American Journal of Epidemiology Advance Access originally published online on September 21, 2005
American Journal of Epidemiology 2005 162(9):826-834; doi:10.1093/aje/kwi286
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Original Contribution |
The Association of Endogenous Sex Steroids and Sex Steroid Binding Proteins with Mammographic Density: Results from the Postmenopausal Estrogen/Progestin Interventions Mammographic Density Study
1 Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
2 Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
3 Department of Preventive Medicine/Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA
4 Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA
5 Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
Correspondence to Dr. Gail A. Greendale, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095-1687 (e-mail: ggreenda{at}mednet.ucla.edu).
Mammographic density is an independent risk factor for breast cancer. In postmenopausal women, higher levels of endogenous sex steroids are associated with an increased risk of breast cancer. Limited prior data suggest that endogenous sex steroids either are not associated (total estradiol and progesterone) or are negatively associated (free estradiol) with higher mammographic density. To analyze the associations between endogenous sex steroids and mammographic density, the authors conducted a 1998–2005 cross-sectional analysis of baseline clinical trial data from the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial for US women who had not used hormone therapy for at least 3.1 months prior to baseline. In models adjusted for age, body mass index, parity, prior use of hormone therapy, time since last use of hormone therapy, and the interaction between prior hormone therapy use and time since last hormone therapy use, higher levels of estrone (ß = 0.0013, p = 0.014), estradiol (ß = 0.0009, p = 0.009), and bioavailable estradiol (ß = 0.0021, p = 0.018) were statistically significantly related to greater mammographic density. (Beta coefficients express the increment in mammographic density per-unit increment (pg/ml) of each hormone.) These results suggest that some sex steroids may increase the risk of breast cancer by stimulating breast epithelial or stromal proliferation, which appears on a mammogram as higher density.
breast neoplasms; mammography; menopause; receptors, steroid; risk factors
Abbreviations: BDL, below detectable limits; BMI, body mass index; PEPI, Postmenopausal Estrogen/Progestin Interventions; SHBG, sex hormone-binding globulin
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