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Bowles EJA, O'Neill SC, Li T, Knerr S, Mandelblatt JS, Schwartz MD, Jayasekera J, Leppig K, Ehrlich K, Farrell D, Gao H, Graham AL, Luta G, Wernli KJ. Effect of a Randomized Trial of a Web-Based Intervention on Patient-Provider Communication About Breast Density. J Womens Health (Larchmt) 2021; 30:1529-1537. [PMID: 34582721 PMCID: PMC8823670 DOI: 10.1089/jwh.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Breast density increases breast cancer risk and decreases mammographic detection. We evaluated a personalized web-based intervention designed to improve breast cancer risk communication between women and their providers. Materials and Methods: This was a secondary outcome analysis of an online randomized trial. Women aged 40-69 years were randomized, February 2017-May 2018, to a control (n = 503) versus intervention website (n = 492). The intervention website included information about breast density, personalized breast cancer risk, chemoprevention, and magnetic resonance imaging. Participants self-reported communication about density with providers (yes/no) at 6 weeks and 12 months. We used logistic regression with generalized estimating equations to evaluate the association of study arm with density communication. In secondary analyses, we tested if the intervention was associated with indicators of patient activation (breast cancer worry, perceived risk, or health care use). Results: Women (mean age 62 years) in the intervention versus control arm were 2.39 times (95% confidence interval [CI] = 1.37-4.18) more likely to report density communication at 6 weeks; this effect persisted at 12 months (odds ratio [OR] = 1.71, 95% CI = 1.25-2.35). At 6 weeks, this effect was only significant among women who reported (OR = 3.23, 95% CI = 1.24-8.40) versus did not report any previous density discussions (OR = 1.64, 95% CI = 0.83-3.26). A quarter of women in each arm never had a density conversation at any time during the study. Conclusions: Despite providing personalized density and risk information, the intervention did not promote density discussions between women and their providers who had not had them previously. This intervention is unlikely to be used clinically to motivate density conversations in women who have not had them before. Clinical trial registration number NCT03029286.
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Affiliation(s)
- Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.,Address correspondence to: Erin J. Aiello Bowles, MPH, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
| | - Suzanne C. O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA
| | - Sarah Knerr
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Marc D. Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Jinani Jayasekera
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Kathleen Leppig
- Clinical Genetics, Washington Permanente Medical Group, Seattle, Washington, USA
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | | | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Amanda L. Graham
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA.,Truth Initiative, Washington, District of Columbia, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
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Dendl K, Koerber SA, Finck R, Mokoala KMG, Staudinger F, Schillings L, Heger U, Röhrich M, Kratochwil C, Sathekge M, Jäger D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI-PET/CT in patients with various gynecological malignancies. Eur J Nucl Med Mol Imaging 2021; 48:4089-4100. [PMID: 34050777 PMCID: PMC8484099 DOI: 10.1007/s00259-021-05378-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE 68Ga-FAPI (fibroblast activation protein inhibitor) is a novel and highly promising radiotracer for PET/CT imaging. The aim of this retrospective analysis is to explore the potential of FAPI-PET/CT in gynecological malignancies. We assessed biodistribution, tumor uptake, and the influence of pre- or postmenopausal status on tracer accumulation in hormone-sensitive organs. Furthermore, a comparison with the current standard oncological tracer 18F-FDG was performed in selected cases. PATIENTS AND METHODS A total of 31 patients (median age 59.5) from two centers with several gynecological tumors (breast cancer; ovarian cancer; cervical cancer; endometrial cancer; leiomyosarcoma of the uterus; tubal cancer) underwent 68Ga-FAPI-PET/CT. Out of 31 patients, 10 received an additional 18F-FDG scan within a median time interval of 12.5 days (range 1-76). Tracer uptake was quantified by standardized uptake values (SUV)max and (SUV)mean, and tumor-to-background ratio (TBR) was calculated (SUVmax tumor/ SUVmean organ). Moreover, a second cohort of 167 female patients with different malignancies was analyzed regarding their FAPI uptake in normal hormone-responsive organs: endometrium (n = 128), ovary (n = 64), and breast (n = 147). These patients were categorized by age as premenopausal (<35 years; n = 12), postmenopausal (>65 years; n = 68), and unknown menstrual status (35-65 years; n = 87), followed by an analysis of FAPI uptake of the pre- and postmenopausal group. RESULTS In 8 out of 31 patients, the primary tumor was present, and all 31 patients showed lesions suspicious for metastasis (n = 81) demonstrating a high mean SUVmax in both the primary (SUVmax 11.6) and metastatic lesions (SUVmax 9.7). TBR was significantly higher in 68Ga-FAPI compared to 18F-FDG for distant metastases (13.0 vs. 5.7; p = 0.047) and by trend for regional lymph node metastases (31.9 vs 27.3; p = 0.6). Biodistribution of 68Ga-FAPI-PET/CT presented significantly lower uptake or no significant differences in 15 out of 16 organs, compared to 18F-FDG-PET/CT. The highest uptake of all primary lesions was obtained in endometrial carcinomas (mean SUVmax 18.4), followed by cervical carcinomas (mean SUVmax 15.22). In the second cohort, uptake in premenopausal patients differed significantly from postmenopausal patients in endometrium (11.7 vs 3.9; p < 0.0001) and breast (1.8 vs 1.0; p = 0.004), whereas no significant difference concerning ovaries (2.8 vs 1.6; p = 0.141) was observed. CONCLUSION Due to high tracer uptake resulting in sharp contrasts in primary and metastatic lesions and higher TBRs than 18F-FDG-PET/CT, 68Ga-FAPI-PET/CT presents a promising imaging method for staging and follow-up of gynecological tumors. The presence or absence of the menstrual cycle seems to correlate with FAPI accumulation in the normal endometrium and breast. This first investigation of FAP ligands in gynecological tumor entities supports clinical application and further research in this field.
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Affiliation(s)
- Katharina Dendl
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Rebecca Finck
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Kgomotso M G Mokoala
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Fabian Staudinger
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Lisa Schillings
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Dirk Jäger
- Department of Medical Oncology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany.
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany.
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Biological Mechanisms and Therapeutic Opportunities in Mammographic Density and Breast Cancer Risk. Cancers (Basel) 2021; 13:cancers13215391. [PMID: 34771552 PMCID: PMC8582527 DOI: 10.3390/cancers13215391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
Mammographic density is an important risk factor for breast cancer; women with extremely dense breasts have a four to six fold increased risk of breast cancer compared to women with mostly fatty breasts, when matched with age and body mass index. High mammographic density is characterised by high proportions of stroma, containing fibroblasts, collagen and immune cells that suggest a pro-tumour inflammatory microenvironment. However, the biological mechanisms that drive increased mammographic density and the associated increased risk of breast cancer are not yet understood. Inflammatory factors such as monocyte chemotactic protein 1, peroxidase enzymes, transforming growth factor beta, and tumour necrosis factor alpha have been implicated in breast development as well as breast cancer risk, and also influence functions of stromal fibroblasts. Here, the current knowledge and understanding of the underlying biological mechanisms that lead to high mammographic density and the associated increased risk of breast cancer are reviewed, with particular consideration to potential immune factors that may contribute to this process.
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Hills N, Leslie M, Davis R, Crowell M, Kameyama H, Rui H, Chervoneva I, Dooley W, Tanaka T. Prolonged Time from Diagnosis to Breast-Conserving Surgery is Associated with Upstaging in Hormone Receptor-Positive Invasive Ductal Breast Carcinoma. Ann Surg Oncol 2021; 28:5895-5905. [PMID: 33748899 PMCID: PMC7982278 DOI: 10.1245/s10434-021-09747-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Time to surgery (TTS) has been suggested to have an association with mortality in early-stage breast cancer. OBJECTIVE This study aims to determine the association between TTS and preoperative disease progression in tumor size or nodal status among women diagnosed with clinical T1N0M0 ductal breast cancer. METHODS Women diagnosed with clinical T1N0M0 ductal breast cancer who had breast-conserving surgery as their first definitive treatment between 2010 and 2016 (n = 90,405) were analyzed using the National Cancer Database. Separate multivariable logistic regression models for hormone receptor (HR)-positive and HR-negative patients, adjusted for clinical and demographic variables, were used to assess the relationship between TTS and upstaging of tumor size (T-upstaging) or nodal status (N-upstaging). RESULTS T-upstaging occurred in 6.76% of HR-positive patients and 11.00% of HR-negative patients, while N-upstaging occurred in 12.69% and 10.75% of HR-positive and HR-negative patients, respectively. Among HR-positive patients, odds of T-upstaging were higher for 61-90 days TTS (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.05-1.34) and ≥91 days TTS (OR 1.47, 95% CI 1.17-1.84) compared with ≤30 days TTS, and odds of N- upstaging were higher for ≥91 days TTS (OR 1.35, 95% CI 1.13-1.62). No association between TTS and either T- or N-upstaging was found among HR-negative patients. Other clinical and demographic variables, including grade, tumor location, and race/ethnicity, were associated with both T- and N-upstaging. CONCLUSION TTS ≥61 and ≥91 days was a significant predictor of T- and N-upstaging, respectively, in HR-positive patients; however, TTS was not associated with upstaging in HR-negative breast cancer. Delays in surgery may contribute to measurable disease progression in T1N0M0 ductal breast cancer.
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Affiliation(s)
- Natalie Hills
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Macall Leslie
- University of Oklahoma Health Sciences Center, College of Medicine, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Rachel Davis
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Marielle Crowell
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Hiroyasu Kameyama
- University of Oklahoma Health Sciences Center, College of Medicine, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Hallgeir Rui
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - William Dooley
- Department of Surgery, University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Takemi Tanaka
- University of Oklahoma Health Sciences Center, College of Medicine, Stephenson Cancer Center, Oklahoma City, OK, USA.
- Department of Pathology, University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA.
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Mokhtary A, Karakatsanis A, Valachis A. Mammographic Density Changes over Time and Breast Cancer Risk: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13194805. [PMID: 34638289 PMCID: PMC8507818 DOI: 10.3390/cancers13194805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Although mammographic density is strongly linked to the risk of breast cancer, research on the relationship between changes in density over time and the risk of breast cancer has shown conflicting results. We found in the present meta-analysis that increased breast density over time was associated with higher breast cancer risk whereas decreased breast density might be associated with lower breast cancer risk. The results of the meta-analysis constitute a potential opportunity for more individualized screening strategies based on the evolution of breast density during mammography screening. Abstract The aim of this meta-analysis was to evaluate the association between mammographic density changes over time and the risk of breast cancer. We performed a systematic literature review based on the PubMed and ISI Web of Knowledge databases. A meta-analysis was conducted by computing extracted hazard ratios (HRs) and 95% confidence intervals (CIs) for cohort studies or odds ratios (ORs) and 95% confidence interval using inverse variance method. Of the nine studies included, five were cohort studies that used HR as a measurement type for their statistical analysis and four were case–control or cohort studies that used OR as a measurement type. Increased breast density over time in cohort studies was associated with higher breast cancer risk (HR: 1.61; 95% CI: 1.33–1.96) whereas decreased breast density over time was associated with lower breast cancer risk (HR: 0.78; 95% CI: 0.71–0.87). Similarly, increased breast density over time was associated with higher breast cancer risk in studies presented ORs (pooled OR: 1.85; 95% CI: 1.29–2.65). Our findings imply that an increase in breast density over time seems to be linked to an increased risk of breast cancer, whereas a decrease in breast density over time seems to be linked to a lower risk of breast cancer.
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Affiliation(s)
- Arezo Mokhtary
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden;
| | | | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Correspondence: ; Tel.: +46-735-617-691
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56
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Lee KH, Chae SW, Yun JS, Park YL, Park CH. Association between skeletal muscle mass and mammographic breast density. Sci Rep 2021; 11:16785. [PMID: 34408263 PMCID: PMC8373895 DOI: 10.1038/s41598-021-96390-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022] Open
Abstract
Mammographic density (MD) of the breast and body mass index (BMI) are inversely associated with each other, but have inconsistent associations with respect to the risk of breast cancer. Skeletal muscle mass index (SMI) has been considered to reflect a relatively accurate fat and muscle percentage in the body. So, we evaluated the relation between SMI and MD. A cross-sectional study was performed in 143,456 women who underwent comprehensive examinations from 2012 to 2016. BMI was adjusted to analyze whether SMI is an independent factor predicting dense breast. After adjustment for confounding factors including BMI, the odds ratios for MD for the dense breasts was between the highest and lowest quartiles of SMI at 2.65 for premenopausal women and at 2.39 for postmenopausal women. SMI was a significant predictor for MD, which could be due to the similar growth mechanism of the skeletal muscle and breast parenchymal tissue. Further studies are needed to understand the causal link between muscularity, MD and breast cancer risk.
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Affiliation(s)
- Kwan Ho Lee
- Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Korea.
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57
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Austin JD, Agovino M, Rodriguez CB, Terry MB, Shelton RC, Wei Y, Desperito E, Schmitt KM, Kukafka R, Tehranifar P. Breast Density Awareness and Knowledge in a Mammography Screening Cohort of Predominantly Hispanic Women: Does Breast Density Notification Matter? Cancer Epidemiol Biomarkers Prev 2021; 30:1913-1920. [PMID: 34348958 DOI: 10.1158/1055-9965.epi-21-0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND New York State law mandates that women with dense breasts receive a written notification of their breast density (BD) and its implications, but data on the impact of dense breast notification (DBN) on BD awareness and knowledge in diverse populations remain limited. METHODS Between 2016 and 2018, we collected survey and mammographic data from 666 women undergoing screening mammography in New York City (ages 40-60, 80% Hispanic, 69% Spanish-speaking) to examine the impact of prior DBN on BD awareness by sociodemographic and breast cancer risk factors, and describe BD knowledge by sources of information. RESULTS Only 24.8% of the overall sample and 34.9% of women receiving DBN had BD awareness. In multivariable models adjusting for DBN, awareness was significantly lower in women who were Spanish-speaking [OR, 0.16; 95% confidence interval (CI), 0.09-0.30 vs. English speakers], were foreign-born (OR, 0.31; 95% CI, 0.16-0.58 vs. U.S.-born), and had lower educational attainment (e.g., high school degree or less; OR, 0.14; 95% CI, 0.08-0.26 vs. college or higher degree). Women receiving DBN were more likely to be aware of BD (OR, 2.61; 95% CI, 1.59-4.27) but not more knowledgeable about the impact of BD on breast cancer risk and detection. However, women reporting additional communication about their BD showed greater knowledge in these areas. CONCLUSIONS DBN increases BD awareness disproportionately across sociodemographic groups. IMPACT Efforts to improve communication of DBN must focus on addressing barriers in lower socioeconomic and racially and ethnically diverse women, including educational and language barriers.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Mariangela Agovino
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Carmen B Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.,Division of Academics, Columbia University School of Nursing, New York, New York
| | - Rita Kukafka
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.,Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. .,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
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Advani SM, Zhu W, Demb J, Sprague BL, Onega T, Henderson LM, Buist DSM, Zhang D, Schousboe JT, Walter LC, Kerlikowske K, Miglioretti DL, Braithwaite D. Association of Breast Density With Breast Cancer Risk Among Women Aged 65 Years or Older by Age Group and Body Mass Index. JAMA Netw Open 2021; 4:e2122810. [PMID: 34436608 PMCID: PMC8391100 DOI: 10.1001/jamanetworkopen.2021.22810] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Breast density is associated with breast cancer risk in women aged 40 to 65 years, but there is limited evidence of its association with risk of breast cancer among women aged 65 years or older. OBJECTIVE To compare the association between breast density and risk of invasive breast cancer among women aged 65 to 74 years vs women aged 75 years or older and to evaluate whether the association is modified by body mass index (BMI). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used data from the Breast Cancer Surveillance Consortium from January 1, 1996, to December 31, 2012, for US women aged 65 years or older who underwent screening mammography. Data were analyzed from January 1, 2018, to December 31, 2020. EXPOSURES Breast Imaging Reporting and Data System breast density category, age, and BMI. MAIN OUTCOMES AND MEASURES The 5-year cumulative incidence of invasive breast cancer by level of breast density (almost entirely fat, scattered fibroglandular densities, or heterogeneous or extreme density) and age (65-74 vs ≥75 years) was calculated using weighted means. Cox proportional hazards models were fit to estimate the association of breast density with invasive breast cancer risk. The likelihood ratio test was used to test the interaction between BMI and breast density. RESULTS A total of 221 714 screening mammograms from 193 787 women were included in the study; a total of 38% of the study population was aged 75 years or older. Of the mammograms, most were from women aged 65 to 74 years (64.6%) and non-Hispanic White individuals (81.4%). The 5-year cumulative incidence of invasive breast cancer increased in association with increasing breast density among women aged 65 to 74 years (almost entirely fatty breasts: 11.3 per 1000 women [95% CI, 10.4-12.5 per 1000 women]; scattered fibroglandular densities: 17.2 per 1000 women [95% CI, 16.1-17.9 per 1000 women]; extremely or heterogeneously dense breasts: 23.7 per 1000 women [95% CI, 22.4-25.3 per 1000 women]) and among those aged 75 years or older (fatty breasts: 13.5 per 1000 women [95% CI, 11.6-15.5]; scattered fibroglandular densities: 18.4 per 1000 women [95% CI, 17.0-19.5 per 1000 women]; extremely or heterogeneously dense breasts: 22.5 per 1000 women [95% CI, 20.2-24.2 per 1000 women]). Extreme or heterogeneous breast density was associated with increased risk of breast cancer compared with scattered fibroglandular breast density in both age categories (65-74 years: hazard ratio [HR], 1.39 [95% CI, 1.28-1.50]; ≥75 years: HR, 1.23 [95% CI, 1.10-1.37]). Women with almost entirely fatty breasts had a decrease of approximately 30% (range, 27%-34%) in the risk of invasive breast cancer compared with women with scattered fibroglandular breast density (65-74 years: HR, 0.66 [95% CI, 0.58-0.75]; ≥75 years: HR, 0.73; 95% CI, 0.62-0.86). Associations between breast density and breast cancer risk were not significantly modified by BMI (for age 65-74 years: likelihood ratio test, 2.67; df, 2; P = .26; for age ≥75 years, 2.06; df, 2; P = .36). CONCLUSIONS AND RELEVANCE The findings suggest that breast density is associated with increased risk of invasive breast cancer among women aged 65 years or older. Breast density and life expectancy should be considered together when discussing the potential benefits vs harms of continued screening mammography in this population.
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Affiliation(s)
- Shailesh M. Advani
- Department of Oncology, Georgetown University, Washington, DC
- Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Joshua Demb
- Department of Medicine, University of California, San Diego
| | - Brian L. Sprague
- Department of Surgery, Larner College of Medicine, University of Vermont, Burlington
| | - Tracy Onega
- Department of Population Sciences, University of Utah, Salt Lake City
| | | | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Dongyu Zhang
- Department of Epidemiology, University of Florida, Gainesville
| | - John T. Schousboe
- Division of Research, Health Partners Institute, Bloomington, Minnesota
| | | | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Public Health Sciences, School of Medicine, University of California, Davis
| | - Dejana Braithwaite
- Terasaki Institute of Biomedical Innovation, Los Angeles, California
- Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville
- Department of Epidemiology, University of Florida, Gainesville
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His M, Lajous M, Gómez-Flores-Ramos L, Monge A, Dossus L, Viallon V, Gicquiau A, Biessy C, Gunter MJ, Rinaldi S. Biomarkers of mammographic density in premenopausal women. Breast Cancer Res 2021; 23:75. [PMID: 34301304 PMCID: PMC8305592 DOI: 10.1186/s13058-021-01454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND While mammographic density is one of the strongest risk factors for breast cancer, little is known about its determinants, especially in young women. We applied targeted metabolomics to identify circulating metabolites specifically associated with mammographic density in premenopausal women. Then, we aimed to identify potential correlates of these biomarkers to guide future research on potential modifiable determinants of mammographic density. METHODS A total of 132 metabolites (acylcarnitines, amino acids, biogenic amines, glycerophospholipids, sphingolipids, hexose) were measured by tandem liquid chromatography/mass spectrometry in plasma samples from 573 premenopausal participants in the Mexican Teachers' Cohort. Associations between metabolites and percent mammographic density were assessed using linear regression models, adjusting for breast cancer risk factors and accounting for multiple tests. Mean concentrations of metabolites associated with percent mammographic density were estimated across levels of several lifestyle and metabolic factors. RESULTS Sphingomyelin (SM) C16:1 and phosphatidylcholine (PC) ae C30:2 were inversely associated with percent mammographic density after correction for multiple tests. Linear trends with percent mammographic density were observed for SM C16:1 only in women with body mass index (BMI) below the median (27.4) and for PC ae C30:2 in women with a BMI over the median. SM C16:1 and PC ae C30:2 concentrations were positively associated with cholesterol (total and HDL) and inversely associated with number of metabolic syndrome components. CONCLUSIONS We identified new biomarkers associated with mammographic density in young women. The association of these biomarkers with mammographic density and metabolic parameters may provide new perspectives to support future preventive actions for breast cancer.
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Affiliation(s)
- Mathilde His
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, 62100, Cuernavaca, México.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Liliana Gómez-Flores-Ramos
- Center for Research on Population Health, National Institute of Public Health, 62100, Cuernavaca, México
- Cátedras-CONACYT, Mexico City, Mexico
| | - Adriana Monge
- Center for Research on Population Health, National Institute of Public Health, 62100, Cuernavaca, México
| | - Laure Dossus
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Vivian Viallon
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Audrey Gicquiau
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Carine Biessy
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Marc J Gunter
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
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Atakpa EC, Brentnall AR, Astley S, Cuzick J, Evans DG, Warren RML, Howell A, Harvie M. The Relationship between Body Mass Index and Mammographic Density during a Premenopausal Weight Loss Intervention Study. Cancers (Basel) 2021; 13:3245. [PMID: 34209579 PMCID: PMC8269424 DOI: 10.3390/cancers13133245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
We evaluated the association between short-term change in body mass index (BMI) and breast density during a 1 year weight-loss intervention (Manchester, UK). We included 65 premenopausal women (35-45 years, ≥7 kg adult weight gain, family history of breast cancer). BMI and breast density (semi-automated area-based, automated volume-based) were measured at baseline, 1 year, and 2 years after study entry (1 year post intervention). Cross-sectional (between-women) and short-term change (within-women) associations between BMI and breast density were measured using repeated-measures correlation coefficients and multivariable linear mixed models. BMI was positively correlated with dense volume between-women (r = 0.41, 95%CI: 0.17, 0.61), but less so within-women (r = 0.08, 95%CI: -0.16, 0.28). There was little association with dense area (between-women r = -0.12, 95%CI: -0.38, 0.16; within-women r = 0.01, 95%CI: -0.24, 0.25). BMI and breast fat were positively correlated (volume: between r = 0.77, 95%CI: 0.69, 0.84, within r = 0.58, 95%CI: 0.36, 0.75; area: between r = 0.74, 95%CI: 0.63, 0.82, within r = 0.45, 95%CI: 0.23, 0.63). Multivariable models reported similar associations. Exploratory analysis suggested associations between BMI gain from 20 years and density measures (standard deviation change per +5 kg/m2 BMI: dense area: +0.61 (95%CI: 0.12, 1.09); fat volume: -0.31 (95%CI: -0.62, 0.00)). Short-term BMI change is likely to be positively associated with breast fat, but we found little association with dense tissue, although power was limited by small sample size.
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Affiliation(s)
- Emma C. Atakpa
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (E.C.A.); (A.R.B.); (J.C.)
| | - Adam R. Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (E.C.A.); (A.R.B.); (J.C.)
| | - Susan Astley
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
- Manchester Breast Centre, The Christie Hospital, Manchester M23 9LT, UK
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (E.C.A.); (A.R.B.); (J.C.)
| | - D. Gareth Evans
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
- Manchester Breast Centre, The Christie Hospital, Manchester M23 9LT, UK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester M23 9LT, UK
- Manchester Centre for Genomic Medicine, NW Genomic Laboratory Hub, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
- Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, Faculty of Biology, School of Biological Sciences, Medicine and Health, University of Manchester, Manchester M23 9LT, UK
| | - Ruth M. L. Warren
- Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK;
- Girton College, University of Cambridge, Cambridge CB3 0JG, UK
| | - Anthony Howell
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
- Manchester Breast Centre, The Christie Hospital, Manchester M23 9LT, UK
- Manchester Academic Health Science Centre, Division of Cancer Sciences, Medicine and Health, University of Manchester, Manchester M23 9LT, UK
| | - Michelle Harvie
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
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Senda N, Kawaguchi-Sakita N, Kawashima M, Inagaki-Kawata Y, Yoshida K, Takada M, Kataoka M, Torii M, Nishimura T, Kawaguchi K, Suzuki E, Kataoka Y, Matsumoto Y, Yoshibayashi H, Yamagami K, Tsuyuki S, Takahara S, Yamauchi A, Shinkura N, Kato H, Moriguchi Y, Okamura R, Kan N, Suwa H, Sakata S, Mashima S, Yotsumoto F, Tachibana T, Tanaka M, Togashi K, Haga H, Yamada T, Kosugi S, Inamoto T, Sugimoto M, Ogawa S, Toi M. Optimization of prediction methods for risk assessment of pathogenic germline variants in the Japanese population. Cancer Sci 2021; 112:3338-3348. [PMID: 34036661 PMCID: PMC8353892 DOI: 10.1111/cas.14986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 12/19/2022] Open
Abstract
Predicting pathogenic germline variants (PGVs) in breast cancer patients is important for selecting optimal therapeutics and implementing risk reduction strategies. However, PGV risk factors and the performance of prediction methods in the Japanese population remain unclear. We investigated clinicopathological risk factors using the Tyrer‐Cuzick (TC) breast cancer risk evaluation tool to predict BRCA PGVs in unselected Japanese breast cancer patients (n = 1,995). Eleven breast cancer susceptibility genes were analyzed using target‐capture sequencing in a previous study; the PGV prevalence in BRCA1, BRCA2, and PALB2 was 0.75%, 3.1%, and 0.45%, respectively. Significant associations were found between the presence of BRCA PGVs and early disease onset, number of familial cancer cases (up to third‐degree relatives), triple‐negative breast cancer patients under the age of 60, and ovarian cancer history (all P < .0001). In total, 816 patients (40.9%) satisfied the National Comprehensive Cancer Network (NCCN) guidelines for recommending multigene testing. The sensitivity and specificity of the NCCN criteria for discriminating PGV carriers from noncarriers were 71.3% and 60.7%, respectively. The TC model showed good discrimination for predicting BRCA PGVs (area under the curve, 0.75; 95% confidence interval, 0.69‐0.81). Furthermore, use of the TC model with an optimized cutoff of TC score ≥0.16% in addition to the NCCN guidelines improved the predictive efficiency for high‐risk groups (sensitivity, 77.2%; specificity, 54.8%; about 11 genes). Given the influence of ethnic differences on prediction, we consider that further studies are warranted to elucidate the role of environmental and genetic factors for realizing precise prediction.
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Affiliation(s)
- Noriko Senda
- Department of Breast Surgery, Kyoto University, Kyoto, Japan
| | | | | | | | - Kenichi Yoshida
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Kyoto University, Kyoto, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Masae Torii
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | | | | | - Eiji Suzuki
- Department of Breast Surgery, Kyoto University, Kyoto, Japan
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, School of Public Health, in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Hiroshi Yoshibayashi
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kazuhiko Yamagami
- Department of Breast Surgery and Oncology, Shinko Hospital, Kobe, Japan
| | - Shigeru Tsuyuki
- Department of Breast Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | | | - Akira Yamauchi
- Department of Breast Surgery, Kitano Hospital, Osaka, Japan
| | - Nobuhiko Shinkura
- Department of Surgery, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hironori Kato
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Ryuji Okamura
- Department of Breast Surgery, Yamatotakada Municipal Hospital, Yamatotakada, Japan
| | | | - Hirofumi Suwa
- Department of Breast Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Shingo Sakata
- Department of Breast Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Susumu Mashima
- Department of Surgery, Japan Community Health Care Organization, Yamato Koriyama Hospital, Yamato Koriyama, Japan
| | - Fumiaki Yotsumoto
- Department of Breast Surgery, Shiga General Hospital, Moriyama, Japan
| | | | - Mitsuru Tanaka
- Department of Surgery, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Yamada
- Department of Medical Ethics/Medical Genetics, Kyoto University, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Ethics/Medical Genetics, Kyoto University, Kyoto, Japan
| | - Takashi Inamoto
- Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Masahiro Sugimoto
- Health Promotion and Preemptive Medicine, Research and Development Center for Minimally Invasive Therapies, Tokyo Medical University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University, Kyoto, Japan
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Vinnicombe S, Harvey H, Healy NA, Papalouka V, Schiller A, Moyle P, Kilburn-Toppin F, Allajbeu I, Sharma N, Maxwell AJ, Payne N, Graves M, Gilbert FJ. Introduction of an abbreviated breast MRI service in the UK as part of the BRAID trial: practicalities, challenges, and future directions. Clin Radiol 2021; 76:427-433. [PMID: 33712291 DOI: 10.1016/j.crad.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022]
Affiliation(s)
- S Vinnicombe
- Thirlestaine Breast Centre, Gloucestershire NHS Foundation Trust, Thirlestaine Road, Cheltenham, GL53 7AS, UK
| | - H Harvey
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - N A Healy
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - V Papalouka
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - A Schiller
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - P Moyle
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - F Kilburn-Toppin
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - I Allajbeu
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - N Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - A J Maxwell
- Nightingale Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK; Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - N Payne
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - M Graves
- MRIS, Cambridge University Hospitals, Box 216, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - F J Gilbert
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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63
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Kim S, Park B. Association between changes in mammographic density category and the risk of breast cancer: A nationwide cohort study in East-Asian women. Int J Cancer 2021; 148:2674-2684. [PMID: 33368233 DOI: 10.1002/ijc.33455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 12/09/2022]
Abstract
Breast density is strongly associated with breast cancer risk; however, studies on the association between density changes and breast cancer risk have controversial results. The aim of our study was to determine the association between breast density changes and breast cancer risk in East-Asian women. We included 3 301 279 women aged ≥40 years screened for breast cancer twice during 2009 to 2010 and 2011 to 2012. Data were obtained from the National Health Insurance Service (NHIS) database. Breast density was evaluated using the Breast Imaging-Reporting and Data System (BI-RADS). Relative risk (RR) and 5-year risk of developing breast cancer according to density category changes were calculated. Overall, 23.0% of the women had a higher breast density and 22.2% of the women had a lower breast density in second screening compared to the first. An increase in the BI-RADS density category between two subsequent mammographic screenings was associated with an increase in breast cancer risk and vice versa in terms of RR. The 5-year breast cancer risk was affected by the initial BI-RADS density category, changes in density category and patients' characteristics such as age, menopausal status and family history of breast cancer. In patients with breast cancer family history, the 5-year breast cancer risk was prominent, at a maximum of 2.39% (95% CI = 1.23-3.55) in women with breast density category of 2 to 4. Changes in the BI-RADS density category were associated with breast cancer risk. Longitudinal measures of BI-RADS density may be helpful in identifying high-risk women, especially those with a breast cancer family history.
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Affiliation(s)
- Soyeoun Kim
- Department of Health Sciences, Hanyang University College of Medicine, Seoul, South Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea
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64
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Chen H, Yaghjyan L, Li C, Peters U, Rosner B, Lindström S, Tamimi RM. Association of Interactions Between Mammographic Density Phenotypes and Established Risk Factors With Breast Cancer Risk, by Tumor Subtype and Menopausal Status. Am J Epidemiol 2021; 190:44-58. [PMID: 32639533 DOI: 10.1093/aje/kwaa131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
Previous studies suggest that the association between mammographic density (MD) and breast cancer risk might be modified by other breast cancer risk factors. In this study, we assessed multiplicative interactions between MD measures and established risk factors on the risk of invasive breast cancer overall and according to menopausal and estrogen receptor status. We used data on 2,137 cases and 4,346 controls from a nested case-control study within the Nurses' Health Study (1976-2004) and Nurses' Health Study II (1989-2007), whose data on percent mammographic density (PMD) and absolute area of dense tissue and nondense tissue (NDA) were available. No interaction remained statistically significant after adjusting for number of comparisons. For breast cancer overall, we observed nominally significant interactions (P < 0.05) between nulliparity and PMD/NDA, age at menarche and area of dense tissue, and body mass index and NDA. Individual nominally significant interactions across MD measures and risk factors were also observed in analyses stratified by either menopausal or estrogen receptor status. Our findings help provide further insights into potential mechanisms underlying the association between MD and breast cancer.
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65
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Rosner B, Tamimi RM, Kraft P, Gao C, Mu Y, Scott C, Winham SJ, Vachon CM, Colditz GA. Simplified Breast Risk Tool Integrating Questionnaire Risk Factors, Mammographic Density, and Polygenic Risk Score: Development and Validation. Cancer Epidemiol Biomarkers Prev 2020; 30:600-607. [PMID: 33277321 DOI: 10.1158/1055-9965.epi-20-0900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical use of breast cancer risk prediction requires simplified models. We evaluate a simplified version of the validated Rosner-Colditz model and add percent mammographic density (MD) and polygenic risk score (PRS), to assess performance from ages 45-74. We validate using the Mayo Mammography Health Study (MMHS). METHODS We derived the model in the Nurses' Health Study (NHS) based on: MD, 77 SNP PRS and a questionnaire score (QS; lifestyle and reproductive factors). A total of 2,799 invasive breast cancer cases were diagnosed from 1990-2000. MD (using Cumulus software) and PRS were assessed in a nested case-control study. We assess model performance using this case-control dataset and evaluate 10-year absolute breast cancer risk. The prospective MMHS validation dataset includes 21.8% of women age <50, and 434 incident cases identified over 10 years of follow-up. RESULTS In the NHS, MD has the highest odds ratio (OR) for 10-year risk prediction: ORper SD = 1.48 [95% confidence interval (CI): 1.31-1.68], followed by PRS, ORper SD = 1.37 (95% CI: 1.21-1.55) and QS, ORper SD = 1.25 (95% CI: 1.11-1.41). In MMHS, the AUC adjusted for age + MD + QS 0.650; for age + MD + QS + PRS 0.687, and the NRI was 6% in cases and 16% in controls. CONCLUSION A simplified assessment of QS, MD, and PRS performs consistently to discriminate those at high 10-year breast cancer risk. IMPACT This simplified model provides accurate estimation of 10-year risk of invasive breast cancer that can be used in a clinical setting to identify women who may benefit from chemopreventive intervention.See related commentary by Tehranifar et al., p. 587.
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Affiliation(s)
- Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Epidemiology, Population Health Sciences Department, Weill Cornell Medicine, New York, New York
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chi Gao
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yi Mu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christopher Scott
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Stacey J Winham
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Celine M Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Graham A Colditz
- Alvin J. Siteman Cancer Center and Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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66
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Sardu C, Gatta G, Pieretti G, Viola L, Sacra C, Di Grezia G, Musto L, Minelli S, La Forgia D, Capodieci M, Galiano A, Vestito A, De Lisio A, Pafundi PC, Sasso FC, Cappabianca S, Nicoletti G, Paolisso G, Marfella R. Pre-Menopausal Breast Fat Density Might Predict MACE During 10 Years of Follow-Up: The BRECARD Study. JACC Cardiovasc Imaging 2020; 14:426-438. [PMID: 33129736 DOI: 10.1016/j.jcmg.2020.08.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study sought to determine whether the breast gland adipose tissue is associated with different rates of major adverse cardiac events (MACEs) in pre-menopausal women. BACKGROUND To our knowledge, no study investigated the impact of breast adipose tissue infiltration on MACEs in pre-menopausal women. METHODS Prospective multicenter cohort study conducted on pre-menopausal women >40 years of age without cardiovascular disease and breast cancer at enrollment. The study started in January 2000 and ended in January 2009, and the end of the follow-up for the evaluation of MACEs was in January 2019. Participants underwent mammography to evaluate breast density and were divided into 4 groups according to their breast density. The primary endpoint was the probability of a MACE at 10 years of follow-up in patients staged for different breast deposition/adipose tissue deposition. RESULTS The propensity score matching divided the baseline population of 16,763 pre-menopausal women, leaving 3,272 women according to the category of breast density from A to D. These women were assigned to 4 groups of the study according to baseline breast density. At 10 years of follow-up, we had 160 MACEs in group 1, 62 MACEs in group 2, 27 MACEs in group 3, and 16 MACEs in group 4. MACEs were predicted by the initial diagnosis of lowest breast density (hazard ratio: 3.483; 95% confidence interval: 1.476 to 8.257). Further randomized clinical trials are needed to translate the results of the present study into clinical practice. The loss of ex vivo breast density models to study the cellular/molecular pathways implied in MACE is another study limitation. CONCLUSIONS Among pre-menopausal women, a higher evidence of adipose tissue at the level of breast gland (lowest breast density, category A) versus higher breast density shows higher rates of MACEs. Therefore, the screening mammography could be proposed in overweight women to stage breast density and to predict MACEs. (Breast Density in Pre-menopausal Women Is Predictive of Cardiovascular Outcomes at 10 Years of Follow-Up [BRECARD]; NCT03779217).
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Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Gianluca Gatta
- Breast Unit, Department of Clinical and Experimental Internship, University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Imaging, University of Naples, Naples, Italy
| | - Gorizio Pieretti
- Breast Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Naples, Naples, Italy
| | - Luigi Viola
- Breast Unit, Department of Clinical and Experimental Internship, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Cosimo Sacra
- Department of Cardiovascular Diseases, "John Paul II" Research and Care Foundation, Campobasso, Italy
| | | | - Lanfranco Musto
- Department of Imaging, "Criscuoli" Hospital, Avellino, Italy
| | | | | | | | | | - Angela Vestito
- Department of Imaging, "Saint Paul" Hospital, Bari, Italy
| | - Angela De Lisio
- Department of Imaging, "Federico II" University of Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Salvatore Cappabianca
- Breast Unit, Department of Clinical and Experimental Internship, University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Imaging, University of Naples, Naples, Italy
| | - Gianfranco Nicoletti
- Department of Imaging, University of Naples, Naples, Italy; Breast Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Naples, Naples, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
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Kim EY, Chang Y, Ahn J, Yun JS, Park YL, Park CH, Shin H, Ryu S. Mammographic breast density, its changes, and breast cancer risk in premenopausal and postmenopausal women. Cancer 2020; 126:4687-4696. [PMID: 32767699 DOI: 10.1002/cncr.33138] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The risk of breast cancer related to changes in breast density over time, including its regression and persistence, remains controversial. The authors investigated the relationship between breast density and its changes over time with the development of breast cancer in premenopausal and postmenopausal women. METHODS The current cohort study included 74,249 middle-aged Korean women (aged ≥35 years) who were free of breast cancer at baseline and who underwent repeated screening mammograms. Mammographic breast density was categorized according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). A dense breast was defined as heterogeneously dense or extremely dense, and changes in dense breasts between baseline and subsequent follow-up were classified as none, developed, regressed, or persistent dense breast. RESULTS During a median follow-up of 6.1 years (interquartile range, 4.1-8.8 years), a total of 803 incident breast cancers were identified. Baseline breast density was found to be positively associated with incident breast cancer in a dose-response manner, and this association did not significantly differ by menopausal status. The multivariable-adjusted hazard ratios (HRs) for breast cancer comparing "heterogeneously dense" and "extremely dense" categories with the nondense category were 1.96 (95% confidence interval [95% CI], 1.40-2.75) and 2.86 (95% CI, 2.04-4.01), respectively. With respect to changes in dense breasts over time, multivariable-adjusted HRs for breast cancer comparing persistent dense breast with none were 2.37 (95% CI, 1.34-4.21) in premenopausal women and 3.61 (95% CI, 1.78-7.30) in postmenopausal women. CONCLUSIONS Both baseline dense breasts and their persistence over time were found to be strongly associated with an increased risk of incident breast cancer in premenopausal and postmenopausal women. LAY SUMMARY Both baseline breast density and its changes over time were found to be independently associated with the risk of breast cancer in both premenopausal and postmenopausal women. The risk of incident breast cancer increased in women with persistent dense breasts, whereas the breast cancer risk decreased as dense breasts regressed. The findings of the current study support that both dense breasts at baseline and their persistence over time are independent risk factors for developing breast cancer.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Lian J, Li K. A Review of Breast Density Implications and Breast Cancer Screening. Clin Breast Cancer 2020; 20:283-290. [DOI: 10.1016/j.clbc.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
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Menopausal Transition, Body Mass Index, and Prevalence of Mammographic Dense Breasts in Middle-Aged Women. J Clin Med 2020; 9:jcm9082434. [PMID: 32751482 PMCID: PMC7465213 DOI: 10.3390/jcm9082434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
The interrelationship between menopausal stage, excessive adiposity and dense breasts remains unclear. We aimed to investigate the relationship between menopausal stage and dense-breast prevalence in midlife women while considering a possible effect modification of being overweight. The present cross-sectional study comprised 82,677 Korean women, aged 35–65 years, who attended a screening exam. Menopausal stages were categorized based on the Stages of Reproductive Aging Workshop (STRAW + 10) criteria. Mammographic breast density was categorized according to Breast Imaging Reporting and Data System (BI-RADS). Dense breasts were defined as BI-RADS Breast Density category D (extremely dense). The prevalence of dense breasts decreased as menopausal stage increased (p-trend < 0.001), and this pattern was pronounced in overweight women than non-overweight women (p-interaction = 0.016). Compared with pre-menopause, the multivariable-adjusted prevalence ratios (and 95% confidence intervals) for dense breasts were 0.98 (0.96–1.00) in early transition, 0.89 (0.86–0.92) in late transition, and 0.55 (0.52–0.59) in post-menopause, among non-overweight women, while corresponding prevalence ratios were 0.92 (0.87–0.98), 0.83 (0.77–0.90) and 0.36 (0.31–0.41) among overweight women. The prevalence of dense breasts was inversely associated with increasing menopausal stages and significantly decreased from the late menopausal transition, with stronger declines among overweight women.
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Pekcan MK, Findik RB, Tokmak A, Taşçi Y. The Relationship Between Breast Density, Bone Mineral Density, and Metabolic Syndrome Among Postmenopausal Turkish Women. J Clin Densitom 2020; 23:490-496. [PMID: 30527863 DOI: 10.1016/j.jocd.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 02/05/2023]
Abstract
The relationship between metabolic syndrome (MetS) and menopause remains unclear. The effects of MetS on breast and bone density in this group of women are also not fully elucidated. Herein, we aimed to investigate the relationship between components of the MetS, mammographic breast density (MBD), and vertebral/femoral bone mineral density (BMD) in postmenopausal Turkish women. The study group consisted of postmenopausal women with MetS whereas controls postmenopausal women without MetS. All consecutive women who applied to our center for routine postmenopausal follow up and met the inclusion criteria, between July 2013 and October 2015 were included in the study. Menopause was defined as the cessation of menstruation for at least 1 year, and we used the definition of the MetS suggested by a joint interim statement. BMD of the spine and femur was measured by dual energy X-ray absorptiometry. The medical records of 390 postmenopausal were retrospectively reviewed. No significant differences were observed between the groups in terms of age, menopause type, and menopause duration (p > 0.05). Decreased MBD (for grade 1-2 and 3-4 densities) was associated with increased MetS risk (p = 0.017). Total femoral BMD, total lumber BMD, femoral neck BMD were significantly higher in postmenopausal women with MetS (p < 0,005). This study is the first report focusing on the relationship between MetS and breast/bone density. According to the results of our study, the presence of MetS in postmenopausal periods has a positive effect on both MBD and BMD.
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Affiliation(s)
- Meryem Kuru Pekcan
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey.
| | - Rahime Bedir Findik
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey.
| | - Aytekin Tokmak
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey.
| | - Yasemin Taşçi
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey.
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Mammographic density changes during neoadjuvant breast cancer treatment: NeoDense, a prospective study in Sweden. Breast 2020; 53:33-41. [PMID: 32563178 PMCID: PMC7375568 DOI: 10.1016/j.breast.2020.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess if mammographic density (MD) changes during neoadjuvant breast cancer treatment and is predictive of a pathological complete response (pCR). METHODS We prospectively included 200 breast cancer patients assigned to neoadjuvant chemotherapy (NACT) in the NeoDense study (2014-2019). Raw data mammograms were used to assess MD with a fully automated volumetric method and radiologists categorized MD using the Breast Imaging-Reporting and Data System (BI-RADS), 5th Edition. Logistic regression was used to calculate odds ratios (OR) for pCR comparing BI-RADS categories c vs. a, b, and d as well as with a 0.5% change in percent dense volume adjusting for baseline characteristics. RESULTS The overall median age was 53.1 years, and 48% of study participants were premenopausal pre-NACT. A total of 23% (N = 45) of the patients accomplished pCR following NACT. Patients with very dense breasts (BI-RADS d) were more likely to have a positive axillary lymph node status at diagnosis: 89% of the patients with very dense breasts compared to 72% in the entire cohort. A total of 74% of patients decreased their absolute dense volume during NACT. The likelihood of accomplishing pCR following NACT was independent of volumetric MD at diagnosis and change in volumetric MD during treatment. No trend was observed between decreasing density according to BI-RADS and the likelihood of accomplishing pCR following NACT. CONCLUSIONS The majority of patients decreased their MD during NACT. We found no evidence of MD as a predictive marker of pCR in the neoadjuvant setting.
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Park B, Lim SE, Ahn H, Yoon J, Choi YS. Heterogenous Effect of Risk Factors on Breast Cancer across the Breast Density Categories in a Korean Screening Population. Cancers (Basel) 2020; 12:cancers12061391. [PMID: 32481621 PMCID: PMC7352951 DOI: 10.3390/cancers12061391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022] Open
Abstract
We evaluated the heterogeneity of the effect of known risk factors on breast cancer development based on breast density by using the Breast Imaging-Reporting and Data System (BI-RADS). In total, 4,898,880 women, aged 40-74 years, who participated in the national breast cancer screening program in 2009-2010 were followed up to December 2018. Increased age showed a heterogeneous association with breast cancer (1-year hazard ratio (HR) = 0.92, 1.00 (reference), 1.03, and 1.03 in women with BI-RADS density category 1, 2, 3, and 4, respectively; P-heterogeneity < 0.001). More advanced age at menopause increased breast cancer risk in all BI-RADS categories. This was more prominent in women with BI-RADS density category 1 but less prominent in women in other BI-RADS categories (P-heterogeneity = 0.009). In postmenopausal women, a family history of breast cancer, body mass index ≥ 25 kg/m2, and smoking showed a heterogeneous association with breast cancer across all BI-RADS categories. Other risk factors including age at menarche, menopause, hormone replacement therapy after menopause, oral contraceptive use, and alcohol consumption did not show a heterogeneous association with breast cancer across the BI-RADS categories. Several known risk factors of breast cancer had a heterogeneous effect on breast cancer development across breast density categories, especially in postmenopausal women.
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Affiliation(s)
- Boyoung Park
- Department of Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (S.-E.L.); (H.A.)
- Correspondence: ; Tel.: +82-2-2220-0682
| | - Se-Eun Lim
- Department of Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (S.-E.L.); (H.A.)
| | - HyoJin Ahn
- Department of Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (S.-E.L.); (H.A.)
| | - Junghyun Yoon
- Graduate School of Public Health, Hanyang University, Seoul 04763, Korea;
| | - Yun Su Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
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McBride RB, Fei K, Rothstein JH, Alexeeff SE, Song X, Sakoda LC, McGuire V, Achacoso N, Acton L, Liang RY, Lipson JA, Yaffe MJ, Rubin DL, Whittemore AS, Habel LA, Sieh W. Alcohol and Tobacco Use in Relation to Mammographic Density in 23,456 Women. Cancer Epidemiol Biomarkers Prev 2020; 29:1039-1048. [PMID: 32066618 PMCID: PMC7196522 DOI: 10.1158/1055-9965.epi-19-0348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/27/2019] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Percent density (PD) is a strong risk factor for breast cancer that is potentially modifiable by lifestyle factors. PD is a composite of the dense (DA) and nondense (NDA) areas of a mammogram, representing predominantly fibroglandular or fatty tissues, respectively. Alcohol and tobacco use have been associated with increased breast cancer risk. However, their effects on mammographic density (MD) phenotypes are poorly understood. METHODS We examined associations of alcohol and tobacco use with PD, DA, and NDA in a population-based cohort of 23,456 women screened using full-field digital mammography machines manufactured by Hologic or General Electric. MD was measured using Cumulus. Machine-specific effects were estimated using linear regression, and combined using random effects meta-analysis. RESULTS Alcohol use was positively associated with PD (P trend = 0.01), unassociated with DA (P trend = 0.23), and inversely associated with NDA (P trend = 0.02) adjusting for age, body mass index, reproductive factors, physical activity, and family history of breast cancer. In contrast, tobacco use was inversely associated with PD (P trend = 0.0008), unassociated with DA (P trend = 0.93), and positively associated with NDA (P trend<0.0001). These trends were stronger in normal and overweight women than in obese women. CONCLUSIONS These findings suggest that associations of alcohol and tobacco use with PD result more from their associations with NDA than DA. IMPACT PD and NDA may mediate the association of alcohol drinking, but not tobacco smoking, with increased breast cancer risk. Further studies are needed to elucidate the modifiable lifestyle factors that influence breast tissue composition, and the important role of the fatty tissues on breast health.
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Affiliation(s)
- Russell B McBride
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kezhen Fei
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph H Rothstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Xiaoyu Song
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Valerie McGuire
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Rhea Y Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Jafi A Lipson
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Martin J Yaffe
- Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Daniel L Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Weiva Sieh
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Gemici AA, Arıbal E, Özaydın AN, Gürdal SÖ, Özçınar B, Cabioğlu N, Özmen V. Comparison of Qualitative and Volumetric Assessments of Breast Density and Analyses of Breast Compression Parameters and Breast Volume of Women in Bahcesehir Mammography Screening Project. Eur J Breast Health 2020; 16:110-116. [PMID: 32285032 DOI: 10.5152/ejbh.2020.4943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 12/25/2019] [Indexed: 11/22/2022]
Abstract
Objective We aimed to compare visual and quantitative measurements of breast density and to reveal the density profile with compression characteristics. Materials and Methods Screening mammograms of 1399 women between May 2014 and May 2015 were evaluated by using Volpara 4th and 5th version. First 379 mammograms were assessed according to ACR BI-RADS 4th edition and compared to Volpara. We categorized the breast density in two subgroups as dens or non-dens. Two radiologists reviewed the images in consensus. Agreement level between visual and volumetric methods and volumetric methods between themselves assessed using weighted kappa statistics. Volpara data such as fibroglandular volume (FGV), breast volume (BV), compression thickness (CT), compression force (CF), compression pressure (CP) were also analyzed with relation to the age. Results 1399 mammograms were distributed as follows: 12.7% VDG1, 39.3% VDG2, 34.1% VDG3, 13.9% VDG4 according to the 4th edition of Volpara; 1.2% VDG1, 46% VDG2, 36.8% VDG3, 15.9% VDG4 according to the 5th edition of Volpara. The difference between two editions was 4.7% increase in dense category. 379 mammograms, according to ACR BI-RADS 4th edition, were distributed as follows: 25.9% category A, 50.9% category B, 19.8% category C, 3.4% category D. The strength of agreement between the Volpara 4th and 5th editions was found substantial (k=0.726). The agreements between visual assessment and both Volpara editions were poor (k=-0.413, k=-0.399 respectively). There was a 142% increase in dense group with the VDG 4th edition and 162% with the VDG 5th edition when compared to visual assessment. Compression force decreased while compression pressure increased with increasing Volpara Density Grade (VDG) (p for trend <0.001 for both). Compression thickness and breast volume decreased with increasing VDG (p for trend <0.001 for both). The FGV decreases with age and the breast volume increases with increasing age (p<0.001). Conclusion Visual assessment of breast density doesn't correlate well with volumetric assessments. Obtaining additional information about physical parameters and breast profile by the results of quantified methods is important for breast cancer risk assessments and prevention strategies.
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Affiliation(s)
- Ayşegül Akdoğan Gemici
- Department of Radiology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Erkin Arıbal
- Department of Radiology, Acıbadem Mehmet Aydınlar University School of Medicine, İstanbul, Turkey
| | - Ayşe Nilüfer Özaydın
- Department of Public Health, Marmara University School of Medicine, İstanbul, Turkey
| | - Sibel Özkan Gürdal
- Department of General Surgery, Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Beyza Özçınar
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Neslihan Cabioğlu
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Lee E, Doanvo N, Lee M, Soe Z, Lee AW, Van Doan C, Deapen D, Ursin G, Spicer D, Reynolds P, Wu AH. Immigration history, lifestyle characteristics, and breast density in the Vietnamese American Women's Health Study: a cross-sectional analysis. Cancer Causes Control 2020; 31:127-138. [PMID: 31916076 PMCID: PMC7842111 DOI: 10.1007/s10552-019-01264-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Breast density is an important risk factor for breast cancer and varies substantially across racial-ethnic groups. However, determinants of breast density in Vietnamese immigrants in the United States (US) have not been studied. We investigated whether reproductive factors, immigration history, and other demographic and lifestyle factors were associated with breast density in Vietnamese Americans. METHODS We collected information on demographics, immigration history, and other lifestyle factors and mammogram reports from a convenience sample of 380 Vietnamese American women in California aged 40 to 70 years. Breast Imaging Reporting and Data System (BI-RADS) breast density was abstracted from mammogram reports. Multivariable logistic regression was used to investigate the association between lifestyle factors and having dense breasts (BI-RADS 3 or 4). RESULTS All participants were born in Viet Nam and 82% had lived in the US for 10 years or longer. Younger age, lower body mass index, nulliparity/lower number of deliveries, and longer US residence (or younger age at migration) were associated with having dense breasts. Compared to women who migrated at age 40 or later, the odds ratios and 95% confidence intervals for having dense breasts among women who migrated between the ages of 30 and 39 and before age 30 were 1.72 (0.96-3.07) and 2.48 (1.43-4.32), respectively. CONCLUSIONS Longer US residence and younger age at migration were associated with greater breast density in Vietnamese American women. Identifying modifiable mediating factors to reduce lifestyle changes that adversely impact breast density in this traditionally low-risk population for breast cancer is warranted.
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Affiliation(s)
- Eunjung Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Namphuong Doanvo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - MiHee Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Zayar Soe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Alice W Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, 92831, USA
| | - Cam Van Doan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Dennis Deapen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | | | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
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Spencer L, Fary R, McKenna L, Jacques A, Lalor J, Briffa K. The relationship between breast size and aspects of health and psychological wellbeing in mature-aged women. WOMEN'S HEALTH (LONDON, ENGLAND) 2020; 16:1745506520918335. [PMID: 32419664 PMCID: PMC7235664 DOI: 10.1177/1745506520918335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/12/2019] [Accepted: 03/02/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Increases in breast size with age are common but have not been widely examined as a factor that could affect the health and psychological wellbeing of mature-aged women. The purpose of this study was to examine the relationships between breast size and aspects of health and psychological wellbeing in mature-aged women. METHODS This was a cross-sectional study of mature-aged women (⩾40 years). Breast size (breast size score) was determined from self-reported bra size and was examined against health-related quality of life (Medical Outcomes Study Short-Form 36 and BREAST-Q), body satisfaction (numerical rating scale), breast satisfaction (BREAST-Q), physical activity levels (Human Activity Profile), the presence of upper back pain and breast and bra fit perceptions. RESULTS Two hundred sixty-nine women (40-85 years) with bra band sizes ranging from 8 to 26 and bra cup sizes from A to HH participated. The mean (standard deviation) breast size score of 7.7 (2.7) was equivalent to a bra size of 14DD. Increasing breast size was associated with significantly lower breast-related physical wellbeing (p < 0.001, R2 = 0.043) and lower ratings of body (p = 0.002, R2 = 0.024) and breast satisfaction (p < 0.001, R2 = 0.065). Women with larger breasts were more likely to be embarrassed by their breasts (odds ratio: 1.49, 95% confidence interval: 1.31 to 1.70); more likely to desire a change in their breasts (odds ratio: 1.55, 95% confidence interval: 1.37 to 1.75) and less likely to be satisfied with their bra fit (odds ratio: 0.84, 95% confidence interval: 0.76 to 0.92). Breast size in addition to age contributed to explaining upper back pain. For each one-size increase in breast size score, women were 13% more likely to report the presence of upper back pain. CONCLUSION Larger breast sizes have a small but significant negative relationship with breast-related physical wellbeing, body and breast satisfaction. Larger breasts are associated with a greater likelihood of upper back pain. Clinicians considering ways to improve the health and psychological wellbeing of mature-aged women should be aware of these relationships.
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Affiliation(s)
- Linda Spencer
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Robyn Fary
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Leanda McKenna
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Angela Jacques
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Jennifer Lalor
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Kathy Briffa
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Breast density measured volumetrically in a clinical environment: cross-sectional study with photon counting technology. Breast Cancer Res Treat 2019; 179:755-762. [DOI: 10.1007/s10549-019-05502-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
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78
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Saikiran P, Ramzan R, S N, Kamineni PD, Priyanka, John AM. Mammographic Breast Density Assessed with Fully Automated Method and its Risk for Breast Cancer. J Clin Imaging Sci 2019; 9:43. [PMID: 31662951 PMCID: PMC6800411 DOI: 10.25259/jcis_70_2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives: We evaluated the association between breast cancer and breast density (BD) measured using fully automated software. We also evaluated the performance of cancer risk models such as only clinical risk factors, density related measures, and both clinical risk factors and density-related measures for determining cancer risk. Materials and Methods: This is a retrospective case–control study. The data were collected from August 2015 to December 2018. Two hundred fifty women with breast cancer and 400 control subjects were included in this study. We evaluated the BD qualitatively using breast imaging-reporting and data system density and quantitatively using 3D slicer. We also collected clinical factors such as age, familial history of breast cancer, menopausal status, number of births, body mass index, and hormonal replacement therapy use. We calculated the odds ratio (OR) for BD to determine the risk of breast cancer. We performed receiver operating characteristic (ROC) curve to assess the performance of cancer risk models. Results: The OR for the percentage BD for second, third, and fourth quartiles was 1.632 (95% confidence intervals [CI]: 1.102–2.416), 2.756 (95% CI: 1.704–4.458), and 3.163 (95% CI: 1.356–5.61). The area under ROC curve for clinical risk factors only, mammographic density measures, combined mammographic, and clinical risk factors was 0.578 (95% CI: 0.45, 0.64), 0.684 (95% CI: 0.58, 0.75), and 0.724 (95% CI: 0.64, 0.80), respectively. Conclusion: Mammographic BD was found to be positively associated with breast cancer. The density related measures combined clinical risk factors, and density model had good discriminatory power in identifying the cancer risk.
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Affiliation(s)
- Pendem Saikiran
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
| | - Ruqiya Ramzan
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
| | - Nandish S
- School of Information Sciences, Manipal Institute of Technology, Manipal, Karnataka, India
| | - Phani Deepika Kamineni
- Department of Radiodiagnosis, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Priyanka
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
| | - Arathy Mary John
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
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79
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Pérez-Benito FJ, Signol F, Pérez-Cortés JC, Pollán M, Pérez-Gómez B, Salas-Trejo D, Casals M, Martínez I, LLobet R. Global parenchymal texture features based on histograms of oriented gradients improve cancer development risk estimation from healthy breasts. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 177:123-132. [PMID: 31319940 DOI: 10.1016/j.cmpb.2019.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The breast dense tissue percentage on digital mammograms is one of the most commonly used markers for breast cancer risk estimation. Geometric features of dense tissue over the breast and the presence of texture structures contained in sliding windows that scan the mammograms may improve the predictive ability when combined with the breast dense tissue percentage. METHODS A case/control study nested within a screening program covering 1563 women with craniocaudal and mediolateral-oblique mammograms (755 controls and the contralateral breast mammograms at the closest screening visit before cancer diagnostic for 808 cases) aging 45 to 70 from Comunitat Valenciana (Spain) was used to extract geometric and texture features. The dense tissue segmentation was performed using DMScan and validated by two experienced radiologists. A model based on Random Forests was trained several times varying the set of variables. A training dataset of 1172 patients was evaluated with a 10-stratified-fold cross-validation scheme. The area under the Receiver Operating Characteristic curve (AUC) was the metric for the predictive ability. The results were assessed by only considering the output after applying the model to the test set, which was composed of the remaining 391 patients. RESULTS The AUC score obtained by the dense tissue percentage (0.55) was compared to a machine learning-based classifier results. The classifier, apart from the percentage of dense tissue of both views, firstly included global geometric features such as the distance of dense tissue to the pectoral muscle, dense tissue eccentricity or the dense tissue perimeter, obtaining an accuracy of 0.56. By the inclusion of a global feature based on local histograms of oriented gradients, the accuracy of the classifier was significantly improved (0.61). The number of well-classified patients was improved up to 236 when it was 208. CONCLUSION Relative geometric features of dense tissue over the breast and histograms of standardized local texture features based on sliding windows scanning the whole breast improve risk prediction beyond the dense tissue percentage adjusted by geometrical variables. Other classifiers could improve the results obtained by the conventional Random Forests used in this study.
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Affiliation(s)
| | - Francois Signol
- Institute of Computer Technology, Universitat Politècnica de València, Camino de Vera, s/n, València, 46022 Spain.
| | - Juan-Carlos Pérez-Cortés
- Institute of Computer Technology, Universitat Politècnica de València, Camino de Vera, s/n, València, 46022 Spain.
| | - Marina Pollán
- National Center for Epidemiology, Carlos III Institute of Health, Monforte de lemos, 5, Madrid, 28029 Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Carlos III Institute of Health, Monforte de Lemos, 5, Madrid, 28029 Spain.
| | - Beatriz Pérez-Gómez
- National Center for Epidemiology, Carlos III Institute of Health, Monforte de lemos, 5, Madrid, 28029 Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Carlos III Institute of Health, Monforte de Lemos, 5, Madrid, 28029 Spain.
| | - Dolores Salas-Trejo
- Valencian Breast Cancer Screening Program, General Directorate of Public Health, València, Spain; Centro Superior de Investigación en Salud Pública CSISP, FISABIO, València, Spain.
| | - María Casals
- Valencian Breast Cancer Screening Program, General Directorate of Public Health, València, Spain; Centro Superior de Investigación en Salud Pública CSISP, FISABIO, València, Spain.
| | - Inmaculada Martínez
- Valencian Breast Cancer Screening Program, General Directorate of Public Health, València, Spain; Centro Superior de Investigación en Salud Pública CSISP, FISABIO, València, Spain.
| | - Rafael LLobet
- Institute of Computer Technology, Universitat Politècnica de València, Camino de Vera, s/n, València, 46022 Spain.
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80
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Rebolj M, Blyuss O, Chia KS, Duffy SW. Long-term excess risk of breast cancer after a single breast density measurement. Eur J Cancer 2019; 117:41-47. [PMID: 31229948 PMCID: PMC6658627 DOI: 10.1016/j.ejca.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
Abstract
AIM Breast density is a risk factor for breast cancer. As density changes across a woman's life span, we studied for how long a single density measurement taken in (post-)menopausal women remains informative. METHODS We used data from Singaporean women who underwent a single mammography screen at age 50-64 years. For each case with breast cancer diagnosed at screening or in the subsequent 10 years, whether screen detected or diagnosed following symptoms, two age-matched controls were selected. We studied the excess risk of breast cancer, calculated as an odds ratio (OR) with conditional logistic regression and adjusted for body mass index, associated with 26-50% and with 51-100% density compared with ≤25% density by time since screening. RESULTS In total, 490 women had breast cancer, of which 361 were diagnosed because of symptoms after screening. Women with 51-100% breast density had an excess risk of breast cancer that did not seem to attenuate with time. In 1-3 years after screening, the OR was 2.22 (95% confidence interval [CI]: 1.07-4.61); in 4-6 years after screening, the OR was 4.09 (95% CI: 2.21-7.58), and in 7-10 years after screening, the OR was 5.35 (95% CI: 2.57-11.15). Excess risk with a stable OR of about 2 was also observed for women with 26-50% breast density. These patterns were robust when the analyses were limited to post-menopausal women, non-users of hormonal replacement therapy and after stratification by age at density measurement. CONCLUSION A single breast density measurement identifies women with an excess risk of breast cancer during at least the subsequent 10 years.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London SE1 9RT, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Oleg Blyuss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; Department of Paediatrics, Sechenov University, Moscow, Russia
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
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81
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Engmann NJ, Scott C, Jensen MR, Winham SJ, Ma L, Brandt KR, Mahmoudzadeh A, Whaley DH, Hruska CB, Wu FF, Norman AD, Hiatt RA, Heine J, Shepherd J, Pankratz VS, Miglioretti DL, Kerlikowske K, Vachon CM. Longitudinal Changes in Volumetric Breast Density in Healthy Women across the Menopausal Transition. Cancer Epidemiol Biomarkers Prev 2019; 28:1324-1330. [PMID: 31186265 DOI: 10.1158/1055-9965.epi-18-1375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/18/2019] [Accepted: 06/03/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mammographic breast density declines during menopause. We assessed changes in volumetric breast density across the menopausal transition and factors that influence these changes. METHODS Women without a history of breast cancer, who had full field digital mammograms during both pre- and postmenopausal periods, at least 2 years apart, were sampled from four facilities within the San Francisco Mammography Registry from 2007 to 2013. Dense breast volume (DV) was assessed using Volpara on mammograms across the time period. Annualized change in DV from pre- to postmenopause was estimated using linear mixed models adjusted for covariates and per-woman random effects. Multiplicative interactions were evaluated between premenopausal risk factors and time to determine whether these covariates modified the annualized changes. RESULTS Among the 2,586 eligible women, 1,802 had one premenopausal and one postmenopausal mammogram, 628 had an additional perimenopausal mammogram, and 156 had two perimenopausal mammograms. Women experienced an annualized decrease in DV [-2.2 cm3 (95% confidence interval, -2.7 to -1.7)] over the menopausal transition. Declines were greater among women with a premenopausal DV above the median (54 cm3) versus below (DV, -3.5 cm3 vs. -1.0 cm3; P < 0.0001). Other breast cancer risk factors, including race, body mass index, family history, alcohol, and postmenopausal hormone therapy, had no effect on change in DV over the menopausal transition. CONCLUSIONS High premenopausal DV was a strong predictor of greater reductions in DV across the menopausal transition. IMPACT We found that few factors other than premenopausal density influence changes in DV across the menopausal transition, limiting targeted prevention efforts.
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Affiliation(s)
| | | | | | | | - Lin Ma
- University of California, San Francisco, California
| | | | | | | | | | | | | | | | | | | | - V Shane Pankratz
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Diana L Miglioretti
- University of California, Davis, California.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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82
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Alexeeff SE, Odo NU, McBride R, McGuire V, Achacoso N, Rothstein JH, Lipson JA, Liang RY, Acton L, Yaffe MJ, Whittemore AS, Rubin DL, Sieh W, Habel LA. Reproductive Factors and Mammographic Density: Associations Among 24,840 Women and Comparison of Studies Using Digitized Film-Screen Mammography and Full-Field Digital Mammography. Am J Epidemiol 2019; 188:1144-1154. [PMID: 30865217 DOI: 10.1093/aje/kwz033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
Breast density is a modifiable factor that is strongly associated with breast cancer risk. We sought to understand the influence of newer technologies of full-field digital mammography (FFDM) on breast density research and to determine whether results are comparable across studies using FFDM and previous studies using traditional film-screen mammography. We studied 24,840 screening-age (40-74 years) non-Hispanic white women who were participants in the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California and underwent screening mammography with either Hologic (Hologic, Inc., Marlborough, Massachusetts) or General Electric (General Electric Company, Boston, Massachusetts) FFDM machines between 2003 and 2013. We estimated the associations of parity, age at first birth, age at menarche, and menopausal status with percent density and dense area as measured by a single radiological technologist using Cumulus software (Canto Software, Inc., San Francisco, California). We found that associations between reproductive factors and mammographic density measured using processed FFDM images were generally similar in magnitude and direction to those from prior studies using film mammography. Estimated associations for both types of FFDM machines were in the same direction. There was some evidence of heterogeneity in the magnitude of the effect sizes by machine type, which we accounted for using random-effects meta-analysis when combining results. Our findings demonstrate the robustness of quantitative mammographic density measurements across FFDM and film mammography platforms.
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Affiliation(s)
- Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Russell McBride
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, School of Medicine, Stanford University, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Joseph H Rothstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jafi A Lipson
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Rhea Y Liang
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Martin J Yaffe
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alice S Whittemore
- Department of Health Research and Policy, Division of Epidemiology, School of Medicine, Stanford University, Stanford, California
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
| | - Daniel L Rubin
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
| | - Weiva Sieh
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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83
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Darcey E, Lloyd R, Cadby G, Pilkington L, Redfern A, Thompson SC, Saunders C, Wylie E, Stone J. The association between mammographic density and breast cancer risk in Western Australian Aboriginal women. Breast Cancer Res Treat 2019; 176:235-242. [PMID: 30977028 DOI: 10.1007/s10549-019-05225-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Mammographic density is an established breast cancer risk factor within many ethnically different populations. The distribution of mammographic density has been shown to be significantly lower in Western Australian Aboriginal women compared to age- and screening location-matched non-Aboriginal women. Whether mammographic density is a predictor of breast cancer risk in Aboriginal women is unknown. METHODS We measured mammographic density from 103 Aboriginal breast cancer cases and 327 Aboriginal controls, 341 non-Aboriginal cases, and 333 non-Aboriginal controls selected from the BreastScreen Western Australia database using the Cumulus software program. Logistic regression was used to examine the associations of percentage dense area and absolute dense area with breast cancer risk for Aboriginal and non-Aboriginal women separately, adjusting for covariates. RESULTS Both percentage density and absolute dense area were strongly predictive of risk in Aboriginal women with odds per adjusted standard deviation (OPERAS) of 1.36 (95% CI 1.09, 1.69) and 1.36 (95% CI 1.08, 1.71), respectively. For non-Aboriginal women, the OPERAS were 1.22 (95% CI 1.03, 1.46) and 1.26 (95% CI 1.05, 1.50), respectively. CONCLUSIONS Whilst mean mammographic density for Aboriginal women is lower than non-Aboriginal women, density measures are still higher in Aboriginal women with breast cancer compared to Aboriginal women without breast cancer. Thus, mammographic density strongly predicts breast cancer risk in Aboriginal women. Future efforts to predict breast cancer risk using mammographic density or standardize risk-associated mammographic density measures should take into account Aboriginal status when applicable.
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Affiliation(s)
- Ellie Darcey
- Centre for Genetic Origins of Health and Disease, Curtin University and The University of Western Australia, 35 Stirling Highway, M409, Perth, WA, 6009, Australia
| | - Rachel Lloyd
- Centre for Genetic Origins of Health and Disease, Curtin University and The University of Western Australia, 35 Stirling Highway, M409, Perth, WA, 6009, Australia
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, Curtin University and The University of Western Australia, 35 Stirling Highway, M409, Perth, WA, 6009, Australia
| | - Leanne Pilkington
- BreastScreen Western Australia, Women and Newborn Health Service, 9th Floor, Eastpoint Plaza, 233 Adelaide Terrace, Perth, WA, 6000, Australia
| | - Andrew Redfern
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia.,Fiona Stanley Hospital, Robin Warren Drive, Murdoch, WA, Australia
| | - Sandra C Thompson
- School of Population and Global Health, Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald St, Geraldton, WA, 6531, Australia
| | - Christobel Saunders
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia.,Fiona Stanley Hospital, Robin Warren Drive, Murdoch, WA, Australia
| | - Elizabeth Wylie
- BreastScreen Western Australia, Women and Newborn Health Service, 9th Floor, Eastpoint Plaza, 233 Adelaide Terrace, Perth, WA, 6000, Australia.,School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Jennifer Stone
- Centre for Genetic Origins of Health and Disease, Curtin University and The University of Western Australia, 35 Stirling Highway, M409, Perth, WA, 6009, Australia. .,The RPH Research Foundation, Royal Perth Hospital, 50 Murray Street, Perth, WA, 6000, Australia.
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84
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Tapia KA, Garvey G, McEntee MF, Rickard M, Lydiard L, Brennan PC. Mammographic densities of Aboriginal and non-Aboriginal women living in Australia's Northern Territory. Int J Public Health 2019; 64:1085-1095. [PMID: 30941443 DOI: 10.1007/s00038-019-01237-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To compare the mammographic densities and other characteristics of Aboriginal and non-Aboriginal women screened in Australia. METHODS Population screening programme data of Aboriginal (n = 857) and non-Aboriginal women (n = 3236) were used. Mann-Whitney U test compared ages at screening and Chi-square tests compared personal and clinical information. Logistic regression analysis was used for density groupings. OR and 95% CI were calculated for multivariate association for density. RESULTS Mammographic density was lower amongst Aboriginal women (P < 0.001). For non-Aboriginal women, higher density was associated with younger age (OR 2.4, 95% CI 2.1-2.8), recall to assessment (OR 2.2, 95% CI 1.6-3.0), family history of breast cancer (OR 1.4, 95% CI 1.2-1.6), English-speaking background (OR 1.4, 95% CI 1.2-1.6), and residence in remote areas (OR 1.2, 95% CI 1.1-1.4). For Aboriginal women, density was associated with younger age (OR 2.7, 95% CI 2.0-3.5; P < 0.001), and recall to assessment (OR 2.3, 95% CI 1.4-3.9; P < 0.05). CONCLUSIONS Significant differences between Aboriginal and non-Aboriginal women were found. There were more significant associations for dense breasts for non-Aboriginal women than for Aboriginal women.
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Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, Room M504, M Block, 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - Gail Garvey
- Faculty of Health Sciences, The University of Sydney, Room M504, M Block, 75 East Street, Lidcombe, NSW, 2141, Australia.,Menzies School of Health Research, Level 1, 147 Wharf Street, Spring Hill, QLD, 4000, Australia
| | - Mark F McEntee
- Department of Medicine, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, T12 AK54, Ireland
| | - Mary Rickard
- Faculty of Health Sciences, The University of Sydney, Room M504, M Block, 75 East Street, Lidcombe, NSW, 2141, Australia.,BreastScreen Australia, Sydney, NSW, Australia
| | - Lorraine Lydiard
- BreastScreen Northern Territory, Level 1, 9 Scaturchio St., Casuarina, NT, 0810, Australia
| | - Patrick C Brennan
- Faculty of Health Sciences, The University of Sydney, Room M221, M Block, 75 East Street, Lidcombe, NSW, 2141, Australia
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85
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Characteristics of Mammographic Breast Density and Associated Factors for Chinese Women: Results from an Automated Measurement. JOURNAL OF ONCOLOGY 2019; 2019:4910854. [PMID: 31015834 PMCID: PMC6444251 DOI: 10.1155/2019/4910854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 11/18/2022]
Abstract
Background Characteristics of mammographic density for Chinese women are understudied. This study aims to identify factors associated with mammographic density in China using a quantitative method. Methods Mammographic density was measured for a total of 1071 (84 with and 987 without breast cancer) women using an automatic algorithm AutoDensity. Pearson tests examined relationships between density and continuous variables and t-tests compared differences of mean density values between groupings of categorical variables. Linear models were built using multiple regression. Results Percentage density and dense area were positively associated with each other for cancer-free (r=0.487, p<0.001) and cancer groups (r=0.446, p<0.001), respectively. For women without breast cancer, weight and BMI (p<0.001) were found to be negatively associated (r=-0.237, r=-0.272) with percentage density whereas they were found to be positively associated (r=0.110, r=0.099) with dense area; age at mammography was found to be associated with percentage density (r=-0.202, p<0.001) and dense area (r=-0.086, p<0.001) but did not add any prediction within multivariate models; lower percentage density was found within women with secondary education background or below compared to women with tertiary education. For women with breast cancer, percentage density demonstrated similar relationships with that of cancer-free women whilst breast area was the only factor associated with dense area (r=0.739, p<0.001). Conclusion This is the first time that mammographic density was measured by a quantitative method for women in China and identified associations should be useful to health policy makers who are responsible for introducing effective models of breast cancer prevention and diagnosis.
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86
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McLean K, Darcey E, Cadby G, Lund H, Pilkington L, Redfern A, Thompson S, Saunders C, Wylie E, Stone J. The distribution and determinants of mammographic density measures in Western Australian aboriginal women. Breast Cancer Res 2019; 21:33. [PMID: 30819215 PMCID: PMC6393976 DOI: 10.1186/s13058-019-1113-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/01/2019] [Indexed: 11/27/2022] Open
Abstract
Background Mammographic density (MD) is an established risk factor for breast cancer. There are significant ethnic differences in MD measures which are consistent with those for corresponding breast cancer risk. This is the first study investigating the distribution and determinants of MD measures within Aboriginal women of Western Australia (WA). Methods Epidemiological data and mammographic images were obtained from 628 Aboriginal women and 624 age-, year of screen-, and screening location-matched non-Aboriginal women randomly selected from the BreastScreen Western Australia database. Women were cancer free at the time of their mammogram between 1989 and 2014. MD was measured using the Cumulus software. Kolmogorov-Smirnov tests were used to compare distributions of absolute dense area (DA), precent dense area (PDA), non-dense area (NDA) and total breast area between Aboriginal and non-Aboriginal women. General linear regression was used to estimate the determinants of MD, adjusting for age, NDA, hormone therapy use, family history, measures of socio-economic status and remoteness of residence for Aboriginal and non-Aboriginal women separately. Results Aboriginal women were found to have lower DA and PDA and higher NDA than non-Aboriginal women. Age (p < 0.001) was negatively associated and several socio-economic indices (p < 0.001) were positively associated with DA and PDA in Aboriginal and non-Aboriginal women. Remoteness of residence was associated with both mammographic measures but for non-Aboriginal women only. Conclusions Aboriginal women have, on average, less MD than non-Aboriginal women but the factors associated with MD are similar for both sample populations. Since reduced MD is associated with improved sensitivity of mammography, this study suggests that mammographic screening is a particularly good test for Australian Indigenous women, a population that suffers from high breast cancer mortality. Electronic supplementary material The online version of this article (10.1186/s13058-019-1113-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirsty McLean
- Centre for Genetic Origins of Health and Disease, School of Biomedical Science, Curtin University and The University of Western Australia, Perth, Western Australia, Australia
| | - Ellie Darcey
- Centre for Genetic Origins of Health and Disease, School of Biomedical Science, Curtin University and The University of Western Australia, Perth, Western Australia, Australia
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, School of Biomedical Science, Curtin University and The University of Western Australia, Perth, Western Australia, Australia
| | - Helen Lund
- BreastScreen Western Australia, Women and Newborn Health Service, Perth, Western Australia, Australia
| | - Leanne Pilkington
- BreastScreen Western Australia, Women and Newborn Health Service, Perth, Western Australia, Australia.,WA Country Health Service, Government of Western Australia, Perth, Western Australia, Australia
| | - Andrew Redfern
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Fiona Stanley Hospital, Robin Warren Drive, Murdoch, Western Australia, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Geraldton, Western Australia, Australia
| | - Christobel Saunders
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Fiona Stanley Hospital, Robin Warren Drive, Murdoch, Western Australia, Australia
| | - Elizabeth Wylie
- BreastScreen Western Australia, Women and Newborn Health Service, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jennifer Stone
- Centre for Genetic Origins of Health and Disease, School of Biomedical Science, Curtin University and The University of Western Australia, Perth, Western Australia, Australia. .,The Medical Research Foundation, Royal Perth Hospital, Perth, Western Australia, Australia. .,Centre for Genetic Origins of Health and Disease, Curtin University and The University of Western Australia, 35 Stirling Highway M409, Crawley, Western Australia, 6009, Australia.
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87
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Napolitano G, Lynge E, Lillholm M, Vejborg I, van Gils CH, Nielsen M, Karssemeijer N. Change in mammographic density across birth cohorts of Dutch breast cancer screening participants. Int J Cancer 2019; 145:2954-2962. [PMID: 30762225 PMCID: PMC6850337 DOI: 10.1002/ijc.32210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/15/2019] [Accepted: 01/31/2019] [Indexed: 12/02/2022]
Abstract
High mammographic density is a well‐known risk factor for breast cancer. This study aimed to search for a possible birth cohort effect on mammographic density, which might contribute to explain the increasing breast cancer incidence. We separately analyzed left and right breast density of Dutch women from a 13‐year period (2003–2016) in the breast cancer screening programme. First, we analyzed age‐specific changes in average percent dense volume (PDV) across birth cohorts. A linear regression analysis (PDV vs. year of birth) indicated a small but statistically significant increase in women of: 1) age 50 and born from 1952 to 1966 (left, slope = 0.04, p = 0.003; right, slope = 0.09, p < 0.0001); 2) age 55 and born from 1948 to 1961 (right, slope = 0.04, p = 0.01); and 3) age 70 and born from 1933 to 1946 (right, slope = 0.05, p = 0.002). A decrease of total breast volume seemed to explain the increase in PDV. Second, we compared proportion of women with dense breast in women born in 1946–1953 and 1959–1966, and observed a statistical significant increase of proportion of highly dense breast in later born women, in the 51 to 55 age‐groups for the left breast (around a 20% increase in each age‐group), and in the 50 to 56 age‐groups for the right breast (increase ranging from 27% to 48%). The study indicated a slight increase in mammography density across birth cohorts, most pronounced for women in their early 50s, and more marked for the right than for the left breast. What's new? Women with dense breast tissue are at increased risk of breast cancer. Here, changes in mammographic density were investigated across birth cohorts in women enrolled in a breast cancer screening program in the Netherlands. The findings reveal an increase in the average fraction of dense tissue in the breast across cohorts. In particular, greater breast density was observed in a higher proportion of women in later‐born than earlier‐born birth cohorts. The increase was most significant among women in their early 50s and may be linked to a reported shift toward older age at menopause among women in Europe.
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Affiliation(s)
- George Napolitano
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martin Lillholm
- Department of Computer Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, University Hospital Copenhagen, Copenhagen, Denmark
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health, Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mads Nielsen
- Department of Computer Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University, Medical Center, Nijmegen, The Netherlands
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88
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Eriksson L, He W, Eriksson M, Humphreys K, Bergh J, Hall P, Czene K. Adjuvant Therapy and Mammographic Density Changes in Women With Breast Cancer. JNCI Cancer Spectr 2019; 2:pky071. [PMID: 31360886 PMCID: PMC6649795 DOI: 10.1093/jncics/pky071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/23/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Tamoxifen decreases mammographic density. Whether compliance affects this relationship is unclear as is the relationship between other types of adjuvant treatment and changes in mammographic density. Methods This prospective cohort study included 2490 women diagnosed with breast cancer during 2001-2015 in Sweden. Mammographic density was assessed within 3 months of diagnosis and 6-36 months post diagnosis. Logistic regression was performed to study the association between each respective adjuvant treatment and mammographic density reduction (annual dense area decrease >15%). Results Intention-to-treat analyses using treatment information from the regional cancer registries showed that tamoxifen-treated patients more frequently experienced mammographic density reductions compared with nontreated patients (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.25 to 1.99), as did chemotherapy-treated patients (OR = 1.28, 95% CI = 1.06 to 1.54). For chemotherapy, the association was mainly seen in premenopausal women. Neither aromatase inhibitors nor radiotherapy was associated with density change. Tamoxifen use based on prescription and dispensation data from the Swedish Prescribed Drug Register showed that users were more likely to have density reductions compared with nonusers (adjusted OR = 2.24, 95% CI = 1.40 to 3.59). Moreover, among tamoxifen users, tamoxifen continuers were more likely than discontinuers to experience density reductions (adjusted OR = 1.50, 95% CI = 1.04 to 2.17). Conclusions Our results indicate that adherence influences the association between tamoxifen and mammographic density reduction. We further found that chemotherapy was associated with density reductions and propose that this is largely secondary to chemotherapy-induced ovarian failure.
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Affiliation(s)
| | - Wei He
- Correspondence to: Wei He, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, Stockholm 171 77, Sweden (e-mail: )
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89
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Bell RJ, Evans J, Fox J, Pridmore V. Using an automated measure of breast density to explore the association between ethnicity and mammographic density in Australian women. J Med Imaging Radiat Oncol 2019; 63:183-189. [DOI: 10.1111/1754-9485.12849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/07/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Robin J Bell
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Jill Evans
- BreastScreen Victoria Melbourne Victoria Australia
- Monash BreastScreen Moorabbin Hospital Bentleigh East Victoria Australia
| | - Jane Fox
- Monash Health Moorabbin Bentleigh East Victoria Australia
- Department of Surgery Monash Medical Centre Monash University Melbourne Victoria Australia
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90
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Denholm R, De Stavola BL, Hipwell JH, Doran SJ, Holly JMP, Folkerd E, Dowsett M, Leach MO, Hawkes DJ, Dos-Santos-Silva I. Circulating Growth and Sex Hormone Levels and Breast Tissue Composition in Young Nulliparous Women. Cancer Epidemiol Biomarkers Prev 2018; 27:1500-1508. [PMID: 30228153 DOI: 10.1158/1055-9965.epi-18-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/30/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endogenous hormones are associated with breast cancer risk, but little is known about their role on breast tissue composition, a strong risk predictor. This study aims to investigate the relationship between growth and sex hormone levels and breast tissue composition in young nulliparous women. METHODS A cross-sectional study of 415 young (age ∼21.5 years) nulliparous women from an English prebirth cohort underwent a MRI examination of their breasts to estimate percent-water (a proxy for mammographic percent density) and provided a blood sample to measure plasma levels of growth factors (insulin-like growth factor-I, insulin-like growth factor-II, insulin growth factor-binding protein-3, growth hormone) and, if not on hormonal contraception (n = 117) sex hormones (dehydroepiandrosterone, androstenedione, testosterone, estrone, estadiol, sex hormone-binding globulin, prolactin). Testosterone (n = 330) and sex hormone-binding globulin (n = 318) were also measured at age 15.5 years. Regression models were used to estimate the relative difference (RD) in percent-water associated with one SD increment in hormone levels. RESULTS Estradiol at age 21.5 and sex hormone-binding globulin at age 21.5 were positively associated with body mass index (BMI)-adjusted percent-water [RD (95% confidence interval (CI)): 3% (0%-7%) and 3% (1%-5%), respectively]. There was a positive nonlinear association between androstenedione at age 21.5 and percent-water. Insulin-like growth factor-I and growth hormone at age 21.5 were also positively associated with BMI-adjusted percent-water [RD (95% CI): 2% (0%-4%) and 4% (1%-7%), respectively]. CONCLUSIONS The findings suggest that endogenous hormones affect breast tissue composition in young nulliparous women. IMPACT The well-established associations of childhood growth and development with breast cancer risk may be partly mediated by the role of endogenous hormones on breast tissue composition.
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Affiliation(s)
- Rachel Denholm
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bianca L De Stavola
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - John H Hipwell
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
| | - Simon J Doran
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeff M P Holly
- IGFs & Metabolic Endocrinology Group, School of Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Folkerd
- The Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Mitch Dowsett
- The Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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91
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Lee E, Luo J, Schumacher FR, Van Den Berg D, Wu AH, Stram DO, Bernstein L, Ursin G. Growth factor genes and change in mammographic density after stopping combined hormone therapy in the California Teachers Study. BMC Cancer 2018; 18:1072. [PMID: 30400783 PMCID: PMC6220514 DOI: 10.1186/s12885-018-4981-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background The contribution of genetic polymorphisms to the large inter-individual variation in mammographic density (MD) changes following starting and stopping use of estrogen and progestin combined therapy (EPT) has not been well-studied. Previous studies have shown that circulating levels of insulin-like growth factors are associated with MD and cross-talk between estrogen signaling and growth factors is necessary for cell proliferation in the breast. We evaluated single nucleotide polymorphisms (SNPs) in growth factor genes in association with MD changes after women stop EPT use. Methods We genotyped 191 SNPs in 13 growth factor pathway genes in 284 non-Hispanic white California Teachers Study participants who previously used EPT and collected their mammograms before and after quitting EPT. Percent MD was assessed using a computer-assisted method. Change in percent MD was calculated by subtracting percent MD of an ‘off-EPT’ mammogram from percent MD of an ‘on-EPT’ (i.e. baseline) mammogram. We used multivariable linear regression analysis to investigate the association between SNPs and change in percent MD. We calculated P-values corrected for multiple testing within a gene (Padj). Results Rs1983210 in INHA and rs35539615 in IGFBP1/3 showed the strongest associations. Per minor allele of rs1983210, the absolute change in percent MD after stopping EPT use decreased by 1.80% (a difference in absolute change in percent MD) (Padj= 0.021). For rs35539615, change in percent MD increased by 1.79% per minor allele (Padj= 0.042). However, after applying a Bonferroni correction for the number of genes tested, these associations were no longer statistically significant. Conclusions Genetic variation in growth factor pathway genes INHA and IGFBP1/3 may predict longitudinal MD change after women quit EPT. The observed differences in EPT-associated changes in percent MD in association with these genetic polymorphisms are modest but may be clinically significant considering that the magnitude of absolute increase in percent MD reported from large clinical trials of EPT ranged from 3% to 7%. Electronic supplementary material The online version of this article (10.1186/s12885-018-4981-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eunjung Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, 90089, USA.
| | - Jianning Luo
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, 90089, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, 90089, USA
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, 90089, USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Giske Ursin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, 90089, USA.,Department of Nutrition, University of Oslo, Oslo, Norway.,Cancer Registry of Norway, Oslo, Norway
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92
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Shia WC, Wu HK, Huang YL, Lin LS, Chen DR. Mammographic Density Distribution of Healthy Taiwanese Women and its Naturally Decreasing Trend with Age. Sci Rep 2018; 8:14937. [PMID: 30297784 PMCID: PMC6175874 DOI: 10.1038/s41598-018-32923-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/07/2018] [Indexed: 11/09/2022] Open
Abstract
We analysed typical mammographic density (MD) distributions of healthy Taiwanese women to augment existing knowledge, clarify cancer risks, and focus public health efforts. From January 2011 to December 2015, 88,193 digital mammograms were obtained from 69,330 healthy Taiwanese women (average, 1.27 mammograms each). MD measurements included dense volume (DV) and volumetric density percentage (VPD) and were quantified by fully automated volumetric density estimation and Box-Cox normalization. Prediction of the declining MD trend was estimated using curve fitting and a rational model. Normalized DV and VPD Lowess curves demonstrated similar but non-identical distributions. In high-density grade participants, the VPD increased from 12.45% in the 35-39-year group to 13.29% in the 65-69-year group but only from 5.21% to 8.47% in low-density participants. Regarding the decreased cumulative VPD percentage, the mean MD declined from 12.79% to 19.31% in the 45-50-year group versus the 50-55-year group. The large MD decrease in the fifth decade in this present study was similar to previous observations of Western women. Obtaining an MD distribution model with age improves the understanding of breast density trends and age variations and provides a reference for future studies on associations between MD and cancer risk.
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Affiliation(s)
- Wei-Chung Shia
- Cancer Research Center, Department of Research, Changhua Christian Hospital, Changhua, Taiwan
| | - Hwa-Koon Wu
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Len Huang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Li-Sheng Lin
- Department of Breast Surgery, The Affiliated Hospital (Group) of Putian University, Putian, Fujian, China
| | - Dar-Ren Chen
- Cancer Research Center, Department of Research, Changhua Christian Hospital, Changhua, Taiwan. .,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
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93
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Ciritsis A, Rossi C, Vittoria De Martini I, Eberhard M, Marcon M, Becker AS, Berger N, Boss A. Determination of mammographic breast density using a deep convolutional neural network. Br J Radiol 2018; 92:20180691. [PMID: 30209957 DOI: 10.1259/bjr.20180691] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE High breast density is a risk factor for breast cancer. The aim of this study was to develop a deep convolutional neural network (dCNN) for the automatic classification of breast density based on the mammographic appearance of the tissue according to the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) Atlas. METHODS In this study, 20,578 mammography single views from 5221 different patients (58.3 ± 11.5 years) were downloaded from the picture archiving and communications system of our institution and automatically sorted according to the ACR density (a-d) provided by the corresponding radiological reports. A dCNN with 11 convolutional layers and 3 fully connected layers was trained and validated on an augmented dataset. The model was finally tested on two different datasets against: i) the radiological reports and ii) the consensus decision of two human readers. None of the test datasets was part of the dataset used for the training and validation of the algorithm. RESULTS The optimal number of epochs was 91 for medio-lateral oblique (MLO) projections and 94 for cranio-caudal projections (CC), respectively. Accuracy for MLO projections obtained on the validation dataset was 90.9% (CC: 90.1%). Tested on the first test dataset of mammographies (850 MLO and 880 CC), the algorithm showed an accordance with the corresponding radiological reports of 71.7% for MLO and of 71.0% for CC. The agreement with the radiological reports improved in the differentiation between dense and fatty breast for both projections (MLO = 88.6% and CC = 89.9%). In the second test dataset of 200 mammographies, a good accordance was found between the consensus decision of the two readers on both, the MLO-model (92.2%) and the right craniocaudal-model (87.4%). In the differentiation between fatty (ACR A/B) and dense breasts (ACR C/D), the agreement reached 99% for the MLO and 96% for the CC projections, respectively. CONCLUSIONS The dCNN allows for accurate classification of breast density based on the ACR BI-RADS system. The proposed technique may allow accurate, standardized, and observer independent breast density evaluation of mammographies. ADVANCES IN KNOWLEDGE Standardized classification of mammographies by a dCNN could lead to a reduction of falsely classified breast densities, thereby allowing for a more accurate breast cancer risk assessment for the individual patient and a more reliable decision, whether additional ultrasound is recommended.
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Affiliation(s)
- Alexander Ciritsis
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Cristina Rossi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | | | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Nicole Berger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
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94
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Childhood body size and midlife mammographic breast density in foreign-born and U.S.-born women in New York City. Ann Epidemiol 2018; 28:710-716. [PMID: 30172558 DOI: 10.1016/j.annepidem.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE We investigated whether childhood body size is associated with midlife mammographic density, a strong risk factor for breast cancer. METHODS We collected interview data, including body size at age 10 years using a pictogram, and measured height and weight from 518 women, recruited at the time of screening mammography in New York City (ages 40-64 years, 71% Hispanic, 68% foreign-born). We used linear regression models to examine childhood body size in relation to percent density and areas of dense and nondense tissue, measured using a computer-assisted method from digital mammograms. RESULTS In models that adjusted for race/ethnicity, and age and body mass index at mammogram, the heaviest relative to leanest childhood body size was associated with 5.94% lower percent density (95% confidence interval [CI]: -9.20, -2.29), 7.69 cm2 smaller dense area (95% CI: -13.94, -0.63), and 26.17 cm2 larger nondense area (95% CI: 9.42, 43.58). In stratified analysis by menopausal status and nativity, the observed associations were stronger for postmenopausal and U.S.-born women although these differences did not reach statistical significance. CONCLUSIONS Heavy childhood body size is associated with lower mammographic density, consistent with its associations with breast cancer risk. Suggestive findings by nativity require confirmation in larger samples.
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95
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Heller SL, Young Lin LL, Melsaether AN, Moy L, Gao Y. Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics 2018; 38:983-996. [DOI: 10.1148/rg.2018180035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Leng Leng Young Lin
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Amy N. Melsaether
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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96
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Golemis EA, Scheet P, Beck TN, Scolnick EM, Hunter DJ, Hawk E, Hopkins N. Molecular mechanisms of the preventable causes of cancer in the United States. Genes Dev 2018; 32:868-902. [PMID: 29945886 PMCID: PMC6075032 DOI: 10.1101/gad.314849.118] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Annually, there are 1.6 million new cases of cancer and nearly 600,000 cancer deaths in the United States alone. The public health burden associated with these numbers has motivated enormous research efforts into understanding the root causes of cancer. These efforts have led to the recognition that between 40% and 45% of cancers are associated with preventable risk factors and, importantly, have identified specific molecular mechanisms by which these exposures modify human physiology to induce or promote cancer. The increasingly refined knowledge of these mechanisms, which we summarize here, emphasizes the need for greater efforts toward primary cancer prevention through mitigation of modifiable risk factors. It also suggests exploitable avenues for improved secondary prevention (which includes the development of therapeutics designed for cancer interception and enhanced techniques for noninvasive screening and early detection) based on detailed knowledge of early neoplastic pathobiology. Such efforts would complement the current emphasis on the development of therapeutic approaches to treat established cancers and are likely to result in far greater gains in reducing morbidity and mortality.
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Affiliation(s)
- Erica A Golemis
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
| | - Paul Scheet
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
| | - Tim N Beck
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
- Molecular and Cell Biology and Genetics Program, Drexel University College of Medicine, Philadelphia, Pennsylvania 19129, USA
| | - Eward M Scolnick
- Eli and Edythe L. Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts 02142, USA
| | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Medical Sciences Division, Oxford OX3 7LF, United Kingdom
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, University of Texas M.D. Anderson Cancer Center, Houston Texas 77030, USA
| | - Nancy Hopkins
- Koch Institute for Integrative Cancer Research, Biology Department, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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97
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Philpotts LE. Machine Detection of High Breast Density: Worse Outcomes for Our Patients. Radiology 2018; 288:353-354. [PMID: 29944080 DOI: 10.1148/radiol.2018180827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Liane E Philpotts
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, New Haven CT 06520-8042
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98
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Hjerkind KV, Ellingjord-Dale M, Johansson AL, Aase HS, Hoff SR, Hofvind S, Fagerheim S, dos-Santos-Silva I, Ursin G. Volumetric Mammographic Density, Age-Related Decline, and Breast Cancer Risk Factors in a National Breast Cancer Screening Program. Cancer Epidemiol Biomarkers Prev 2018; 27:1065-1074. [DOI: 10.1158/1055-9965.epi-18-0151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/25/2018] [Accepted: 06/15/2018] [Indexed: 11/16/2022] Open
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99
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Al-Shamsi HO, Alrawi S. Breast cancer screening in the United Arab Emirates: is it time to call for a screening at an earlier age? ACTA ACUST UNITED AC 2018. [DOI: 10.15406/jcpcr.2018.09.00334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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100
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Puvanesarajah S, Nyante SJ, Kuzmiak CM, Chen M, Tse CK, Sun X, Allott EH, Kirk EL, Carey LA, Perou CM, Olshan AF, Henderson LM, Troester MA. PAM50 and Risk of Recurrence Scores for Interval Breast Cancers. Cancer Prev Res (Phila) 2018; 11:327-336. [PMID: 29622545 PMCID: PMC5984721 DOI: 10.1158/1940-6207.capr-17-0368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/01/2018] [Accepted: 03/28/2018] [Indexed: 12/20/2022]
Abstract
Breast cancers detected after a negative breast screening examination and prior to the next screening are referred to as interval cancers. These cancers generally have poor clinical characteristics compared with screen-detected cancers, but associations between interval cancer and genomic cancer characteristics are not well understood. Mammographically screened women diagnosed with primary invasive breast cancer from 1993 to 2013 (n = 370) were identified by linking the Carolina Breast Cancer Study and the Carolina Mammography Registry. Among women with a registry-identified screening mammogram 0 to 24 months before diagnosis, cancers were classified as screen-detected (N = 165) or interval-detected (N = 205). Using logistic regression, we examined the association of mode of detection with cancer characteristics (clinical, IHC, and genomic), overall, and in analyses stratified on mammographic density and race. Interval cancer was associated with large tumors [>2 cm; OR, 2.3; 95% confidence interval (CI), 1.5-3.7], positive nodal status (OR, 1.8; 95% CI, 1.1-2.8), and triple-negative subtype (OR, 2.5; 95% CI, 1.1-5.5). Interval cancers were more likely to have non-Luminal A subtype (OR, 2.9; 95% CI, 1.5-5.7), whereas screen-detected cancers tended to be more indolent (96% had low risk of recurrence genomic scores; 71% were PAM50 Luminal A). When stratifying by mammographic density and race, associations between interval detection and poor prognostic features were similar by race and density status. Strong associations between interval cancers and poor-prognosis genomic features (non-Luminal A subtype and high risk of recurrence score) suggest that aggressive tumor biology is an important contributor to interval cancer rates. Cancer Prev Res; 11(6); 327-36. ©2018 AACR.
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Affiliation(s)
| | - Sarah J Nyante
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Cherie M Kuzmiak
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Mengjie Chen
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Chiu-Kit Tse
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Xuezheng Sun
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Emma H Allott
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Erin L Kirk
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Lisa A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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