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Issues in breast cancer prevention: body mass index, breast density, and fractures

Cecchini, Reena S. (2012) Issues in breast cancer prevention: body mass index, breast density, and fractures. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Breast cancer is the most frequently diagnosed cancer besides skin and the second leading cause of cancer death among American women. Breast cancer prevention comprises all techniques that lower the risk for developing breast cancer, thereby lowering population incidence and mortality. This dissertation used breast cancer prevention clinical trials data from the National Surgical Adjuvant Breast and Bowel Project to evaluate important issues related to breast cancer prevention. Some breast cancer risk factors are modifiable and can be changed with lifestyle adjustments. For example, high body weight has been associated with increased breast cancer risk among postmenopausal women, but the relationship in premenopausal women has remained unclear. In the first analysis, we found a significant association between overweight and obesity and increased breast cancer risk in premenopausal women, and a nonsignificant association among postmenopausal women. Other risk factors are not modifiable and require more complex interventions such as chemopreventive therapies. The Gail model is the most popular risk prediction model to determine who might benefit from these therapies, but it does not include breast density which is an established breast cancer risk factor. In a second analysis, high breast density was significantly associated with increased breast cancer risk when considered with the Gail score, but provided only slight improvement in discriminatory accuracy. Despite the success and availability of tamoxifen and raloxifene as chemopreventive agents, they have been underused in clinical settings. Providing more information about these drugs may help to increase their popularity. A final analysis expanded on prior findings about tamoxifen and bone fractures, and showed that tamoxifen reduced osteoporotic fracture risk for all subgroups of women. The public health significance of this dissertation is realized in the clarification and expansion of knowledge surrounding important issues in breast cancer prevention for both clinicians and patients. We showed that maintaining a healthy weight is likely beneficial for all women at high-risk for developing breast cancer, and that women receiving tamoxifen will gain the added benefit of fracture risk reduction. Furthermore, among postmenopausal women, a single assessment of breast density does not provide substantial risk prediction improvement.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Cecchini, Reena S.cecchini@nsabp.pitt.eduRLS18
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCauley, Jane A.jcauley@pitt.eduJCAULEY
Committee MemberCostantino, Joseph P.costan@nsabp.pitt.eduCOSTAN
Committee MemberWeissfeld, Joel L.jwepid@pitt.eduJWEPID
Committee MemberWickerham, D.
Committee MemberBandos, Hannahab7@pitt.eduHAB7
Date: 29 June 2012
Date Type: Completion
Defense Date: 27 March 2012
Approval Date: 29 June 2012
Submission Date: 3 April 2012
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 131
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: breast cancer, obesity, chemoprevention, tamoxifen, raloxifene, Gail model
Date Deposited: 29 Jun 2012 21:53
Last Modified: 29 Jun 2017 05:15

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  • Issues in breast cancer prevention: body mass index, breast density, and fractures. (deposited 29 Jun 2012 21:53) [Currently Displayed]


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