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Prevalence of Breast Cancer and Atypia in Patients With High Bone Mineral Density: A Retrospective Analysis

Mai, Vinh Q. DO; Firdous, Saba MD; Nguyen, Huong D. MD; Krook, Linda S. MD; Shakir, K M. Mohamed MD

doi: 10.1097/TEN.0b013e3181c03e7a
Preliminary Study

Elevated bone mineral density (BMD) may be associated with the development of breast cancer and atypia. We investigated the prevalence of breast cancer and atypia in patients with elevated BMD from our outpatient endocrine clinic at the National Naval Medical Center in Bethesda, Maryland.

We retrospectively examined our database for all bone density scans performed on our Discovery QDR (Hologic Inc, Bedford, Mass) dual-energy x-ray absortiometry from July 2003 to September 2006 with an elevated z score ≥ +2.5 at the total spine, femoral neck or one-third distal forearm. Our dual-energy x-ray absortiometry is operated and calibrated according to the clinic's standard operating procedure. We obtained the patients’ diagnoses and characteristics from our electronic and paper chart systems including database from the Breast Care Clinic, where our patients received their treatment and follow-up care.

We found a total of 211 patients with bone density scans that matched our inclusion criteria. Twenty-eight of 211 patients (13.3%) had a diagnosis of breast cancer confirmed histopathologically. Six of 211 patients (2.8%) were diagnosed with atypical ductal hyperplasia. Their characteristics were analyzed according to age, ethnicity, menarche, age at diagnosis, age at menopause, smoking, alcohol use, medications, parity, family history of breast cancer, type of breast cancer, age at first pregnancy, breast cancer receptor status, degenerative joint disease, and Gail score.

We found a 16% prevalence of breast cancer and atypical ductal hyperplasia in our patient cohort with elevated bone density, z score ≥ +2.5, at the total spine, femoral neck or one-third distal forearm. The modestly increased prevalence of breast cancer and atypia from our population with elevated BMD suggest that high BMD based on the World Health Organization criteria may not be “normal” and may indicate the need for further evaluation.

From the Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, National Naval Medical Center, Bethesda, MD.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.

Reprints: Vinh Q. Mai, DO, Division of Endocrinology, National Naval Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889-5600. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.