Bone Mass and the Risk of Breast Cancer among Postmenopausal Women
Yuqing Zhang, D.Sc., M.B., Douglas P. Kiel, M.D., M.P.H., Bernard E. Kreger, M.D., M.P.H., L. Adrienne Cupples, Ph.D., R. Curtis Ellison, M.D., Joanne F. Dorgan, Ph.D., M.P.H., Arthur Schatzkin, M.D., Dr.Ph., Daniel Levy, M.D., and David T. Felson, M.D., M.P.H.
Background Recent studies have shown a direct relation betweenserum estrogen levels assessed at a single point in time andthe risk of breast cancer, but no evidence links estrogen levelsassessed repeatedly over an extended interval to the risk ofbreast cancer. Bone mass has been proposed as a marker of cumulativeexposure to estrogen in women. We therefore studied the associationbetween bone mass and the incidence of breast cancer.
Methods Between 1967 and 1970, 1373 women who were 47 to 80years old and had no history of breast cancer underwent posteroanteriorhand radiography in the Framingham Study. We used radiogrametryto measure the cortical width of each woman's second metacarpal.Participants were followed until the end of 1993. All incidentcases of breast cancer were confirmed by pathological reports.We used a Cox proportional-hazards model to examine the relationof metacarpal bone mass to the risk of postmenopausal breastcancer.
Results Postmenopausal breast cancer developed in 91 subjects.Incidence rates per 1000 person-years increased from 2.0 amongthe women in the lowest age-specific quartile of metacarpalbone mass to 2.6, 2.7, and 7.0 among the women in the second,third, and highest quartiles, respectively. After adjustmentsfor age and other potential confounding factors, the rate ratiosfor the risk of breast cancer were 1.0, 1.3, 1.3, and 3.5 fromthe lowest quartile to the highest (P for trend, <0.001).
Conclusions Women in the highest quartile of bone mass are athigher risk for postmenopausal breast cancer than those in thelowest quartile. The mechanisms underlying this relation arenot understood, but cumulative exposure to estrogen may playa part.
Source Information
From the Boston University Arthritis Center (Y.Z., D.T.F.), the Section of Preventive Medicine and Epidemiology (Y.Z., B.E.K., R.C.E., D.L.), and the Section of General Internal Medicine (B.E.K.), Evans Department of Medicine, Boston University School of Medicine; the Hebrew Rehabilitation Center for Aged and the Division on Aging, Harvard Medical School (D.P.K.); and the Department of Epidemiology and Biostatistics, Boston University School of Public Health (L.A.C.) — all in Boston; the Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, Md. (J.F.D., A.S.); and the Framingham Study, Framingham, Mass., and the National Heart, Lung, and Blood Institute, Bethesda, Md. (D.L.).
Address reprint requests to Dr. Zhang at Rm. B-612, Boston University Medical Center, 88 E. Newton St., Boston, MA 02118.
Bone Mass and the Risk of Breast Cancer
Atkins C. D., Walker A. R.P., Burger H. M., Ballesteros M., Nash D., Fix A., Bush T., Shealy C. N., Zhang Y., Kiel D. P., Felson D. T.
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N Engl J Med 1997;
337:199-200, Jul 17, 1997.
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