Conjugated equine estrogen influence on mammographic density in postmenopausal women in a substudy of the women's health initiative randomized trial

Anne McTiernan, Rowan T. Chlebowski, Christopher Martin, Jennifer David Peck, Aaron Aragaki, Etta D. Pisano, C. Y. Wang, Karen Johnson, Jo Ann E. Manson, Robert B. Wallace, Mara Z. Vitolins, Gerardo Heiss

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Abstract

Purpose: Increased mammographic density is associated with increased breast cancer risk and reduced sensitivity of screening mammography and is related to hormone exposure. However, the effects of conjugated equine estrogens (CEEs) alone on mammographic density in diverse racial/ethnic populations are not established. We examined the effect of CEE alone on mammographic density in a subsample of the Women's Health Initiative (WHI) clinical trial participants. Patients and Methods: In the WHI trial, women were randomly assigned to daily CEE 0.625 mg or placebo. The effect of CEE on mammographic percent density was determined over 1 and 2 years in a stratified random sample of 435 racially and ethnically diverse participants from 15 of 40 WHI clinics. Results: Use of CEE resulted in mean increase in mammographic percent density of 1.6 percentage points (95% CI, 0.8 to 2.4) at year 1 compared with a mean decrease of 1.0 percentage point (95% CI, -1.7 to -0.4) in the placebo group (P < .001). The effect persisted for 2 years, with a mean increase of 1.7 percentage points (95% CI, 0.7 to 2.7) versus a mean decrease of 1.2 percentage points (95% CI, -1.8 to -0.5; P < .001) in the hormone and placebo groups, respectively. These effects were greater in women age 60 to 79 years (P = .03 for interaction across age). Conclusion: Use of CEE results in a modest but statistically significant increase in mammographic density that is sustained over at least a 2-year period. The clinical significance of the CEE effect on mammographic density remains to be determined.

Original languageEnglish (US)
Pages (from-to)6135-6143
Number of pages9
JournalJournal of Clinical Oncology
Volume27
Issue number36
DOIs
StatePublished - Dec 20 2009

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Conjugated (USP) Estrogens
Women's Health
Placebos
Hormones
Mammography
Breast Density
Estrogens
Clinical Trials
Breast Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Conjugated equine estrogen influence on mammographic density in postmenopausal women in a substudy of the women's health initiative randomized trial. / McTiernan, Anne; Chlebowski, Rowan T.; Martin, Christopher; Peck, Jennifer David; Aragaki, Aaron; Pisano, Etta D.; Wang, C. Y.; Johnson, Karen; Manson, Jo Ann E.; Wallace, Robert B.; Vitolins, Mara Z.; Heiss, Gerardo.

In: Journal of Clinical Oncology, Vol. 27, No. 36, 20.12.2009, p. 6135-6143.

Research output: Contribution to journalArticle

McTiernan, A, Chlebowski, RT, Martin, C, Peck, JD, Aragaki, A, Pisano, ED, Wang, CY, Johnson, K, Manson, JAE, Wallace, RB, Vitolins, MZ & Heiss, G 2009, 'Conjugated equine estrogen influence on mammographic density in postmenopausal women in a substudy of the women's health initiative randomized trial', Journal of Clinical Oncology, vol. 27, no. 36, pp. 6135-6143. https://doi.org/10.1200/JCO.2008.21.7166
McTiernan, Anne ; Chlebowski, Rowan T. ; Martin, Christopher ; Peck, Jennifer David ; Aragaki, Aaron ; Pisano, Etta D. ; Wang, C. Y. ; Johnson, Karen ; Manson, Jo Ann E. ; Wallace, Robert B. ; Vitolins, Mara Z. ; Heiss, Gerardo. / Conjugated equine estrogen influence on mammographic density in postmenopausal women in a substudy of the women's health initiative randomized trial. In: Journal of Clinical Oncology. 2009 ; Vol. 27, No. 36. pp. 6135-6143.
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abstract = "Purpose: Increased mammographic density is associated with increased breast cancer risk and reduced sensitivity of screening mammography and is related to hormone exposure. However, the effects of conjugated equine estrogens (CEEs) alone on mammographic density in diverse racial/ethnic populations are not established. We examined the effect of CEE alone on mammographic density in a subsample of the Women's Health Initiative (WHI) clinical trial participants. Patients and Methods: In the WHI trial, women were randomly assigned to daily CEE 0.625 mg or placebo. The effect of CEE on mammographic percent density was determined over 1 and 2 years in a stratified random sample of 435 racially and ethnically diverse participants from 15 of 40 WHI clinics. Results: Use of CEE resulted in mean increase in mammographic percent density of 1.6 percentage points (95{\%} CI, 0.8 to 2.4) at year 1 compared with a mean decrease of 1.0 percentage point (95{\%} CI, -1.7 to -0.4) in the placebo group (P < .001). The effect persisted for 2 years, with a mean increase of 1.7 percentage points (95{\%} CI, 0.7 to 2.7) versus a mean decrease of 1.2 percentage points (95{\%} CI, -1.8 to -0.5; P < .001) in the hormone and placebo groups, respectively. These effects were greater in women age 60 to 79 years (P = .03 for interaction across age). Conclusion: Use of CEE results in a modest but statistically significant increase in mammographic density that is sustained over at least a 2-year period. The clinical significance of the CEE effect on mammographic density remains to be determined.",
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AU - Chlebowski, Rowan T.

AU - Martin, Christopher

AU - Peck, Jennifer David

AU - Aragaki, Aaron

AU - Pisano, Etta D.

AU - Wang, C. Y.

AU - Johnson, Karen

AU - Manson, Jo Ann E.

AU - Wallace, Robert B.

AU - Vitolins, Mara Z.

AU - Heiss, Gerardo

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Y1 - 2009/12/20

N2 - Purpose: Increased mammographic density is associated with increased breast cancer risk and reduced sensitivity of screening mammography and is related to hormone exposure. However, the effects of conjugated equine estrogens (CEEs) alone on mammographic density in diverse racial/ethnic populations are not established. We examined the effect of CEE alone on mammographic density in a subsample of the Women's Health Initiative (WHI) clinical trial participants. Patients and Methods: In the WHI trial, women were randomly assigned to daily CEE 0.625 mg or placebo. The effect of CEE on mammographic percent density was determined over 1 and 2 years in a stratified random sample of 435 racially and ethnically diverse participants from 15 of 40 WHI clinics. Results: Use of CEE resulted in mean increase in mammographic percent density of 1.6 percentage points (95% CI, 0.8 to 2.4) at year 1 compared with a mean decrease of 1.0 percentage point (95% CI, -1.7 to -0.4) in the placebo group (P < .001). The effect persisted for 2 years, with a mean increase of 1.7 percentage points (95% CI, 0.7 to 2.7) versus a mean decrease of 1.2 percentage points (95% CI, -1.8 to -0.5; P < .001) in the hormone and placebo groups, respectively. These effects were greater in women age 60 to 79 years (P = .03 for interaction across age). Conclusion: Use of CEE results in a modest but statistically significant increase in mammographic density that is sustained over at least a 2-year period. The clinical significance of the CEE effect on mammographic density remains to be determined.

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