scholarly journals Breast Cancer Prevention: Time for Change

2021 ◽  
pp. OP.21.00343
Author(s):  
Rowan T. Chlebowski ◽  
Aaron K. Aragaki ◽  
Kathy Pan
Keyword(s):  
Breast Cancer ◽  
Cancer Prevention ◽  
Women's Health ◽  
Intervention Group ◽  
Hazard Ratio ◽  
Breast Cancer Prevention ◽  
Targeted Agents ◽  
Health Initiative ◽  
Er Positive ◽  
The Women’S Health Initiative

Agency breast cancer prevention guidelines for other than hereditary cancers have not materially changed in 20 years; endocrine-targeted agents (then, tamoxifen; now, adding raloxifene and aromatase inhibitors) reduce good prognosis estrogen receptor (ER)–positive, progesterone receptor (PR)–positive cancers without reducing deaths from breast cancer. Across three tamoxifen placebo-controlled prevention trials (N = 23,360) begun almost 30 years ago, although there were 226 fewer breast cancer cases, there were nine more deaths from breast cancer in the tamoxifen groups. Following clinical advances, currently more than half of breast cancer cases are solved problems with extremely low risk of death. As endocrine-targeted agents commonly prevent these cancers, widespread implementation of current prevention strategies may not reduce deaths from breast cancer. Compared with other breast cancers, ER-positive, PR-negative cancers and triple-negative cancers have inferior survival (90.6% v 83.8% v 78.1%, respectively; P < .001). Against this background, in the Women's Health Initiative Dietary Modification randomized trial (N = 48,835), ER-positive, PR-negative cancers were statistically significantly reduced in the intervention group (hazard ratio, 0.77; 95% CI, 0.64 to 0.94) and deaths from breast cancer were reduced 21% ( P = .02). In the Women's Health Initiative randomized, placebo-controlled trial evaluating conjugated equine estrogen (N = 10,739), ER-positive, PR-negative cancers were statistically significantly reduced in the intervention group (hazard ratio, 0.44; 95% CI, 0.27 to 0.74) and deaths from breast cancer were reduced 40% ( P = .04). These findings suggest that reexamination of breast cancer risk reduction strategies and clinical practice is needed.

Abstract 13500: Association Between Breast Cancer and Cardiac Autonomic Function as Measured by Heart Rate Variability in the Women’s Health Initiative

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mary Branch ◽  
Christopher L Schaich ◽  
Daniel Beavers ◽  
Elsayed Z Soliman ◽  
Kerryn Reding ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Women's Health ◽  
Rr Intervals ◽  
Women's Health Initiative ◽  
Women’S Health Initiative ◽  
Health Initiative ◽  
Incident Breast Cancer ◽  
The Women’S Health Initiative

Background: Autonomic dysfunction (AD) as measured by heart rate variability (HRV) is associated with increased risk of cardiovascular disease (CVD) and breast cancer. No study has utilized a large prospective multi-center cohort of diverse women to assess differences in HRV associated with incident breast cancer. Objectives: To identify heart rate variability changes in women with breast cancer compared to controls in the Women’s Health Initiative (WHI). Methods: In a retrospective cohort study, we utilized 5,031 women in the WHI CT cohort who were breast cancer free at baseline and compared 1) those with incident breast cancer v. 2) those who were breast cancer free during the ECG follow-up period as controls. HRV was calculated utilizing 10-second ECG with two measures of two-domain HRV: standard deviation of all normal-to-normal RR intervals (SDNN) and the root mean square of successive differences in normal-to-normal RR intervals (rMSSD). HRV was measured from ECGs collected at baseline, years 3, 6, and 9 in the comparison groups. An adjusted mixed linear model was used to evaluate the differences in SDNN and rMSSD comparing women with incident breast cancer to controls. Cardiovascular risk factors utilized in the adjusted model were determined via questionnaire at baseline. Results: At baseline, women with incident breast cancer diagnosed by years 3, 6, or 9 were significantly older (median age 63 vs. 61, P<0.0001) and had a higher prevalence of hypertension (35% vs. 32%, P=0.02). SDNN at years 3 and 6 in women with breast cancer compared to controls was significantly lower (P=0.0002, P=0.03 respectively). As well, rMSSD was significantly lower at year 3 compared to controls (P<0.0001) ( Figure 1 ). Conclusions: HRV as a measure of AD is significantly lower in women with incident breast cancer compared to women without breast cancer. Reduction in HRV is associated with CVD outcomes in the literature. Our study suggests HRV may predict CVD in breast cancer patients.

Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women’s Health Initiative

Cancer ◽  
2020 ◽  
Vol 126 (16) ◽  
pp. 3638-3647
Author(s):  
Kathy Pan ◽  
Rowan T. Chlebowski ◽  
Joanne E. Mortimer ◽  
Marc J. Gunther ◽  
Thomas Rohan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Insulin Resistance ◽  
Women's Health ◽  
Postmenopausal Women ◽  
Cancer Incidence ◽  
Breast Cancer Incidence ◽  
Women's Health Initiative ◽  
Health Initiative ◽  
Incidence And Mortality ◽  
The Women’S Health Initiative
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