Prevention of Breast Cancer in Postmenopausal Women: Approaches to Estimating and Reducing Risk

Background It is uncertain whether evidence supports routinely estimating a postmenopausal woman's risk of breast cancer and intervening to reduce risk. Methods We systematically reviewed prospective studies about models and sex hormone levels to assess breast cancer risk and used meta-analysis...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 2009-03, Vol.101 (6), p.384-398
Main Authors: Cummings, Steven R., Tice, Jeffrey A., Bauer, Scott, Browner, Warren S., Cuzick, Jack, Ziv, Elad, Vogel, Victor, Shepherd, John, Vachon, Celine, Smith-Bindman, Rebecca, Kerlikowske, Karla
Format: Article
Language:English
Subjects:
Aged
Antineoplastic Agents, Hormonal - administration & dosage
Biological and medical sciences
Biomarkers, Tumor - blood
Breast - pathology
Breast cancer
Breast Neoplasms - blood
Breast Neoplasms - epidemiology
Breast Neoplasms - etiology
Breast Neoplasms - pathology
Breast Neoplasms - prevention & control
Case-Control Studies
Confidence Intervals
Confounding Factors (Epidemiology)
Disease prevention
Estrogen Receptor Modulators - administration & dosage
Female
Gonadal Steroid Hormones - blood
Gynecology. Andrology. Obstetrics
Health behavior
Humans
Life Style
Mammary gland diseases
Medical sciences
Middle Aged
Models, Statistical
Odds Ratio
Older people
Oncology
Postmenopause
Predictive Value of Tests
Prospective Studies
Raloxifene Hydrochloride - administration & dosage
Randomized Controlled Trials as Topic
Research Design
Risk Assessment
Risk Factors
Risk Reduction Behavior
Tamoxifen - administration & dosage
Tumors
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Summary:Background It is uncertain whether evidence supports routinely estimating a postmenopausal woman's risk of breast cancer and intervening to reduce risk. Methods We systematically reviewed prospective studies about models and sex hormone levels to assess breast cancer risk and used meta-analysis with random effects models to summarize the predictive accuracy of breast density. We also reviewed prospective studies of the effects of exercise, weight management, healthy diet, moderate alcohol consumption, and fruit and vegetable intake on breast cancer risk, and used random effects models for a meta-analyses of tamoxifen and raloxifene for primary prevention of breast cancer. All studies reviewed were published before June 2008, and all statistical tests were two-sided. Results Risk models that are based on demographic characteristics and medical history had modest discriminatory accuracy for estimating breast cancer risk (c-statistics range = 0.58–0.63). Breast density was strongly associated with breast cancer (relative risk [RR] = 4.03, 95% confidence interval [CI] = 3.10 to 5.26, for Breast Imaging Reporting and Data System category IV vs category I; RR = 4.20, 95% CI = 3.61 to 4.89, for >75% vs
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/djp018