Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy: results of the MEDICI study
Abstract
Background: Oestrogen-receptor positive breast cancer patients are typically treated with adjuvant endocrine therapy (AET), some develop AET resistance. Previous research suggests mammographic density (MD) may represent an imaging biomarker, with fewer local or distant recurrences occurring with decreasing MD. We investigate whether reduction in MD after 1 and/or 3 years is associated with improved breast cancer specific survival (BCSS), metastasis-free survival (MFS) or disease-free survival (DFS).
Methods: This retrospective cohort study was generated from a Mammo-50 trial subset. Participants taking AET (cases) and controls were included. MD was assessed in the AET group using a 0-100% visual analogue scale (VAS). Readers scored mammograms at diagnosis, 1 year and 3 years post-surgery. A decrease in MD was defined as ≥10% reduction from diagnosis. A second reader reviewed paired mammograms and assessed whether there had been a temporal change in MD.
Results: Data from 1364 cases and 367 controls were included. Median VAS MD was approximately 30% for cases and controls at all time-points; 20% showed decreased MD at 1 year and 21% at 3 years for both cases and controls. Of the AET group, 23 died from breast cancer and 33 developed metastases during follow-up (median 8.7 years post-surgery). The 5-year BCSS rate was 99.6% (95%CI:97.4-99.9) versus 98.3% (95%CI:97.2-98.9) for those with and without a ≥10% reduction in MD at 1 year, p=0.35. The 5-year MFS rate for those with…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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