the authors note that many of the patients had dense mammograms. This is a variable that is not considered in the analysis, despite the fact that many others are considered. Indeed, the ability to obtain samples of breast cells and to detect the presence of hyperplasia (2) may be closely associated with dense mammograms, and this variable, also associated with breast cancer risk (3), should be added to the analysis in future studies of aspirated samples for risk analysis. DAVID PAGE
REFERENCES
Re: Short-Term Breast Cancer Prediction by Random Periareolar Fine-Needle Aspiration Cytology and the Gail Risk Model The article by Fabian et al. (1) regarding short-term prediction of breast cancer development by fine-needle aspiration cytology may be an important addition, certainly for testing in the area of cancer prediction and breast cancer risk. However, on page 1218 of the article,
68 CORRESPONDENCE
CAROL J. FABIAN BRUCE F. KIMLER MATTHEW S. MAYO
NOTES Affiliation of authors: University of Kansas Medical Center, Kansas City. Correspondence to: Carol J. Fabian, M.D., University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160–7820 (e-mail:
[email protected]).
NOTE Correspondence to: David Page, M.D., Department of Pathology, Vanderbilt University School of Medicine, Medical Center North, C-3321, 21st Ave., South, Nashville, TN 37232–2561.
RESPONSE We agree with Dr. Page that mammographic breast density is an important variable that may be associated with risk of development of breast cancer. However, we were not able to incorporate quantitative breast density data into the
Journal of the National Cancer Institute, Vol. 93, No. 1, January 3, 2001
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(1) Fabian CJ, Kimler BF, Zalles CM, Klemp JR, Kamel S, Zeiger S, et al. Short-term breast cancer prediction by random periareolar fineneedle aspiration cytology and the Gail risk model. J Natl Cancer Inst 2000;92:1217–27. (2) Boyd NF, Jensen HM, Cooke G, Han HL, Lockwood GA, Miller AB. Mammographic densities and the prevalence and incidence of histological types of benign breast disease. Reference Pathologists of the Canadian National Breast Screening Study. Eur J Cancer Prev 2000;9:15–24. (3) Boyd NF, Lockwood GA, Byng JW, Tritchler DL, Yaffe MJ. Mammographic densities and breast cancer risk. Cancer Epidemiol Biomarkers Prev 1998;7:1133–44.
analysis because not all mammograms before fine-needle aspiration were performed at the University of Kansas Medical Center, Kansas City, and, therefore, were not readily available for digitization. Approximately 6 years ago, we did institute a policy that all preaspiration mammograms must be performed in our facility. For the past 3 years, we have also required that a calibration step wedge be included. This will hopefully provide us the opportunity to assess breast density (quantitatively as well as qualitatively) as a putative risk factor in the future. Breast density is also being studied along with random periareolar fine-needle aspiration cytology as a potential surrogate end point biomarker in our phase II chemoprevention trials.
