Carla de Venecia, MD

52-year-old asymptomatic female with family history of breast cancer presents for annual mammogram.

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Mammographic mediolateral oblique (MLO) and craniocaudal (CC) views of the left breast (same appearance as right breast) demonstrate an increase in breast density from 2012 to 2014. Prior mammographic MLO and CC images of the left breast demonstrate similar heterogeneously dense breast parenchyma in 2007 and 2014. From 2007 to 2008, there is significant reduction in fibroglandular density. The fibroglandular density remains stable between 2008 and 2012, and then increases significantly to the 2007 baseline fibroglandular density from 2012 to 2014. Upon further questioning, the patient reported receiving tamoxifen treatment for chemoprevention in the 5-year period between 2008 and 2012. 


Tamoxifen is an estrogen-receptor (ER) antagonist that has been used for decades as a treatment for women diagnosed with ER-positive breast cancer. More recently, tamoxifen has been used as a chemopreventive agent in women at high risk for breast cancer.

 The American Society of Clinical Oncology currently recommends discussing a 5-year course of tamoxifen as an option to reduce the risk of ER-positive breast cancer among high-risk premenopausal women.

Studies have shown that tamoxifen reduces mammographic breast density, continuing 54 months into treatment.

 The International Breast Cancer Intervention Study showed that the mean reduction in mammographic breast density at 54 months among women in the tamoxifen group was 13.7% compared with 7.3% in the placebo group.

 A similar study conducted by Chen et al using 3D magnetic resonance imaging showed that tamoxifen therapy causes a significant reduction in breast density. This reduction positively correlated with treatment duration and baseline breast density.

We report a case of a high-risk premenopausal woman treated with tamoxifen for 5 years whose mammographic density decreased while on tamoxifen and returned to baseline following discontinuation of the drug. The clinical significance of this resumption to baseline mammographic density following discontinuation of tamoxifen remains to be determined.

1. Nazarali SA, Narod SA. Tamoxifen for women at high risk of breast cancer. 

2. Visvanathan K, Hurley P, Bantug E, Brown P, Col NF, Cuzick J, Davidson NE, Decensi A, Fabian C, Ford L, Garber J, Katapodi M, Kramer B, Morrow M, Parker B, Runowicz C, Vogel VG 3rd, Wade JL, Lippman SM. Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. 

3. Cuzick J, Warwick J, Pinney E, Warren RM, Duffy SW. Tamoxifen and breast density in women at increased risk of breast cancer. 

4. Chen J-H, Change Y-C, Chang D, et al. Reduction of breast density following tamoxifen treatment evaluated by 3-D MRI: preliminary study. 

Carla de Venecia, MD

Articles

Image IQ: 52-year-old Female with Family History of Breast Cancer