Selected prognostic variables for mammographic parenchymal patterns.

Conjecture exists about the influence of numerous risk-factors for breast cancer on mammographic parenchymal patterns. To allow more precise documentation of the common variables considered influential in alterations of breast parenchyma, we conducted a randomized retrospective analysis. Of 10,132 women participants in the Louisville Breast Cancer Detection Demonstration Project, every tenth participant was randomly selected for evaluation using SPSS statistical programming. Each accessioned patient had discriminant analysis for the risk factors of age, parity, age at birth of first child, family history, personal history, previous history of breast biopsy, and exogenous estrogen therapy. One-thousand-and-two women were examined for the significance of the selected prognostic variable association with Wolfe mammographic parenchymal patterns (WMPP). Each prognostic factor was tested by chi-square analysis for the low-risk pattern (N1P1) versus the high-risk pattern (P2DY). A high correlation existed between the age of patient and WMPP (P = 0.0002) in the subjects evaluated (50--85 years, mean 60). Similarly, a very significant correlation was evident between WMPP and parity (P = 0.0002), age at birth of first child (P = 0.0014), family history of breast cancer (P = 0.097), and history of previous breast biopsy (P = 0.0066). Little correlation existed between the Wolfe parenchymal pattern classification and a personal history of breast cancer (P = 0.7779) or the use of exogenous estrogens (P = 0.5776).

The effects of exogenous estrogen replacement therapy of the breast: breast cancer risk and mammographic parenchymal patterns.

A retrospective pilot study was implemented to better define the potential carcinogenic role of conjugated equine estrogen (Premarin) on the breast, and the influence of these hormone analogues on proliferative and atrophic breast parenchyma as determined by high-quality serial xeromammograms. Four hundred and five postmenopausal (spontaneous and surgical) women (mean age 59.7 years) were group matched for the risk factors of age and parity. The dominant parenchymal pattern (N1P1P2DY) as disclosed mammographically was determined for each patient, who was then categorized into one of four groups: Group 1 Asymptomatic-no hormones, 124 patients; Group 2 Symptomatic-no hormones, 75 patients; Group 3 Asymptomatic-hormones; 152 patients; and Group 4 Symptomatic-hormones, 54 patients. Patients in Groups 3 and 4 were treated with therapeutic estrogens a minimum of 18 months (mean 79 months) and follow-up ranged from 39-344 months. In the entire series, 25 carcinomas (6.2%) were detected. In Group 3, five carcinomas (2.4%) were detected, but two cancers (1.0%) were found in symptomatic estrogen users. The occurrence of carcinoma in Group 2 was greater than the remaining categories; however, cancer risk was not statistically greater in any category with regard to hormone replacement therapy. Patients treated with therapeutic estrogens were observed to have an increase of 8.9% in the frequency of a more glandular (P2,DY) mammographic parenchymal pattern and this was noted to be within the range of interpretation error of the mammographer. This suggests a physiologic effect of therapeutic estrogens on atrophic breast parenchyma with conversion to a glandular, proliferative state. This study suggests that long-term replacement estrogen therapy for postmenopausal symptoms does not significantly alter mammographic parenchymal patterns and that the use of these compounds in therapeutic doses does not increase the risk of breast cancer.