We read with great interest the article by Douchi et al. [
Douchi T, Yonehara Y, Kosha S, et al. Bone mineral density in breast cancer patients
with positive estrogen receptor tumor status. Maturitas. 2007 January 18 [Epub ahead
] in which they showed that postmenopausal breast cancer patients with positive estrogen
receptor (ER) tumor status have higher bone mineral density (BMD) than age-matched,
healthy postmenopausal women. However, as they pointed out that those ER-negative
patients were not included in their study because of small size. Recent study from
M.D. Anderson Cancer evaluated the association of BMD at the time of diagnosis with
clinical-pathologic findings (history of hormone replacement therapy, existence of
in situ component, estrogen and progesterone receptor concentrations, tumor size,
nodal status, stage, grade, existence of lymphovascular invasion, and histology) in
patients with 117 operable postmenopausal breast cancer [
- Altundag K.
- Kim E.
- Broglio K.
- et al.
Characterization of bone mineral density (BMD) at the time of diagnosis in postmenopausal
patients with operable breast cancer: association with clinical-pathological findings.
]. Median age at diagnosis was 62 (range 49–83). Sixty-two patients had stage I disease
and 55 had stage II disease. Patients with higher BMD were found to have low grade
= 0.01 for lumbar spine BMD and P
= 0.09 for total hip BMD), no lymphovascular invasion (P
= 0.02 for lumbar spine BMD and P
= 0.03 for total hip BMD) and progesterone receptor-positive tumors (P
= 0.05 for lumbar spine BMD). Patients with low Ki-67 level also tended to have high
= 0.06 for lumbar spine BMD). However, linear regression models for lumbar and hip BMD,
adjusting for age showed there was no difference between ER-positive (n
= 103) and ER-negative (n
= 6) breast cancer patients (P
= 0.25 and 0.99, respectively). Although ER-negative patients in this study are in small
size, this preliminary result may suggest that estrogen may also play a role in the
pathogenesis of ER-negative postmenopausal breast cancer patients. This proposal should
be tested in large prospective studies.