title: Bone mass and breast cancer risk in older women: differences by stage at diagnosis.
abstract: BACKGROUND
  Older women with low bone mineral density (BMD) have a decreased incidence of breast cancer. It is not known whether this association is confined to early-stage, slow-growing tumors.
  
  
  METHODS
  We prospectively studied 8905 women who were 65 years of age or older during the period from 1986 through 1988 and had no history of breast cancer. At study entry, we used single-photon absorptiometry to measure each woman's BMD at three skeletal sites: the wrist, forearm, and heel. The women were followed for a mean of 6.5 years for the occurrence of breast cancer. All statistical tests were two-sided.
  
  
  RESULTS
  During 57 516 person-years of follow-up, 315 women developed primary invasive or in situ breast cancer. Multivariate analyses that adjusted for age, obesity, and other covariates revealed that the risk of breast cancer for women in the highest quartile of BMD for all three skeletal sites was 2.7 (95% confidence interval [CI] = 1.4 to 5.3) times greater than that for women in the lowest quartile at all three skeletal sites. The magnitude of increased risk associated with high BMD differed by the stage of disease at diagnosis and was greater for more advanced tumors (relative risk [RR] for TNM [i.e., tumor-lymph node-metastasis] stage II or higher tumors = 5.6; 95% CI = 1.2 to 27.4) than for early-stage disease (RR for in situ/TNM stage I tumors = 2.2; 95% CI = 1.0 to 4.8).
  
  
  CONCLUSIONS
  Elderly women with high BMD have an increased risk of breast cancer, especially advanced cancer, compared with women with low BMD. These findings suggest an association between osteoporosis and invasive breast cancer, two of the most prevalent conditions affecting an older woman's health.
authors: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA. epidjmz@pitt.edu
authors: J M
authors: JM
authors: Zmuda
authors: J A
authors: JA
authors: Cauley
authors: B M
authors: BM
authors: Ljung
authors: D C
authors: DC
authors: Bauer
authors: S R
authors: SR
authors: Cummings
authors: L H
authors: LH
authors: Kuller
mesh_terms: D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D001827:Body Height; D015992:Body Mass Index; D015519:Bone Density; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008572:Menarche; D008593:Menopause; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009765:Obesity / Q000453:epidemiology; D010024:Osteoporosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology