Bone mass and breast cancer risk in older women: Differences by stage at diagnosis

Background: Cider women with low bone mineral density (BMD) have a decrease d incidence of breast cancer. It is not known whether this association is c onfined to early-stage, slow-growing tumors. Methods: We prospectively stud ied 8905 women who were 65 years of age or older during the period from 198 6 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 57516 person-years of follow-up, 315 women devel oped primary invasive or in situ breast cancer. Multivariate analyses that adjusted for age, obesity, and other covariates revealed that the risk of b reast cancer for nomen in the highest quartile of BMD for all three skeleta l sites was 2.1 (95% confidence interval [CI] = 1.4 to 5.3) times greater t han 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 tu mors = 5.6; 95% CI = 1.2 to 27.4) than for early-stage disease (RR for in s itu/TNM stage I tumors = 2.2; 95% CI = 1.0 to 4.8). Conclusions: Elderly wo men with high BMD have an increased risk of breast cancer, especially advan ced cancer, compared with women with low BMD. These findings suggest an ass ociation between osteoporosis and invasive breast cancer, two of the most p revalent conditions affecting an older woman's health.