Lung, and Blood Institute, Bethesda, MD): Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, and Nancy Geller. Clinical Coordinating Center: Fred Hutchinson Cancer Research Center, Seattle, WA (Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L. Kooperberg, Ruth E. Patterson, and Anne McTiernan); Wake Forest University School of Medicine, Winston-Salem, NC (Sally Shumaker); Medical Research Labs, Highland Heights, KY (Evan Stein); and University of California at San Francisco, San Francisco, CA (Steven Cummings). Clinical Centers: Albert Einstein College of Medicine, Bronx, NY (Sylvia Wassertheil-Smoller); Baylor College of Medicine, Houston, TX (Jennifer Hays); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (JoAnn Manson); Brown University, Providence, RI (Annlouise R. Assaf); Emory University, Atlanta, GA (Lawrence Phillips); Fred Hutchinson Cancer Research Center, Seattle, WA (Shirley Beresford); George Washington University Medical Center, Washington, DC (Judith Hsia); Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles Medical Center, Torrance, CA (Rowan Chlebowski); Kaiser Permanente Center for Health Research, Portland, OR (Evelyn Whitlock); Kaiser Permanente Division of Research, Oakland, CA (Bette Caan); Medical College of Wisconsin, Milwaukee, WI (Jane Morley Kotchen); MedStar Research Institute/Howard University, Washington, DC (Barbara V. Howard); Northwestern University, Chicago/Evanston, IL (Linda Van Horn); Rush Medical Center, Chicago, IL (Henry Black); Stanford Prevention Research Center, Stanford, CA (Marcia L. Stefanick); State University of New York at Stony Brook, Stony Brook, NY (Dorothy Lane); The Ohio State University, Columbus, OH (Rebecca Jackson); University of Alabama at Birmingham, Birmingham, AL (Cora E. Lewis); University of Arizona, Tucson/Phoenix, AZ (Tamsen Bassford); University at Buffalo, Buffalo, NY (Jean Wactawski-Wende); University of California at Davis, Sacramento, CA (John Robbins); University of California at Irvine, Irvine, CA (F. Allan Hubbell); University of California at Los Angeles, Los Angeles, CA (Howard Judd); University of California at San Diego, LaJolla/Chula Vista, CA (Robert D. Langer); University of Cincinnati, Cincinnati, OH (Margery Gass); University of Florida, Gainesville/Jacksonville, FL (Marian Limacher); University of Hawaii, Honolulu, HI (David Curb); University of Iowa, Iowa City/Davenport, IA (Robert Wallace); University of Massachusetts/Fallon Clinic, Worcester, MA (Judith Ockene); University of Medicine and Dentistry of New Jersey, Newark, NJ (Norman Lasser); University of Miami, Miami, FL (Mary Jo O'Sullivan); University of Minnesota, Minneapolis, MN (Karen Margolis); University of Nevada, Reno, NV (Robert Brunner); University of North Carolina, Chapel Hill, NC (Gerardo Heiss); University of Pittsburgh, Pittsburgh, PA (Lewis Kuller); University of Tennessee, Memphis, TN (Karen C. Johnson); University of Texas Health Science Center, San Antonio, TX (Robert Brzyski); University of Wisconsin, Madison, WI (Gloria E. Sarto); Wake Forest University School of Medicine, Winston-Salem, NC (Denise Bonds); and Wayne State University School of Medicine/Hutzel Hospital, Detroit, MI (Susan Hendrix).

Abstract

BACKGROUND.

The Gail model has been commonly used to estimate a woman's risk of breast cancer within a certain time period. High bone mineral density (BMD) is also a significant risk factor for breast cancer, but it appears to play no role in the Gail model. The objective of the current study was to investigate whether hip BMD predicts postmenopausal breast cancer risk independently of the Gail score.

METHODS.

In this prospective study, 9941 postmenopausal women who had a baseline hip BMD and Gail score from the Women's Health Initiative were included in the analysis. Their average age was 63.0 ± 7.4 years at baseline.

RESULTS.

After an average of 8.43 years of follow-up, 327 incident breast cancer cases were reported and adjudicated. In a multivariate Cox proportional hazards model, the hazards ratios (95% confidence interval [95% CI]) for incident breast cancer were 1.35 (95% CI, 1.05-1.73) for high Gail score (≥1.67%) and 1.25 (95% CI, 1.11-1.40) for each unit of increase in the total hip BMD T-score. Restricting the analysis to women with both BMD and a Gail score above the median, a sharp increase in incident breast cancer for women with the highest BMD and Gail scores was found (P < .05).

CONCLUSIONS.

The contribution of BMD to the prediction of incident postmenopausal breast cancer across the entire population was found to be independent of the Gail score. However, among women with both high BMD and a high Gail score, there appears to be an interaction between these 2 factors. These findings suggest that BMD and Gail score may be used together to better quantify the risk of breast cancer. Cancer 2008. © 2008 American Cancer Society.

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