Efforts to reduce women's breast density, cornerstone of strategies to prevent breast cancer

Women's mammographic breast density may hold vital clues to better understand and ultimately prevent breast cancer, according to international experts speaking at world's fifth Latin American Livial Expert Meeting (LALEM).





"Evidence is accumulating that indicate that efforts to reduce the density of women's breast tissue may prove to be the cornerstone of strategies to prevent breast cancer analogous to the way that reducing high blood pressure can reduce the risk of heart attacks," commented Dr Miguel Bracho; Mastologist and Oncological Surgeon "La Unidad de MastologпїЅa y AtenciпїЅn Integral de la Mujer", Barcelona, Venezuela. Further work is needed but there are certainly grounds for real optimism in this area."


Recent work indicates that women with a high mammographic breast density are up to five times more likely to develop breast cancer compared to women who have low densities. As such breast density is one of the strongest known risk factors for breast cancer.


Dr Bracho said: "The reason for the current excitement around breast density is that it is modifiable, and there is the strong possibility that by reducing breast density, we can substantially reduce the subsequent risk of developing breast cancer."


While in recent years great strides have been made in relation to the early diagnosis of breast cancer and its treatment, progress in relation to its prevention have been slight. Efforts have been hampered by the fact that researchers have not known what changes in the breast act as intermediate or surrogate markers for the subsequent development of breast cancer and hence could be used to rapidly test possible methods of prevention.


However evidence presented during the symposium suggests that increased mammographic breast density is such a marker. [1]


Dr Bracho explained: "The importance of identifying a surrogate marker for breast cancer cannot be over emphasized. At the moment efforts to identify how we can prevent breast cancer are severely hampered by the need for very long and large trials to investigate the effects of a specific intervention. Confirmation that breast density is an acceptable surrogate marker will greatly increase the feasibility of trials - by reducing their length and size. Moreover, such knowledge will help us better assess individual's women's risk of breast cancer and allow us to gain better insights into the etiology of this disease."



The issue of increased breast density also has important and immediate implications in relation to the use of menopausal therapies - a topic also addressed during the symposium. Menopausal therapies containing estrogen and progestogen - recently shown to be associated with an increased risk of breast cancer - have also been shown to increase women's breast density. But there are different products (without estrogen and progestogen) available such as tibolone. [2]



Dr Bracho commented: "Increases in breast density following menopausal treatment should be regarded as an unwanted and potentially hazardous side effect of treatment. Such an effect undoubtedly interferes with the early identification of breast cancer and may directly correlate with an increase in the risk of breast cancer. Physicians should choose treatments for women on the basis of their relative effects on mammographic density."



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1. Breast density reflects the amount of fibroglandular tissue in the breast. Increased breast density is believed to represent both more breast tissue and increased proliferation of breast tissue and has consistently been associated with an increased risk of breast cancer.


2. Tibolone (branded as Livial) is a treatment licensed for the relief of menopausal symptoms and the prevention of bone loss in post menopausal women.





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