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Krishnan K, Baglietto L, Apicella C, Stone J, Southey MC, English DR, Giles GG, Hopper JL. Mammographic density and risk of breast cancer by mode of detection and tumor size: a case-control study. Breast Cancer Res 2016; 18:63. [PMID: 27316945 PMCID: PMC4912759 DOI: 10.1186/s13058-016-0722-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/28/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Risk of screen-detected breast cancer mostly reflects inherent risk, while risk of interval cancer reflects inherent risk and risk of masking (risk of the tumor not being detected due to increased dense tissue). Therefore the predictors of whether a breast cancer is interval or screen-detected include those that predict masking. Our aim was to investigate the associations between mammographic measures and (1) inherent risk, and (2) masking. METHODS We conducted a case-control study nested within the Melbourne collaborative cohort study of 244 screen-detected cases (192 small tumors (<2 cm)) matched to 700 controls and 148 interval cases (76 small tumors) matched to 446 controls. Dense area (DA), percent dense area (PDA), and non-dense area (NDA) were measured using the Cumulus software. Conditional and unconditional logistic regression were applied as appropriate to estimate the odds per adjusted standard deviation (OPERA) adjusted for age and body mass index (BMI), allowing for the association with BMI to be a function of age at diagnosis. Tests of fit were performed using the Bayesian information criterion (BIC) and the area under the receiver operating characteristic curve. RESULTS For screen-detected cancer, the association with BMI had a marginally significant dependence on age at diagnosis, and after adjustment both DA and PDA were associated with risk (OPERA approximately 1.2) and gave a similar fit. NDA was not associated with risk. For interval cancer, the BMI risk association was not dependent on age at diagnosis and the best fitting model was PDA alone (OPERA = 2.24, 95 % confidence interval 1.75, 2.86). Prediction of interval versus screen-detected cancer was best achieved by PDA alone (OPERA = 1.76, 95 % confidence interval 1.39, 2.22) with no association with BMI. When the analysis was restricted to small tumors to reduce the influence of tumor growth, we obtained similar results. CONCLUSIONS Inherent breast cancer risk is predicted by BMI and DA or PDA, but not NDA. Masking is predicted by PDA, and not by BMI. Understanding risk and masking could help tailor mammographic screening.
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Affiliation(s)
- Kavitha Krishnan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Laura Baglietto
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Jennifer Stone
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Centre for Genetic Origins of Health and Disease, Curtin University and University of Western Australia, Crawley, Australia
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
- Seoul Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea.
- Institute of Health and Environment, Seoul National University, Seoul, Korea.
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202
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Habel LA, Lipson JA, Achacoso N, Rothstein JH, Yaffe MJ, Liang RY, Acton L, McGuire V, Whittemore AS, Rubin DL, Sieh W. Case-control study of mammographic density and breast cancer risk using processed digital mammograms. Breast Cancer Res 2016; 18:53. [PMID: 27209070 PMCID: PMC4875652 DOI: 10.1186/s13058-016-0715-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Full-field digital mammography (FFDM) has largely replaced film-screen mammography in the US. Breast density assessed from film mammograms is strongly associated with breast cancer risk, but data are limited for processed FFDM images used for clinical care. Methods We conducted a case-control study nested among non-Hispanic white female participants of the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California who were aged 40 to 74 years and had screening mammograms acquired on Hologic FFDM machines. Cases (n = 297) were women with a first invasive breast cancer diagnosed after a screening FFDM. For each case, up to five controls (n = 1149) were selected, matched on age and year of FFDM and image batch number, and who were still under follow-up and without a history of breast cancer at the age of diagnosis of the matched case. Percent density (PD) and dense area (DA) were assessed by a radiological technologist using Cumulus. Conditional logistic regression was used to estimate odds ratios (ORs) for breast cancer associated with PD and DA, modeled continuously in standard deviation (SD) increments and categorically in quintiles, after adjusting for body mass index, parity, first-degree family history of breast cancer, breast area, and menopausal hormone use. Results Median intra-reader reproducibility was high with a Pearson’s r of 0.956 (range 0.902 to 0.983) for replicate PD measurements across 23 image batches. The overall mean was 20.02 (SD, 14.61) for PD and 27.63 cm2 (18.22 cm2) for DA. The adjusted ORs for breast cancer associated with each SD increment were 1.70 (95 % confidence interval, 1.41–2.04) for PD, and 1.54 (1.34–1.77) for DA. The adjusted ORs for each quintile were: 1.00 (ref.), 1.49 (0.91–2.45), 2.57 (1.54–4.30), 3.22 (1.91–5.43), 4.88 (2.78–8.55) for PD, and 1.00 (ref.), 1.43 (0.85–2.40), 2.53 (1.53–4.19), 2.85 (1.73–4.69), 3.48 (2.14–5.65) for DA. Conclusions PD and DA measured using Cumulus on processed FFDM images are positively associated with breast cancer risk, with similar magnitudes of association as previously reported for film-screen mammograms. Processed digital mammograms acquired for routine clinical care in a general practice setting are suitable for breast density and cancer research.
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Affiliation(s)
- Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA. .,Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Jafi A Lipson
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA
| | - Joseph H Rothstein
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin J Yaffe
- Departments of Medical Biophysics and Medical Imaging, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Smarter Imaging Program, Ontario Institute for Cancer Research, Toronto, Canada
| | - Rhea Y Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alice S Whittemore
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel L Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Weiva Sieh
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
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203
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Jung S, Goloubeva O, Klifa C, LeBlanc ES, Snetselaar LG, Van Horn L, Dorgan JF. Dietary Fat Intake During Adolescence and Breast Density Among Young Women. Cancer Epidemiol Biomarkers Prev 2016; 25:918-26. [PMID: 27197283 DOI: 10.1158/1055-9965.epi-15-1146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lack of association between fat intake and breast cancer risk in cohort studies might be attributed to the disregard of temporal effects during adolescence when breasts develop and are particularly sensitive to stimuli. We prospectively examined associations between adolescent fat intakes and breast density. METHOD Among 177 women who participated in the Dietary Intervention Study in Children, dietary intakes at ages 10-18 years were assessed on five occasions by 24-hour recalls and averaged. We calculated geometric mean and 95% confidence intervals for MRI-measured breast density at ages 25-29 years across quartiles of fat intake using linear mixed-effect regression. RESULTS Comparing women in the extreme quartiles of adolescent fat intakes, percent dense breast volume (%DBV) was positively associated with saturated fat (mean = 16.4% vs. 21.5%; Ptrend < 0.001). Conversely, %DBV was inversely associated with monounsaturated fat (25.0% vs. 15.8%; Ptrend < 0.001) and the ratio of polyunsaturated fat to saturated fat (P/S ratio; 19.1% vs. 14.3%; Ptrend < 0.001). When examining intake by pubertal stages, %DBV was inversely associated with intake of polyunsaturated fat (20.8% vs. 16.4%; Ptrend = 0.04), long-chain omega-3 fat (17.8% vs. 15.8%; Ptrend < 0.001), and P/S ratio (22.5% vs. 16.1%; Ptrend < 0.001) before menarche, but not after. These associations observed with %DBV were consistently observed with absolute dense breast volume but not with absolute nondense breast volume. CONCLUSIONS In our study, adolescent intakes of higher saturated fat and lower mono- and polyunsaturated fat are associated with higher breast density measured approximately 15 years later. IMPACT The fat subtype composition in adolescent diet may be important in early breast cancer prevention. Cancer Epidemiol Biomarkers Prev; 25(6); 918-26. ©2016 AACR.
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Affiliation(s)
- Seungyoun Jung
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Olga Goloubeva
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joanne F Dorgan
- University of Maryland School of Medicine, Baltimore, Maryland.
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204
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Bertrand KA, Baer HJ, Orav EJ, Klifa C, Kumar A, Hylton NM, LeBlanc ES, Snetselaar LG, Van Horn L, Dorgan JF. Early Life Body Fatness, Serum Anti-Müllerian Hormone, and Breast Density in Young Adult Women. Cancer Epidemiol Biomarkers Prev 2016; 25:1151-7. [PMID: 27197299 DOI: 10.1158/1055-9965.epi-16-0185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Emerging evidence suggests positive associations between serum anti-Müllerian hormone (AMH), a marker of ovarian function, and breast cancer risk. Body size at young ages may influence AMH levels, but few studies have examined this. Also, no studies have examined the relation of AMH levels with breast density, a strong predictor of breast cancer risk. METHODS We examined associations of early life body fatness, AMH concentrations, and breast density among 172 women in the Dietary Intervention Study in Children (DISC). Height and weight were measured at baseline (ages 8-10) and throughout adolescence. Serum AMH concentrations and breast density were assessed at ages 25-29 at the DISC 2006 Follow-up visit. We used linear mixed effects models to quantify associations of AMH (dependent variable) with quartiles of age-specific youth body mass index (BMI) Z-scores (independent variable). We assessed cross-sectional associations of breast density (dependent variable) with AMH concentration (independent variable). RESULTS Neither early life BMI nor current adult BMI was associated with AMH concentrations. There were no associations between AMH and percent or absolute dense breast volume. In contrast, women with higher AMH concentrations had significantly lower absolute nondense breast volume (Ptrend < 0.01). CONCLUSIONS We found no evidence that current or early life BMI influences AMH concentrations in later life. Women with higher concentrations of AMH had similar percent and absolute dense breast volume, but lower nondense volume. IMPACT These results suggest that AMH may be associated with lower absolute nondense breast volume; however, future prospective studies are needed to establish temporality. Cancer Epidemiol Biomarkers Prev; 25(7); 1151-7. ©2016 AACR.
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Affiliation(s)
| | - Heather J Baer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Nola M Hylton
- Department of Radiology, University of California, San Francisco, California
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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205
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Sherratt MJ, McConnell JC, Streuli CH. Raised mammographic density: causative mechanisms and biological consequences. Breast Cancer Res 2016; 18:45. [PMID: 27142210 PMCID: PMC4855337 DOI: 10.1186/s13058-016-0701-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
High mammographic density is the most important risk factor for breast cancer, after ageing. However, the composition, architecture, and mechanical properties of high X-ray density soft tissues, and the causative mechanisms resulting in different mammographic densities, are not well described. Moreover, it is not known how high breast density leads to increased susceptibility for cancer, or the extent to which it causes the genomic changes that characterise the disease. An understanding of these principals may lead to new diagnostic tools and therapeutic interventions.
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Affiliation(s)
- Michael J Sherratt
- Faculties of Life and Medical and Human Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - James C McConnell
- Faculties of Life and Medical and Human Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Charles H Streuli
- Faculties of Life and Medical and Human Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
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206
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Performance of DWI as a Rapid Unenhanced Technique for Detecting Mammographically Occult Breast Cancer in Elevated-Risk Women With Dense Breasts. AJR Am J Roentgenol 2016; 207:205-16. [PMID: 27077731 DOI: 10.2214/ajr.15.15873] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the performance of DWI to detect mammographically occult breast cancer in elevated-risk women with dense breasts. MATERIALS AND METHODS We retrospectively reviewed all women who underwent screening breast MRI at our institution from January 2007 through May 2013. We created a case-control cohort composed of 48 subjects with mammographically dense breasts: 24 with mammographically occult cancer detected on MRI and 24 healthy women with negative MRI findings who were matched to the subjects with breast cancer patients for age, breast density, and MRI protocol. The contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC), and conspicuity score (range, 1-5) were assessed on DWI for all malignancies. Lesions and normal tissue were compared using the Wilcoxon signed rank test; associations with clinical characteristics were evaluated using the Mann-Whitney U test. Three experienced breast imagers who were blinded to medical records and contrast-enhanced MRI findings independently evaluated the unenhanced MRI scans of the 48 women for the presence of cancer. RESULTS Mammographically occult breast cancers (invasive carcinoma, n = 16; ductal carcinoma in situ, n = 8) in women with dense breasts typically exhibited higher signal intensity on DWI than normal parenchyma (median CNR of cancers, 1.4; median conspicuity score of cancers, 4) and a lower ADC (median, 1.31 vs 1.79 × 10(-3) mm(2)/s, respectively) (p < 0.0001). The conspicuity score, CNR, and ADC were not associated with patient age, menopausal status, lesion size, morphologic type, or histology (p > 0.05). Average reader performance using unenhanced MRI was 45% sensitivity, 91% specificity, 62% positive predictive value, and 83% negative predictive value. CONCLUSION In elevated-risk women with dense breasts, DWI can reveal cancers in addition to those detected on mammography alone with a low false-positive rate; these results suggest that DWI may have potential as a rapid supplemental screening tool.
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207
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Lundberg FE, Johansson ALV, Rodriguez-Wallberg K, Brand JS, Czene K, Hall P, Iliadou AN. Association of infertility and fertility treatment with mammographic density in a large screening-based cohort of women: a cross-sectional study. Breast Cancer Res 2016; 18:36. [PMID: 27072636 PMCID: PMC4830010 DOI: 10.1186/s13058-016-0693-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/07/2016] [Indexed: 12/02/2022] Open
Abstract
Background Ovarian stimulation drugs, in particular hormonal agents used for controlled ovarian stimulation (COS) required to perform in vitro fertilization, increase estrogen and progesterone levels and have therefore been suspected to influence breast cancer risk. This study aims to investigate whether infertility and hormonal fertility treatment influences mammographic density, a strong hormone-responsive risk factor for breast cancer. Methods Cross-sectional study including 43,313 women recruited to the Karolinska Mammography Project between 2010 and 2013. Among women who reported having had infertility, 1576 had gone through COS, 1429 had had hormonal stimulation without COS and 5958 had not received any hormonal fertility treatment. Percent and absolute mammographic densities were obtained using the volumetric method Volpara™. Associations with mammographic density were assessed using multivariable generalized linear models, estimating mean differences (MD) with 95 % confidence intervals (CI). Results After multivariable adjustment, women with a history of infertility had 1.53 cm3 higher absolute dense volume compared to non-infertile women (95 % CI: 0.70 to 2.35). Among infertile women, only those who had gone through COS treatment had a higher absolute dense volume than those who had not received any hormone treatment (adjusted MD 3.22, 95 % CI: 1.10 to 5.33). No clear associations were observed between infertility, fertility treatment and percent volumetric density. Conclusions Overall, women reporting infertility had more dense tissue in the breast. The higher absolute dense volume in women treated with COS may indicate a treatment effect, although part of the association might also be due to the underlying infertility. Continued monitoring of cancer risk in infertile women, especially those who undergo COS, is warranted. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0693-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frida E Lundberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, 171 77, Sweden.
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, 171 77, Sweden
| | - Kenny Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet and Reproductive Medicine, Karolinska University Hospital Huddinge, Stockholm, 141 86, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, 171 77, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, 171 77, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, 171 77, Sweden
| | - Anastasia N Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm, 171 77, Sweden
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208
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Sak M, Duric N, Littrup P, Sherman ME, Gierach GL. Using ultrasound tomography to identify the distributions of density throughout the breast. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9790. [PMID: 28943704 DOI: 10.1117/12.2217611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Women with high breast density are at increased risk of developing breast cancer. Breast density has usually been defined using mammography as the ratio of fibroglandular tissue to total breast area. Ultrasound tomography (UST) is an emerging modality that can also be used to measure breast density. UST creates tomographic sound speed images of the patient's breast which is useful as sound speed is directly proportional to tissue density. Furthermore, the volumetric and quantitative information contained in the sound speed images can be used to describe the distribution of breast density. The work presented here measures the UST sound speed density distributions of 165 women with negative screening mammography. Frequency distributions of the sound speed voxel information were examined for each patient. In a preliminary analysis, the UST sound speed distributions were averaged across patients and grouped by various patient and density-related factors (e.g., age, body mass index, menopausal status, average mammographic breast density). It was found that differences in the distribution of density could be easily visualized for different patient groupings. Furthermore, findings suggest that the shape of the distributions may be used to identify participants with varying amounts of dense and non-dense tissue.
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Affiliation(s)
- Mark Sak
- Delphinus Medical Technologies, 46701 Commerce Center Dr, Plymouth, MI, 48170
| | - Neb Duric
- Delphinus Medical Technologies, 46701 Commerce Center Dr, Plymouth, MI, 48170
| | - Peter Littrup
- Delphinus Medical Technologies, 46701 Commerce Center Dr, Plymouth, MI, 48170.,Brown University, Rhode Island Hospital, 593 Eddy Street, Providence RI, 02903
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Gretchen L Gierach
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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209
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Chen L, Ray S, Keller BM, Pertuz S, McDonald ES, Conant EF, Kontos D. The Impact of Acquisition Dose on Quantitative Breast Density Estimation with Digital Mammography: Results from ACRIN PA 4006. Radiology 2016; 280:693-700. [PMID: 27002418 DOI: 10.1148/radiol.2016151749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the impact of radiation dose on breast density estimation in digital mammography. Materials and Methods With institutional review board approval and Health Insurance Portability and Accountability Act compliance under waiver of consent, a cohort of women from the American College of Radiology Imaging Network Pennsylvania 4006 trial was retrospectively analyzed. All patients underwent breast screening with a combination of dose protocols, including standard full-field digital mammography, low-dose digital mammography, and digital breast tomosynthesis. A total of 5832 images from 486 women were analyzed with previously validated, fully automated software for quantitative estimation of density. Clinical Breast Imaging Reporting and Data System (BI-RADS) density assessment results were also available from the trial reports. The influence of image acquisition radiation dose on quantitative breast density estimation was investigated with analysis of variance and linear regression. Pairwise comparisons of density estimations at different dose levels were performed with Student t test. Agreement of estimation was evaluated with quartile-weighted Cohen kappa values and Bland-Altman limits of agreement. Results Radiation dose of image acquisition did not significantly affect quantitative density measurements (analysis of variance, P = .37 to P = .75), with percent density demonstrating a high overall correlation between protocols (r = 0.88-0.95; weighted κ = 0.83-0.90). However, differences in breast percent density (1.04% and 3.84%, P < .05) were observed within high BI-RADS density categories, although they were significantly correlated across the different acquisition dose levels (r = 0.76-0.92, P < .05). Conclusion Precision and reproducibility of automated breast density measurements with digital mammography are not substantially affected by variations in radiation dose; thus, the use of low-dose techniques for the purpose of density estimation may be feasible. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Lin Chen
- From the Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia PA 19104-2643
| | - Shonket Ray
- From the Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia PA 19104-2643
| | - Brad M Keller
- From the Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia PA 19104-2643
| | - Said Pertuz
- From the Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia PA 19104-2643
| | - Elizabeth S McDonald
- From the Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia PA 19104-2643
| | - Emily F Conant
- From the Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia PA 19104-2643
| | - Despina Kontos
- From the Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia PA 19104-2643
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210
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Esbona K, Inman D, Saha S, Jeffery J, Schedin P, Wilke L, Keely P. COX-2 modulates mammary tumor progression in response to collagen density. Breast Cancer Res 2016; 18:35. [PMID: 27000374 PMCID: PMC4802888 DOI: 10.1186/s13058-016-0695-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/03/2016] [Indexed: 12/27/2022] Open
Abstract
Background High breast density is linked to an increased risk of breast cancer, and correlates with changes in collagen. In a mouse model of mammary carcinoma in the context of increased collagen deposition, the MMTV-PyMT/Col1a1tm1jae, there is accelerated mammary tumor formation and progression. Previous gene expression analysis suggests that increased collagen density elevates expression of PTGS2 (prostaglandin-endoperoxide synthase 2), the gene for cyclooxygenase-2 (COX-2). Methods To understand the role of COX-2 in tumor progression within a collagen-dense microenvironment, we treated MMTV-PyMT or MMTV-PyMT/Col1a1tm1jae tumors prior to and after tumor formation. Animals received treatment with celecoxib, a specific COX-2 inhibitor, or placebo. Mammary tumors were examined for COX-2, inflammatory and stromal cell components, and collagen deposition through immunohistochemical analysis, immunofluorescence, multiplex cytokine ELISA and tissue imaging techniques. Results PyMT/Col1a1tm1jae tumors were larger, more proliferative, and expressed higher levels of COX-2 and PGE2 than PyMT tumors in wild type (WT) mice. Treatment with celecoxib significantly decreased the induced tumor size and metastasis of the PyMT/Col1a1 tumors, such that their size was not different from the smaller PyMT tumors. Celecoxib had minimal effect on the PyMT tumors. Celecoxib decreased expression levels of COX-2, PGE2, and Ki-67. Several cytokines were over-expressed in PyMT/Col1a1 compared to PyMT, and celecoxib treatment prevented their over-expression. Furthermore, macrophage and neutrophil recruitment were enhanced in PyMT/Col1a1 tumors, and this effect was inhibited by celecoxib. Notably, COX-2 inhibition reduced overall collagen deposition. Finally, when celecoxib was used prior to tumor formation, PyMT/Col1a1 tumors were fewer and smaller than in untreated animals. Conclusion These findings suggest that COX-2 has a direct role in modulating tumor progression in tumors arising within collagen-dense microenvironments, and suggest that COX-2 may be an effective therapeutic target for women with dense breast tissue and early-stage breast cancer. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0695-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karla Esbona
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, WI, USA.,Institute for Clinical and Translational Research (ICTR), University of Wisconsin-Madison, Madison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - David Inman
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Sandeep Saha
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Justin Jeffery
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Pepper Schedin
- Department of Cell and Developmental Biology, School of Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Lee Wilke
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Patricia Keely
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, WI, USA. .,School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
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Crew KD. Addressing barriers to uptake of breast cancer chemoprevention for patients and providers. Am Soc Clin Oncol Educ Book 2016:e50-8. [PMID: 25993215 DOI: 10.14694/edbook_am.2015.35.e50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Breast cancer is the most common malignancy among women in the United States, and the primary prevention of this disease is a major public health issue. Because there are relatively few modifiable breast cancer risk factors, pharmacologic interventions with antiestrogens have the potential to significantly affect the primary prevention setting. Breast cancer chemoprevention with selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene, and with aromatase inhibitors (AIs) exemestane and anastrozole, is underutilized despite several randomized controlled trials demonstrating up to a 50% to 65% relative risk reduction in breast cancer incidence among women at high risk. An estimated 10 million women in the United States meet high-risk criteria for breast cancer and are potentially eligible for chemoprevention, but less than 5% of women at high risk who are offered antiestrogens for primary prevention agree to take it. Reasons for low chemoprevention uptake include lack of routine breast cancer risk assessment in primary care, inadequate time for counseling, insufficient knowledge about antiestrogens among patients and providers, and concerns about side effects. Interventions designed to increase chemoprevention uptake, such as decision aids and incorporating breast cancer risk assessment into clinical practice, have met with limited success. Clinicians can help women make informed decisions about chemoprevention by effectively communicating breast cancer risk and enhancing knowledge about the risks and benefits of antiestrogens. Widespread adoption of chemoprevention will require a major paradigm shift in clinical practice for primary care providers (PCPs). However, enhancing uptake and adherence to breast cancer chemoprevention holds promise for reducing the public health burden of this disease.
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Affiliation(s)
- Katherine D Crew
- From the Department of Medicine, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
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Incorporating Biomarkers in Studies of Chemoprevention. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 882:69-94. [PMID: 26987531 DOI: 10.1007/978-3-319-22909-6_3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite Food and Drug Administration approval of tamoxifen and raloxifene for breast cancer risk reduction and endorsement by multiple agencies, uptake of these drugs for primary prevention in the United States is only 4% for risk eligible women likely to benefit from their use. Side effects coupled with incomplete efficacy and lack of a survival advantage are the likely reasons. This disappointing uptake, after the considerable effort and expense of large Phase III cancer incidence trials required for approval, suggests that a new paradigm is required. Current prevention research is focused on (1) refining risk prediction, (2) exploring behavioral and natural product interventions, and (3) utilizing novel translational trial designs for efficacy. Risk biomarkers will play a central role in refining risk estimates from traditional models and selecting cohorts for prevention trials. Modifiable risk markers called surrogate endpoint or response biomarkers will continue to be used in Phase I and II prevention trials to determine optimal dose or exposure and likely effectiveness from an intervention. The majority of Phase II trials will continue to assess benign breast tissue for response and mechanism of action biomarkers. Co-trials are those in which human and animal cohorts receive the same effective dose and the same tissue biomarkers are assessed for modulation due to the intervention, but then additional animals are allowed to progress to cancer development. These collaborations linking biomarker modulation and cancer prevention may obviate the need for cancer incidence trials for non-prescription interventions.
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213
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Kalli S, Freer PE. Breast Density Assessment, Risk, and Significance in the Screening of Breast Cancer. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-015-0130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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214
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Mariapun S, Ho WK, Kang PCE, Li J, Lindström S, Yip CH, Teo SH. Variants in 6q25.1 Are Associated with Mammographic Density in Malaysian Chinese Women. Cancer Epidemiol Biomarkers Prev 2015; 25:327-33. [PMID: 26677210 DOI: 10.1158/1055-9965.epi-15-0746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/08/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mammographic density is an established risk factor for breast cancer and has a strong heritable component. Genome-wide association studies (GWAS) for mammographic density conducted in women of European descent have identified several genetic associations, but none of the studies have been tested in Asians. We sought to investigate whether these genetic loci, and loci associated with breast cancer risk and breast size, are associated with mammographic density in an Asian cohort. METHODS We conducted genotyping by mass spectrometry in 1,189 women (865 Chinese, 187 Indian, and 137 Malay). Quantitative measurements of mammographic density were performed using ImageJ, a fully automated thresholding technique. The associations of SNPs to densities were analyzed using linear regression models. RESULTS We successfully evaluated the associations of 36 SNPs with mammographic densities. After adjusting for age, body mass index, parity, and menopausal status, we found that in our cohort of 865 Malaysian Chinese, three SNPs in the 6q25.1 region near ESR1 (rs2046210, rs12173570, and rs10484919) that were associated with mammographic density, breast cancer risk, or breast size in previous GWAS were significantly associated with both percentage density and absolute dense area. We could not replicate the most significant association found previously in European women (rs10995190, ZNF365 gene) because the minor allele was absent for Asian women. CONCLUSION We found that the directions of genetic associations were similar to those reported in Caucasian women. IMPACT Our results show that even in Asian women with lower population risk to breast cancer, there is shared heritability between mammographic density and breast cancer risk.
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Affiliation(s)
- Shivaani Mariapun
- Cancer Research Malaysia (formerly known as Cancer Research Initiatives Foundation), Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia. Breast Cancer Research Group, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Weang Kee Ho
- Department of Applied Mathematics, Faculty of Engineering, University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia
| | - Peter Choon Eng Kang
- Cancer Research Malaysia (formerly known as Cancer Research Initiatives Foundation), Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Lindström
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | | | - Soo Hwang Teo
- Cancer Research Malaysia (formerly known as Cancer Research Initiatives Foundation), Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia. Breast Cancer Research Group, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Soguel L, Diorio C. Anthropometric factors, adult weight gain, and mammographic features. Cancer Causes Control 2015; 27:333-40. [PMID: 26667319 DOI: 10.1007/s10552-015-0706-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/06/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the association between anthropometric factors, weight gain during adulthood, and mammographic features among 1,435 women recruited at screening mammography. METHODS Spearman's partial coefficients were used to evaluate the correlation of anthropometric factors with mammographic features (percent density, absolute dense area, and non-dense area). Multivariate generalized linear models were used to evaluate the associations between weight change categories and mammographic features. RESULTS Body mass index was inversely correlated with percent density (r = -0.49, p < 0.0001) or absolute dense area (r = -0.21, p < 0.0001) and positively correlated with absolute non-dense area (r = 0.69, p < 0.0001). However, body mass index was positively correlated with absolute dense area when adjusting for absolute non-dense area (r = 0.16, p < 0.0001). Similar results were observed for weight, waist circumference, and waist-to-hip ratio with mammographic features. Within increasing categories of weight change, percent density (p trend < 0.0001) and absolute dense area (p trend = 0.025) increased, while absolute non-dense area decreased (p trend < 0.0001). After stratification by the median of non-dense area, the positive association between weight gain and absolute dense area remained only among women with higher non-dense area. CONCLUSIONS Adiposity seems positively associated with both dense and non-dense areas following adjustment for each other. Our findings suggest a higher breast dense area among women who gained weight and that a minimum of breast fat may be needed to promote the proliferation of this fibroglandular tissue.
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Affiliation(s)
- Ludivine Soguel
- Department of Social and Preventive Medicine, Cancer Research Center, Laval University, 2325, rue de l'Université, Quebec City, QC, G1V 0A6, Canada.,Oncology Unit, CHU de Québec Research Center, Saint-Sacrement Hospital, 1050, chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada.,Nutrition and Dietetics Department, University of Applied Sciences Western Switzerland (HES-SO) Geneva, rue des Caroubiers 25, 1227, Carouge, Switzerland
| | - Caroline Diorio
- Department of Social and Preventive Medicine, Cancer Research Center, Laval University, 2325, rue de l'Université, Quebec City, QC, G1V 0A6, Canada. .,Oncology Unit, CHU de Québec Research Center, Saint-Sacrement Hospital, 1050, chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada. .,Deschênes-Fabia Center for Breast Diseases, Saint-Sacrement Hospital, 1050, chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada.
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Pertuz S, McDonald ES, Weinstein SP, Conant EF, Kontos D. Fully Automated Quantitative Estimation of Volumetric Breast Density from Digital Breast Tomosynthesis Images: Preliminary Results and Comparison with Digital Mammography and MR Imaging. Radiology 2015; 279:65-74. [PMID: 26491909 DOI: 10.1148/radiol.2015150277] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess a fully automated method for volumetric breast density (VBD) estimation in digital breast tomosynthesis (DBT) and to compare the findings with those of full-field digital mammography (FFDM) and magnetic resonance (MR) imaging. MATERIALS AND METHODS Bilateral DBT images, FFDM images, and sagittal breast MR images were retrospectively collected from 68 women who underwent breast cancer screening from October 2011 to September 2012 with institutional review board-approved, HIPAA-compliant protocols. A fully automated computer algorithm was developed for quantitative estimation of VBD from DBT images. FFDM images were processed with U.S. Food and Drug Administration-cleared software, and the MR images were processed with a previously validated automated algorithm to obtain corresponding VBD estimates. Pearson correlation and analysis of variance with Tukey-Kramer post hoc correction were used to compare the multimodality VBD estimates. RESULTS Estimates of VBD from DBT were significantly correlated with FFDM-based and MR imaging-based estimates with r = 0.83 (95% confidence interval [CI]: 0.74, 0.90) and r = 0.88 (95% CI: 0.82, 0.93), respectively (P < .001). The corresponding correlation between FFDM and MR imaging was r = 0.84 (95% CI: 0.76, 0.90). However, statistically significant differences after post hoc correction (α = 0.05) were found among VBD estimates from FFDM (mean ± standard deviation, 11.1% ± 7.0) relative to MR imaging (16.6% ± 11.2) and DBT (19.8% ± 16.2). Differences between VDB estimates from DBT and MR imaging were not significant (P = .26). CONCLUSION Fully automated VBD estimates from DBT, FFDM, and MR imaging are strongly correlated but show statistically significant differences. Therefore, absolute differences in VBD between FFDM, DBT, and MR imaging should be considered in breast cancer risk assessment.
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Affiliation(s)
- Said Pertuz
- From the Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia, PA 19104
| | - Elizabeth S McDonald
- From the Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia, PA 19104
| | - Susan P Weinstein
- From the Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia, PA 19104
| | - Emily F Conant
- From the Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia, PA 19104
| | - Despina Kontos
- From the Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3600 Market St, Suite 360, Philadelphia, PA 19104
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Tagliafico A, Bignotti B, Tagliafico G, Tosto S, Signori A, Calabrese M. Quantitative evaluation of background parenchymal enhancement (BPE) on breast MRI. A feasibility study with a semi-automatic and automatic software compared to observer-based scores. Br J Radiol 2015; 88:20150417. [PMID: 26462852 DOI: 10.1259/bjr.20150417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate quantitative measurements of background parenchymal enhancement (BPE) on breast MRI and compare them with observer-based scores. METHODS BPE of 48 patients (mean age: 48 years; age range: 36-66 years) referred to 3.0-T breast MRI between 2012 and 2014 was evaluated independently and blindly to each other by two radiologists. BPE was estimated qualitatively with the standard Breast Imaging Reporting and Data System (BI-RADS) scale and quantitatively with a semi-automatic and an automatic software interface. To assess intrareader agreement, MRIs were re-read after a 4-month interval by the same two readers. The Pearson correlation coefficient (r) and the Bland-Altman method were used to compare the methods used to estimate BPE. p-value <0.05 was considered significant. RESULTS The mean value of BPE with the semi-automatic software evaluated by each reader was 14% (range: 2-79%) for Reader 1 and 16% (range: 1-61%) for Reader 2 (p > 0.05). Mean values of BPE percentages for the automatic software were 17.5 ± 13.1 (p > 0.05 vs semi-automatic). The automatic software was unable to produce BPE values for 2 of 48 (4%) patients. With BI-RADS, interreader and intrareader values were κ = 0.70 [95% confidence interval (CI) 0.49-0.91] and κ = 0.69 (95% CI 0.46-0.93), respectively. With semi-automated software, interreader and intrareader values were κ = 0.81 (95% CI 0.59-0.99) and κ = 0.85 (95% CI 0.43-0.99), respectively. BI-RADS scores correlated with the automatic (r = 0.55, p < 0.001) and semi-automatic scores (r = 0.60, p < 0.001). Automatic scores correlated with the semi-automatic scores (r = 0.77, p < 0.001). The mean percentage difference between automatic and semi-automatic scores was 3.5% (95% CI 1.5-5.2). CONCLUSION BPE quantitative evaluation is feasible with both semi-automatic and automatic software and correlates with radiologists' estimation. ADVANCES IN KNOWLEDGE Computerized BPE quantitative evaluation is feasible with both semi-automatic and automatic software. Computerized BPE quantitative scores correlate with radiologists' estimation.
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Affiliation(s)
- Alberto Tagliafico
- 1 Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Genova, Italy
| | - Bianca Bignotti
- 2 Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | | | - Simona Tosto
- 4 Department of Diagnostic Senology, Ist Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Alessio Signori
- 2 Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Massimo Calabrese
- 4 Department of Diagnostic Senology, Ist Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
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219
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Yaghjyan L, Pettersson A, Colditz GA, Collins LC, Schnitt SJ, Beck AH, Rosner B, Vachon C, Tamimi RM. Postmenopausal mammographic breast density and subsequent breast cancer risk according to selected tissue markers. Br J Cancer 2015; 113:1104-13. [PMID: 26335607 PMCID: PMC4651128 DOI: 10.1038/bjc.2015.315] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/29/2015] [Accepted: 08/07/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND This study aimed to determine if associations of pre-diagnostic percent breast density, absolute dense area, and non-dense area with subsequent breast cancer risk differ by the tumour's molecular marker status. METHODS We included 1010 postmenopausal women with breast cancer and 2077 matched controls from the Nurses' Health Study (NHS) and the Nurses' Health Study II (NHS II) cohorts. Breast density was estimated from digitised film mammograms using computer-assisted thresholding techniques. Information on breast cancer risk factors was obtained prospectively from biennial questionnaires. Polychotomous logistic regression was used to assess associations of breast density measures with tumour subtypes by the status of selected tissue markers. All tests of statistical significance were two sided. RESULTS The association of percent density with breast cancer risk appeared to be stronger in ER- as compared with ER+ tumours, but the difference did not reach statistical significance (density ⩾50% vs <10% odds ratio (OR)=3.06, 95% confidence interval (CI) 2.17-4.32 for ER+; OR=4.61, 95% CI 2.36-9.03 for ER-, Pheterogeneity=0.08). Stronger positive associations were found for absolute dense area and CK5/6- and EGFR- as compared with respective marker-positive tumours (Pheterogeneity=0.002 and 0.001, respectively). Stronger inverse associations of non-dense area with breast cancer risk were found for ER- as compared with ER+ tumours (Pheterogeneity=0.0001) and for AR+, CK5/6+, and EGFR+ as compared with respective marker-negative tumours (Pheterogeneity=0.03, 0.005, and 0.009, respectively). The associations of density measures with breast cancer did not differ by progesterone receptor and human epidermal growth factor receptor 2 status. CONCLUSIONS Breast density influences the risk of breast cancer subtypes by potentially different mechanisms.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, USA
| | - Andreas Pettersson
- Department of Epidemiology, Harvard School of Public Health, 181 Longwood Avenue, Boston, MA 02115, USA
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, 171 76 Solna, Stockholm, Sweden
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, 660S. Euclid Avenue, St Louis, MO 63110, USA
- Institute for Public Health, Washington University in St Louis, St Louis, MO, USA
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Andrew H Beck
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Charlton 6-239, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard School of Public Health, 181 Longwood Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA
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Sak MA, Littrup PJ, Duric N, Mullooly M, Sherman ME, Gierach GL. Current and Future Methods for Measuring Breast Density: A Brief Comparative Review. BREAST CANCER MANAGEMENT 2015; 4:209-221. [PMID: 28943893 PMCID: PMC5609705 DOI: 10.2217/bmt.15.13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Breast density is one of the strongest predictors of breast cancer risk. Women with the densest breasts are 4 to 6 times more likely to develop cancer compared with those with the lowest densities. Breast density is generally assessed using mammographic imaging; however, this approach has limitations. Magnetic resonance imaging and ultrasound tomography are some alternative imaging modalities that can aid mammography in patient screening and the measurement of breast density. As breast density becomes more commonly discussed, knowledge of the advantages and limitations of breast density as a marker of risk will become more critical. This review article discusses the relationship between breast density and breast cancer risk, lists the benefits and drawbacks of using multiple different imaging modalities to measure density and briefly discusses how breast density will be applied to aid in breast cancer prevention and treatment.
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Affiliation(s)
- Mark A Sak
- Karmanos Cancer Institute, Wayne State University, 4100 John R Street, Detroit MI 48201
| | - Peter J Littrup
- Delphinus Medical Technologies, 46701 Commerce Center Dr, Plymouth, MI, 48170
- Brown University, Rhode Island Hospital, 593 Eddy Street, Providence RI, 02903
| | - Neb Duric
- Karmanos Cancer Institute, Wayne State University, 4100 John R Street, Detroit MI 48201
- Delphinus Medical Technologies, 46701 Commerce Center Dr, Plymouth, MI, 48170
| | - Maeve Mullooly
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Bertrand KA, Baer HJ, Orav EJ, Klifa C, Shepherd JA, Van Horn L, Snetselaar L, Stevens VJ, Hylton NM, Dorgan JF. Body fatness during childhood and adolescence and breast density in young women: a prospective analysis. Breast Cancer Res 2015; 17:95. [PMID: 26174168 PMCID: PMC4502611 DOI: 10.1186/s13058-015-0601-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/18/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Overweight and obesity in childhood and adolescence are associated with reduced breast cancer risk, independent of adult body mass index (BMI). These associations may be mediated through breast density. METHODS We prospectively examined associations of early life body fatness with adult breast density measured by MRI in 182 women in the Dietary Intervention Study in Children (DISC) who were ages 25-29 at follow-up. Height, weight, and other factors were measured at baseline (ages 8-10) and annual clinic visits through adolescence. We used linear mixed-effects models to quantify associations of percent breast density and dense and non-dense breast volume at ages 25-29 with quartiles of age-specific youth body mass index (BMI) Z-scores, adjusting for clinic, treatment group, current adult BMI, and other well-established risk factors for breast cancer and predictors of breast density. RESULTS We observed inverse associations between age-specific BMI Z-scores at all youth clinic visits and percent breast density, adjusting for current adult BMI and other covariates (all p values <0.01). Women whose baseline BMI Z-scores (at ages 8-10 years) were in the top quartile had significantly lower adult breast density, after adjusting for current adult BMI and other covariates [least squares mean (LSM): 23.4 %; 95 % confidence interval (CI): 18.0 %, 28.8 %] compared to those in the bottom quartile (LSM: 31.8 %; 95 % CI: 25.2 %, 38.4 %) (p trend <0.01). Significant inverse associations were also observed for absolute dense breast volume (all p values <0.01), whereas there were no clear associations with non-dense breast volume. CONCLUSIONS These results support the hypothesis that body fatness during childhood and adolescence may play an important role in premenopausal breast density, independent of current BMI, and further suggest direct or indirect influences on absolute dense breast volume. CLINICAL TRIALS REGISTRATION NUMBER NCT00458588 ; April 9, 2007.
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Affiliation(s)
- Kimberly A Bertrand
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Heather J Baer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02120, USA.
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02120, USA. .,Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Catherine Klifa
- Dangeard Group, 740 chemin de la Commanderie St Jean de Malte, 13080, Luynes, France.
| | - John A Shepherd
- Department of Radiology, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, 680 North Lake Shore Drive, Chicago, IL, 60611, USA.
| | - Linda Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, 145 North Riverside Drive, Iowa City, IA, 52242, USA.
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227, USA.
| | - Nola M Hylton
- Department of Radiology, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA.
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The metabolic syndrome and mammographic breast density in a racially diverse and predominantly immigrant sample of women. Cancer Causes Control 2015; 26:1393-403. [PMID: 26169301 DOI: 10.1007/s10552-015-0630-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/01/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE The metabolic syndrome [MetS, clustering of elevated blood pressure, triglycerides and glucose, reduced high-density lipoprotein cholesterol (HDL-C), abdominal obesity] has been associated with increased breast cancer risk, but less is known about its association with mammographic breast density, a strong risk factor for breast cancer. METHODS We collected data on risk factors, body size, and blood pressure via in-person interviews and examinations and measured glucose, triglycerides, and HDL-C from dried blood spots from women recruited through a mammography screening clinic (n = 373; 68 % Hispanic, 17 % African-American, 63 % foreign born). We performed linear regression models to examine the associations of each MetS component and the MetS cluster (≥3 components) with percent density and dense breast area, measured using a computer-assisted technique and Cumulus software. RESULTS About 45 % of women had the MetS, with the prevalence of the individual components ranging from 68 % for abdominal obesity to 33 % for elevated triglycerides. The prevalence of the MetS increased with higher body mass index (BMI) and postmenopausal status, but did not vary substantially by ethnicity, immigrant generational status, parity, age at menarche, or alcohol consumption. Low HDL-C (<50 mg/dL), but not the MetS cluster or the other MetS components, was associated with larger dense breast area after adjusting for age, BMI, fasting time, and educational attainment (β = 8.77, 95 % CI 2.39, 15.14). The MetS and its individual components were not associated with BMI-adjusted percent density. CONCLUSIONS HDL-C alone may have an influence on dense breast tissue that is independent of BMI, and may be in the same direction as its association with breast cancer risk.
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van der Waal D, Emaus MJ, Bakker MF, den Heeten GJ, Karssemeijer N, Pijnappel RM, Veldhuis WB, Verbeek ALM, van Gils CH, Broeders MJM. Geographic variation in volumetric breast density between screening regions in the Netherlands. Eur Radiol 2015; 25:3328-37. [PMID: 26134996 PMCID: PMC4595533 DOI: 10.1007/s00330-015-3742-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/10/2015] [Accepted: 03/25/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Differences in breast density between populations may explain part of the variation in regional breast cancer screening performance. This study aimed to determine whether regional differences in breast density distribution are present in the Dutch screening population. METHODS As part of the DENSE trial, mammographic density was measured using a fully-automated volumetric method. The regions in our study were based on the geographic coverage of 14 reading units representing a large part of the Netherlands. General linear models were used. RESULTS Four hundred eighty-five thousand and twenty-one screening participants with a median age of 60 years were included (2013-2014). The proportion of women with heterogeneously or extremely dense breasts ranged from 32.5% to 45.7% between regions. Mean percent dense volume varied between 6.51% (95% confidence interval [CI]: 6.46-6.55) and 7.68% (95% CI: 7.66-7.71). Age differences could not explain the variation. Socio-economic status (SES) was positively associated with volumetric density in all analyses (low SES: 6.95% vs. high SES: 7.63%; p trend < 0.0001), whereas a potential association between urbanisation and breast density only became apparent after SES adjustment. CONCLUSION There appears to be geographic variation in mammographic density in the Netherlands, emphasizing the importance of including breast density as parameter in the evaluation of screening performance. KEY POINTS • Mammographic density may affect regional breast cancer screening performance. • Volumetric breast density varies across screening areas. • SES is positively associated with breast density. • Implications of volumetric breast density differences need to be studied further.
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Affiliation(s)
- Daniëlle van der Waal
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marleen J Emaus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard J den Heeten
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Ruud M Pijnappel
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - André L M Verbeek
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Dutch Reference Centre for Screening, Nijmegen, The Netherlands
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Stone J, Thompson DJ, Dos Santos Silva I, Scott C, Tamimi RM, Lindstrom S, Kraft P, Hazra A, Li J, Eriksson L, Czene K, Hall P, Jensen M, Cunningham J, Olson JE, Purrington K, Couch FJ, Brown J, Leyland J, Warren RML, Luben RN, Khaw KT, Smith P, Wareham NJ, Jud SM, Heusinger K, Beckmann MW, Douglas JA, Shah KP, Chan HP, Helvie MA, Le Marchand L, Kolonel LN, Woolcott C, Maskarinec G, Haiman C, Giles GG, Baglietto L, Krishnan K, Southey MC, Apicella C, Andrulis IL, Knight JA, Ursin G, Alnaes GIG, Kristensen VN, Borresen-Dale AL, Gram IT, Bolla MK, Wang Q, Michailidou K, Dennis J, Simard J, Pharoah P, Dunning AM, Easton DF, Fasching PA, Pankratz VS, Hopper JL, Vachon CM. Novel Associations between Common Breast Cancer Susceptibility Variants and Risk-Predicting Mammographic Density Measures. Cancer Res 2015; 75:2457-67. [PMID: 25862352 PMCID: PMC4470785 DOI: 10.1158/0008-5472.can-14-2012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 03/10/2015] [Indexed: 12/30/2022]
Abstract
Mammographic density measures adjusted for age and body mass index (BMI) are heritable predictors of breast cancer risk, but few mammographic density-associated genetic variants have been identified. Using data for 10,727 women from two international consortia, we estimated associations between 77 common breast cancer susceptibility variants and absolute dense area, percent dense area and absolute nondense area adjusted for study, age, and BMI using mixed linear modeling. We found strong support for established associations between rs10995190 (in the region of ZNF365), rs2046210 (ESR1), and rs3817198 (LSP1) and adjusted absolute and percent dense areas (all P < 10(-5)). Of 41 recently discovered breast cancer susceptibility variants, associations were found between rs1432679 (EBF1), rs17817449 (MIR1972-2: FTO), rs12710696 (2p24.1), and rs3757318 (ESR1) and adjusted absolute and percent dense areas, respectively. There were associations between rs6001930 (MKL1) and both adjusted absolute dense and nondense areas, and between rs17356907 (NTN4) and adjusted absolute nondense area. Trends in all but two associations were consistent with those for breast cancer risk. Results suggested that 18% of breast cancer susceptibility variants were associated with at least one mammographic density measure. Genetic variants at multiple loci were associated with both breast cancer risk and the mammographic density measures. Further understanding of the underlying mechanisms at these loci could help identify etiologic pathways implicated in how mammographic density predicts breast cancer risk.
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Affiliation(s)
- Jennifer Stone
- Centre for Genetic Origins of Health and Disease, University of Western Australia, Crawley, Western Australia, Australia
| | - Deborah J Thompson
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Isabel Dos Santos Silva
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher Scott
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rulla M Tamimi
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara Lindstrom
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Program in Genetic Epidemiology and Statistical Genetics, Harvard 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, Harvard School of Public Health, Boston, Massachusetts. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aditi Hazra
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Louise Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matt Jensen
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Julie Cunningham
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Janet E Olson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Kristen Purrington
- Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Judith Brown
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jean Leyland
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ruth M L Warren
- Department of Radiology, University of Cambridge, Addenbrooke's NHS Foundation Trust, Cambridge, United Kingdom
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival (CNC), University of Cambridge, Cambridge, United Kingdom
| | - Paula Smith
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sebastian M Jud
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Katharina Heusinger
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Matthias W Beckmann
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Julie A Douglas
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kaanan P Shah
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark A Helvie
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | - Christy Woolcott
- Department of Obstetrics and Genecology, IWK Health Centre, Halifax, Canada
| | | | - Christopher Haiman
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. Centre for Research in Epidemiology and Population Health, Gustave Roussy Institute, Villejuif Cedex, France. Paris-South University, Villejuif, France
| | - Kavitha Krishnan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Melissa C Southey
- Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Irene L Andrulis
- Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Julia A Knight
- Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Giske Ursin
- Institute of Basic Medical Sciences, University of Oslo, Norway. Department of Preventive Medicine, University of Southern California, California
| | - Grethe I Grenaker Alnaes
- Department of Genetics, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, Oslo, Norway
| | - Vessela N Kristensen
- Department of Genetics, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, Oslo, Norway
| | - Anne-Lise Borresen-Dale
- Department of Genetics, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, Oslo, Norway
| | - Inger Torhild Gram
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Qin Wang
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jacques Simard
- Centre Hospitalier Universitaire de Québec Research Center and Laval University, Quebec, Canada
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Peter A Fasching
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany. Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - V Shane Pankratz
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Celine M Vachon
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota.
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Jung S, Egleston BL, Chandler DW, Van Horn L, Hylton NM, Klifa CC, Lasser NL, LeBlanc ES, Paris K, Shepherd JA, Snetselaar LG, Stanczyk FZ, Stevens VJ, Dorgan JF. Adolescent endogenous sex hormones and breast density in early adulthood. Breast Cancer Res 2015; 17:77. [PMID: 26041651 PMCID: PMC4468804 DOI: 10.1186/s13058-015-0581-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/13/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION During adolescence the breasts undergo rapid growth and development under the influence of sex hormones. Although the hormonal etiology of breast cancer is hypothesized, it remains unknown whether adolescent sex hormones are associated with adult breast density, which is a strong risk factor for breast cancer. METHODS Percentage of dense breast volume (%DBV) was measured in 2006 by magnetic resonance imaging in 177 women aged 25-29 years who had participated in the Dietary Intervention Study in Children from 1988 to 1997. They had sex hormones and sex hormone-binding globulin (SHBG) measured in serum collected on one to five occasions between 8 and 17 years of age. Multivariable linear mixed-effect regression models were used to evaluate the associations of adolescent sex hormones and SHBG with %DBV. RESULTS Dehydroepiandrosterone sulfate (DHEAS) and SHBG measured in premenarche serum samples were significantly positively associated with %DBV (all P trend ≤0.03) but not when measured in postmenarche samples (all P trend ≥0.42). The multivariable geometric mean of %DBV across quartiles of premenarcheal DHEAS and SHBG increased from 16.7 to 22.1 % and from 14.1 to 24.3 %, respectively. Estrogens, progesterone, androstenedione, and testosterone in pre- or postmenarche serum samples were not associated with %DBV (all P trend ≥0.16). CONCLUSIONS Our results suggest that higher premenarcheal DHEAS and SHBG levels are associated with higher %DBV in young women. Whether this association translates into an increased risk of breast cancer later in life is currently unknown. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier, NCT00458588 April 9, 2007; NCT00000459 October 27, 1999.
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Affiliation(s)
- Seungyoun Jung
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA.
| | - Brian L Egleston
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - D Walt Chandler
- Esoterix Inc, 4301 Lost Hills Road, Calabasas Hills, CA, 91301, USA.
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 303 E Chicago Avenue, Chicago, IL, 60611, USA.
| | - Nola M Hylton
- Department of Radiology, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Catherine C Klifa
- Dangeard Group, 580 W Remington Drive, San Francisco, CA, 94087, USA.
| | - Norman L Lasser
- Department of Medicine, Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA.
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR, 97227, USA.
| | - Kenneth Paris
- Department of Pediatrics, Louisiana State University School of Medicine, 1901 Perdido Street, New Orleans, LA, 70112, USA.
| | - John A Shepherd
- Department of Radiology, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR, 97227, USA.
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA.
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Trinh T, Christensen SE, Brand JS, Cuzick J, Czene K, Sjölander A, Bälter K, Hall P. Background risk of breast cancer influences the association between alcohol consumption and mammographic density. Br J Cancer 2015; 113:159-65. [PMID: 26035701 PMCID: PMC4647543 DOI: 10.1038/bjc.2015.185] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/27/2015] [Accepted: 05/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background: Alcohol consumption has been suggested to increase risk of breast cancer through a mechanism that also increases mammographic density. Whether the association between alcohol consumption and mammographic density is modified by background breast cancer risk has, however, not been studied. Methods: We conducted a population-based cross-sectional study of 53 060 Swedish women aged 40–74 years. Alcohol consumption was assessed using a web-based self-administered questionnaire. Mammographic density was measured using the fully-automated volumetric Volpara method. The Tyrer–Cuzick prediction model was used to estimate risk of developing breast cancer in the next 10 years. Linear regression models were used to evaluate the association between alcohol consumption and volumetric mammographic density and the potential influence of Tyrer–Cuzick breast cancer risk. Results: Overall, increasing alcohol consumption was associated with higher absolute dense volume (cm3) and per cent dense volume (%). The association between alcohol consumption and absolute dense volume was most pronounced among women with the highest (⩾5%) Tyrer–Cuzick 10-year risk. Among high-risk women, women consuming 5.0–9.9, 10.0–19.9, 20.0–29.9, and 30.0–40.0 g of alcohol per day had 2.6 cm3 (95% confidence interval (CI), 0.2–4.9), 2.9 cm3 (95% CI, −0.6 to 6.3), 4.6 cm3 (95% CI, 1.5–7.7), and 10.8 cm3 (95% CI, 4.8–17.0) higher absolute dense volume, respectively, as compared with women abstaining from alcohol. A trend of increasing alcohol consumption and higher absolute dense volume was seen in women at low (⩽3%) risk, but not in women at moderate (3.0–4.9%) risk. Conclusion: Alcohol consumption may increase breast cancer risk through increasing mammographic density, particularly in women at high background risk of breast cancer.
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Affiliation(s)
- T Trinh
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm 171 77, Sweden
| | - S E Christensen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm 171 77, Sweden
| | - J S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm 171 77, Sweden
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - K Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm 171 77, Sweden
| | - A Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm 171 77, Sweden
| | - K Bälter
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm 171 77, Sweden
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm 171 77, Sweden
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Wanders JOP, Bakker MF, Veldhuis WB, Peeters PHM, van Gils CH. The effect of weight change on changes in breast density measures over menopause in a breast cancer screening cohort. Breast Cancer Res 2015; 17:74. [PMID: 26025139 PMCID: PMC4487974 DOI: 10.1186/s13058-015-0583-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/13/2015] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION High weight and high percentage mammographic breast density are both breast cancer risk factors but are negatively correlated. Therefore, we wanted to obtain more insight into this apparent paradox. METHODS We investigated in a longitudinal study how weight change over menopause is related to changes in mammographic breast features. Five hundred ninety-one participants of the EPIC-NL cohort were divided into three groups according to their prospectively measured weight change over menopause: (1) weight loss (more than -3.0 %), (2) stable weight (between -3.0 % and +3.0 %), and (3) weight gain (more than 3.0 %). SPSS GLM univariate analysis was used to determine both the mean breast measure changes in, and the trend over, the weight change groups. RESULTS Over a median period of 5 years, the mean changes in percent density in these groups were -5.0 % (95 % confidence interval (CI) -8.0; -2.1), -6.8 % (95 % CI -9.0; -4.5), and -10.2 % (95 % CI -12.5; -7.9), respectively (P-trend = 0.001). The mean changes in dense area were -16.7 cm(2) (95 % CI -20.1; -13.4), -16.4 cm(2) (95 % CI -18.9; -13.9), and -18.1 cm(2) (95 % CI -20.6; -15.5), respectively (P-trend = 0.437). Finally, the mean changes in nondense area were -6.1 cm(2) (95 % CI -11.9; -0.4), -0.6 cm(2) (95 % CI -4.9; 3.8), and 5.3 cm(2) (95 % CI 0.9; 9.8), respectively (P-trend < 0.001). CONCLUSIONS Going through menopause is associated with a decrease in both percent density and dense area. Owing to an increase in the nondense tissue, the decrease in percent density is largest in women who gain weight. The decrease in dense area is not related to weight change. So the fact that both high percent density and high weight or weight gain are associated with high postmenopausal breast cancer risk can probably not be explained by an increase (or slower decrease) of dense area in women gaining weight compared with women losing weight or maintaining a stable weight. These results suggest that weight and dense area are presumably two independent postmenopausal breast cancer risk factors.
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Affiliation(s)
- Johanna Olga Pauline Wanders
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Marije Fokje Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Wouter Bernard Veldhuis
- Department of Radiology, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Petra Huberdina Maria Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
| | - Carla Henrica van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
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Skarping I, Brand JS, Hall P, Borgquist S. Effects of statin use on volumetric mammographic density: results from the KARMA study. BMC Cancer 2015; 15:435. [PMID: 26016855 PMCID: PMC4446081 DOI: 10.1186/s12885-015-1457-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 05/21/2015] [Indexed: 01/14/2023] Open
Abstract
Background Epidemiological data on statins and breast cancer risk have been inconclusive. The aim of this study was to clarify the role of statins in breast cancer risk by studying their effect on mammographic density. Methods The KARolinska MAmmography project for risk prediction of breast cancer (KARMA) includes 70,877 women who underwent either a screening or clinical mammography from January 2011 to December 2013. In total, 41,102 women responded to a web-based questionnaire, and had raw digital mammograms stored. Volumetric mammographic density was measured using Volpara™ and information on statin use was obtained through linkage with the Swedish National Prescription Register. Analysis of covariance was used to study the effect of statin use on mammographic density, adjusting for a large set of potential confounders. We also studied the effects of statin class and treatment duration and tested for potential effect modification by hormone replacement therapy (HRT). Results Statin use was recorded in 3,337 women (8.1 %) of the study population and lipophilic statins was the most commonly prescribed type (93.4 % of all statin users). After multivariable adjustment, percent dense volume was lower in statin users than in non-users (P < 0.001). This association was explained by a larger absolute non-dense volume in statin users (P < 0.001). Overall, no difference in absolute dense volume was detected, but interaction analyses revealed a larger dense volume among statin users who reported ever HRT use (P = 0.03). No differential effects were observed according to statin lipophilicity and treatment duration. Conclusions We observed no overall effect of statin use on mammographic density in terms of absolute dense volume, although a larger absolute dense volume was observed in statin users who reported ever HRT use, which requires further investigation.
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Affiliation(s)
- Ida Skarping
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden.
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
| | - Signe Borgquist
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden. .,Department of Oncology, Skåne University Hospital, Lund, Sweden.
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229
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Flote VG, Frydenberg H, Ursin G, Iversen A, Fagerland MW, Ellison PT, Wist EA, Egeland T, Wilsgaard T, McTiernan A, Furberg AS, Thune I. High-density lipoprotein-cholesterol, daily estradiol and progesterone, and mammographic density phenotypes in premenopausal women. Cancer Prev Res (Phila) 2015; 8:535-44. [PMID: 25804612 DOI: 10.1158/1940-6207.capr-14-0267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
Abstract
High-density lipoprotein-cholesterol (HDL-C) may influence the proliferation of breast tumor cells, but it is unclear whether low HDL-C levels, alone or in combination with cyclic estrogen and progesterone, are associated with mammographic density, a strong predictor of breast cancer development. Fasting morning serum concentrations of HDL-C were assessed in 202 premenopausal women, 25 to 35 years of age, participating in the Norwegian Energy Balance and Breast Cancer Aspects (EBBA) I study. Estrogen and progesterone were measured both in serum, and daily in saliva, throughout an entire menstrual cycle. Absolute and percent mammographic density was assessed by a computer-assisted method (Madena), from digitized mammograms (days 7-12). Multivariable models were used to study the associations between HDL-C, estrogen and progesterone, and mammographic density phenotypes. We observed a positive association between HDL-C and percent mammographic density after adjustments (P = 0.030). When combining HDL-C, estradiol, and progesterone, we observed among women with low HDL-C (<1.39 mmol/L), a linear association between salivary 17β-estradiol, progesterone, and percent and absolute mammographic density. Furthermore, in women with low HDL-C, each one SD increase of salivary mid-menstrual 17β-estradiol was associated with an OR of 4.12 (95% confidence intervals; CI, 1.30-13.0) of having above-median percent (28.5%), and an OR of 2.5 (95% CI, 1.13-5.50) of having above-median absolute mammographic density (32.4 cm(2)). On the basis of plausible biologic mechanisms linking HDL-C to breast cancer development, our findings suggest a role of HDL-C, alone or in combination with estrogen, in breast cancer development. However, our small hypothesis generating study requires confirmation in larger studies.
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Affiliation(s)
- Vidar G Flote
- The Cancer Centre, Oslo University Hospital, Oslo, Norway.
| | | | - Giske Ursin
- Cancer Registry of Norway, Majorstuen, Oslo, Norway
| | - Anita Iversen
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Morten W Fagerland
- Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Peter T Ellison
- Department of Anthropology, Harvard University, Cambridge, Massachusetts
| | - Erik A Wist
- The Cancer Centre, Oslo University Hospital, Oslo, Norway
| | - Thore Egeland
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Aas, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne McTiernan
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington
| | - Anne-Sofie Furberg
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Inger Thune
- The Cancer Centre, Oslo University Hospital, Oslo, Norway. Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
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230
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Bertrand KA, Scott CG, Tamimi RM, Jensen MR, Pankratz VS, Norman AD, Visscher DW, Couch FJ, Shepherd J, Chen YY, Fan B, Wu FF, Ma L, Beck AH, Cummings SR, Kerlikowske K, Vachon CM. Dense and nondense mammographic area and risk of breast cancer by age and tumor characteristics. Cancer Epidemiol Biomarkers Prev 2015; 24:798-809. [PMID: 25716949 DOI: 10.1158/1055-9965.epi-14-1136] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 02/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mammographic density (MD) is a strong breast cancer risk factor. We previously reported associations of percent mammographic density (PMD) with larger and node-positive tumors across all ages, and estrogen receptor (ER)-negative status among women ages <55 years. To provide insight into these associations, we examined the components of PMD [dense area (DA) and nondense area (NDA)] with breast cancer subtypes. METHODS Data were pooled from six studies including 4,095 breast cancers and 8,558 controls. DA and NDA were assessed from digitized film-screen mammograms and standardized across studies. Breast cancer odds by density phenotypes and age according to histopathologic characteristics and receptor status were calculated using polytomous logistic regression. RESULTS DA was associated with increased breast cancer risk [OR for quartiles: 0.65, 1.00 (Ref), 1.22, 1.55; P(trend) <0.001] and NDA was associated with decreased risk [ORs for quartiles: 1.39, 1.00 (Ref), 0.88, 0.72; P(trend) <0.001] across all ages and invasive tumor characteristics. There were significant trends in the magnitude of associations of both DA and NDA with breast cancer by increasing tumor size (P(trend) < 0.001) but no differences by nodal status. Among women <55 years, DA was more strongly associated with increased risk of ER(+) versus ER(-) tumors (P(het) = 0.02), while NDA was more strongly associated with decreased risk of ER(-) versus ER(+) tumors (P(het) = 0.03). CONCLUSIONS DA and NDA have differential associations with ER(+) versus ER(-) tumors that vary by age. IMPACT DA and NDA are important to consider when developing age- and subtype-specific risk models.
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Affiliation(s)
- Kimberly A Bertrand
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher G Scott
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Matthew R Jensen
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - V Shane Pankratz
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aaron D Norman
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Daniel W Visscher
- Department of Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Fergus J Couch
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - John Shepherd
- Department of Radiology, University of California, San Francisco, California
| | - Yunn-Yi Chen
- Department of Pathology, University of California, San Francisco, California
| | - Bo Fan
- Department of Radiology, University of California, San Francisco, California
| | - Fang-Fang Wu
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Lin Ma
- Department of Medicine, University of California, San Francisco, California
| | - Andrew H Beck
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California
| | - Karla Kerlikowske
- Departments of Epidemiology and Biostatistics and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, California
| | - Celine M Vachon
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
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232
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Yaghjyan L, Colditz GA, Rosner B, Tamimi RM. Mammographic breast density and breast cancer risk: interactions of percent density, absolute dense, and non-dense areas with breast cancer risk factors. Breast Cancer Res Treat 2015; 150:181-9. [PMID: 25677739 DOI: 10.1007/s10549-015-3286-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 12/20/2022]
Abstract
We investigated if associations of breast density and breast cancer differ according to the level of other known breast cancer risk factors, including body mass index (BMI), age at menarche, parity, age at first child's birth, age at menopause, alcohol consumption, a family history of breast cancer, a history of benign breast disease, and physical activity. This study included 1,044 postmenopausal incident breast cancer cases diagnosed within the Nurses' Health Study cohort and 1,794 matched controls. Percent breast density, absolute dense, and non-dense areas were measured from digitized film images with computerized techniques. Information on breast cancer risk factors was obtained prospectively from biennial questionnaires. Percent breast density was more strongly associated with breast cancer risk in current postmenopausal hormone users (≥50 vs. 10 %: OR 5.34, 95 % CI 3.36-8.49) as compared to women with past (OR 2.69, 95 % CI 1.32-5.49) or no hormone history (OR 2.57, 95 % CI 1.18-5.60, p-interaction = 0.03). Non-dense area was inversely associated with breast cancer risk in parous women, but not in women without children (p-interaction = 0.03). Associations of density with breast cancer risk did not differ by the levels of BMI, age at menarche, parity, age at first child's birth, age at menopause, alcohol consumption, a family history of breast cancer, a history of benign breast disease, and physical activity. Women with dense breasts, who currently use menopausal hormone therapy are at a particularly high risk of breast cancer. Most breast cancer risk factors do not modify the association between mammographic breast density and breast cancer risk.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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233
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Bertrand KA, Rosner B, Eliassen AH, Hankinson SE, Rexrode KM, Willett W, Tamimi RM. Premenopausal plasma 25-hydroxyvitamin D, mammographic density, and risk of breast cancer. Breast Cancer Res Treat 2015; 149:479-87. [PMID: 25543181 PMCID: PMC4310753 DOI: 10.1007/s10549-014-3247-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/15/2014] [Indexed: 12/18/2022]
Abstract
Epidemiologic evidence for an association between plasma 25-hydroxyvitamin D [25(OH)D] and breast cancer is inconsistent. Data are especially limited for premenopausal women and for associations with mammographic density. To test the hypothesis that plasma concentration of 25(OH)D is associated with mammographic density, we conducted a cross-sectional study among 835 premenopausal women in the Nurses' Health Studies. We measured 25(OH)D in blood samples and used multivariable linear regression to quantify the association of average percent density by quartile of plasma 25(OH)D. In a nested case-control analysis including 493 breast cancer cases, we evaluated risk of breast cancer associated with vitamin D status within tertiles of mammographic density. Women in the top quartile of plasma 25(OH)D levels had an average percent breast density 5.2 percentage points higher than women in the bottom quartile (95 % confidence interval: 1.8, 8.7; P trend <0.01), after adjusting for predictors of 25(OH)D and established breast cancer risk factors. Plasma 25(OH)D concentration was significantly inversely associated with breast cancer risk among women with high mammographic density (P trend < 0.01) but not among women in lower tertiles of mammographic density (P-interaction < 0.01). These results do not support the hypothesis that vitamin D is inversely associated with percent mammographic density in premenopausal women. There was evidence that the association between premenopausal 25(OH)D and breast cancer risk varies by mammographic density, with an inverse association apparent only among women with high mammographic density.
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Affiliation(s)
- Kimberly A Bertrand
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA,
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234
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Flote VG, Furberg AS, McTiernan A, Frydenberg H, Ursin G, Iversen A, Lofteroed T, Ellison PT, Wist EA, Egeland T, Wilsgaard T, Makar KW, Chang-Claude J, Thune I. Gene variations in oestrogen pathways, CYP19A1, daily 17β-estradiol and mammographic density phenotypes in premenopausal women. Breast Cancer Res 2014; 16:499. [PMID: 25522654 PMCID: PMC4303212 DOI: 10.1186/s13058-014-0499-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION High mammographic density is an established breast cancer risk factor, and circulating oestrogen influences oestrogen-regulating gene expression in breast cancer development. However, less is known about the interrelationships of common variants in the CYP19A1 gene, daily levels of oestrogens, mammographic density phenotypes and body mass index (BMI) in premenopausal women. METHODS Based on plausible biological mechanisms related to the oestrogen pathway, we investigated the association of single nucleotide polymorphisms (SNPs) in CYP19A1, 17β-estradiol and mammographic density in 202 premenopausal women. DNA was genotyped using the Illumina Golden Gate platform. Daily salivary 17β-estradiol concentrations were measured throughout an entire menstrual cycle. Mammographic density phenotypes were assessed using a computer-assisted method (Madena). We determined associations using multivariable linear and logistic regression models. RESULTS The minor alleles of rs749292 were positively (P = 0.026), and the minor alleles of rs7172156 were inversely (P = 0.002) associated with daily 17β-estradiol. We observed an 87% lower level of daily 17β-estradiol throughout a menstrual cycle in heavier women (BMI >23.6 kg/m(2)) of rs7172156 with minor genotype aa compared with major genotype AA. Furthermore, the rs749292 minor alleles were inversely associated with absolute mammographic density (P = 0.032). Lean women with rs749292 minor alleles had 70 to 80% lower risk for high absolute mammographic density (>32.4 cm(2)); Aa: odds ratio (OR) = 0.23 (95% CI 0.07 to 0.75). Lean women with rs7172156 minor homozygous genotype had OR 5.45 for high absolute mammographic density (aa: OR = 5.45 (95% CI 1.13 to 26.3)). CONCLUSION Our findings suggest that two SNPs in CYP19A1, rs749292 and rs7172156, are associated with both daily oestrogen levels and mammographic density phenotypes. BMI may modify these associations, but larger studies are needed.
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Affiliation(s)
- Vidar G Flote
- The Cancer Centre, Oslo University Hospital, Oslo, N-0424, Norway.
| | - Anne-Sofie Furberg
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, N-9037, Norway.
| | - Anne McTiernan
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA, 98109-1024, USA.
| | - Hanne Frydenberg
- The Cancer Centre, Oslo University Hospital, Oslo, N-0424, Norway.
| | - Giske Ursin
- Cancer Registry of Norway, PO Box 5313, Majorstuen, Oslo, N-0304, Norway.
| | - Anita Iversen
- Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, N-9037, Norway.
| | - Trygve Lofteroed
- The Cancer Centre, Oslo University Hospital, Oslo, N-0424, Norway.
| | - Peter T Ellison
- Department of Anthropology, Harvard University, Cambridge, MA, 02138, USA.
| | - Erik A Wist
- The Cancer Centre, Oslo University Hospital, Oslo, N-0424, Norway.
| | - Thore Egeland
- Department of Chemistry, Norwegian University of Life Sciences, Biotechnology and Food Science, Aas, N-1432, Norway.
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, N-9037, Norway.
| | - Karen W Makar
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA, 98109-1024, USA.
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, Deutches Krebsforschungszentrum, 69120, Heidelberg, Germany.
| | - Inger Thune
- The Cancer Centre, Oslo University Hospital, Oslo, N-0424, Norway. .,Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, N-9037, Norway.
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Assi V, Massat NJ, Thomas S, MacKay J, Warwick J, Kataoka M, Warsi I, Brentnall A, Warren R, Duffy SW. A case-control study to assess the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk. Int J Cancer 2014; 136:2378-87. [PMID: 25333209 DOI: 10.1002/ijc.29275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/12/2014] [Indexed: 11/08/2022]
Abstract
Mammographic density is a strong risk factor for breast cancer, but its potential application in risk management is not clear, partly due to uncertainties about its interaction with other breast cancer risk factors. We aimed to quantify the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk of breast cancer (average lifetime risk of 23%), in particular in premenopausal women, and to investigate its relationship with other breast cancer risk factors in this population. We present the results from a case-control study nested with the FH01 cohort study of 6,710 women mostly aged 40-49 at intermediate familial risk of breast cancer. One hundred and three cases of breast cancer were age-matched to one or two controls. Density was measured by semiautomated interactive thresholding. Absolute density, but not percent density, was a significant risk factor for breast cancer in this population after adjusting for area of nondense tissue (OR per 10 cm(2) = 1.07, 95% CI 1.00-1.15, p = 0.04). The effect was stronger in premenopausal women, who made up the majority of the study population. Absolute density remained a significant predictor of breast cancer risk after adjusting for age at menarche, age at first live birth, parity, past or present hormone replacement therapy, and the Tyrer-Cuzick 10-year relative risk estimate of breast cancer. Absolute density can improve breast cancer risk stratification and delineation of high-risk groups alongside the Tyrer-Cuzick 10-year relative risk estimate.
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Affiliation(s)
- Valentina Assi
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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Lindström S, Thompson DJ, Paterson AD, Li J, Gierach GL, Scott C, Stone J, Douglas JA, dos-Santos-Silva I, Fernandez-Navarro P, Verghase J, Smith P, Brown J, Luben R, Wareham NJ, Loos RJF, Heit JA, Pankratz VS, Norman A, Goode EL, Cunningham JM, deAndrade M, Vierkant RA, Czene K, Fasching PA, Baglietto L, Southey MC, Giles GG, Shah KP, Chan HP, Helvie MA, Beck AH, Knoblauch NW, Hazra A, Hunter DJ, Kraft P, Pollan M, Figueroa JD, Couch FJ, Hopper JL, Hall P, Easton DF, Boyd NF, Vachon CM, Tamimi RM. Genome-wide association study identifies multiple loci associated with both mammographic density and breast cancer risk. Nat Commun 2014; 5:5303. [PMID: 25342443 PMCID: PMC4320806 DOI: 10.1038/ncomms6303] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 09/17/2014] [Indexed: 12/29/2022] Open
Abstract
Mammographic density reflects the amount of stromal and epithelial tissues in relation to adipose tissue in the breast and is a strong risk factor for breast cancer. Here we report the results from meta-analysis of genome-wide association studies (GWAS) of three mammographic density phenotypes: dense area, non-dense area and percent density in up to 7,916 women in stage 1 and an additional 10,379 women in stage 2. We identify genome-wide significant (P<5 × 10(-8)) loci for dense area (AREG, ESR1, ZNF365, LSP1/TNNT3, IGF1, TMEM184B and SGSM3/MKL1), non-dense area (8p11.23) and percent density (PRDM6, 8p11.23 and TMEM184B). Four of these regions are known breast cancer susceptibility loci, and four additional regions were found to be associated with breast cancer (P<0.05) in a large meta-analysis. These results provide further evidence of a shared genetic basis between mammographic density and breast cancer and illustrate the power of studying intermediate quantitative phenotypes to identify putative disease-susceptibility loci.
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Affiliation(s)
- Sara Lindström
- 1] Program in Genetic Epidemiology and Statistical Genetics, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [2] Department of Epidemiology, Harvard School Of Public Health, Boston, Massachusetts 02115, USA
| | - Deborah J Thompson
- 1] Centre for Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK [2] Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Andrew D Paterson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Bethesda, Maryland 20850, USA
| | - Christopher Scott
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Jennifer Stone
- Centre for Genetic Origins of Health and Disease, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Julie A Douglas
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Isabel dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Pablo Fernandez-Navarro
- 1] Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain [2] Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid 28029, Spain
| | - Jajini Verghase
- 1] Centre for Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK [2] Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [3] Plastic Surgery Unit, Royal Free Hospital, London NW3 2QG, UK
| | - Paula Smith
- 1] Centre for Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK [2] Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Judith Brown
- 1] Centre for Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK [2] Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Robert Luben
- Centre for Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Nicholas J Wareham
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge CB1 8RN, UK
| | - Ruth J F Loos
- 1] Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge CB1 8RN, UK [2] The Icahn School of Medicine at Mount Sinai, The Charles Bronfman Institute for Personalized Medicine, The Mindich Child Health and Development Institute, New York, New York 10029, USA
| | - John A Heit
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - V Shane Pankratz
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Aaron Norman
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Ellen L Goode
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Julie M Cunningham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Mariza deAndrade
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Robert A Vierkant
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Peter A Fasching
- 1] Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, 910 54 Erlangen, Germany [2] Division Hematology/Oncology, Department of Medicine, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California 90024, USA
| | - Laura Baglietto
- 1] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria 3004, Australia [2] Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Melissa C Southey
- Department of Pathology, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Graham G Giles
- 1] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria 3004, Australia [2] Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Kaanan P Shah
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Mark A Helvie
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | - Andrew H Beck
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Nicholas W Knoblauch
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Aditi Hazra
- 1] Program in Genetic Epidemiology and Statistical Genetics, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [2] Department of Epidemiology, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [3] Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - David J Hunter
- 1] Program in Genetic Epidemiology and Statistical Genetics, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [2] Department of Epidemiology, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [3] Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Peter Kraft
- 1] Program in Genetic Epidemiology and Statistical Genetics, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [2] Department of Epidemiology, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [3] Department of Biostatistics, Harvard School Of Public Health, Boston, Massachusetts 02115, USA
| | - Marina Pollan
- 1] Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid 28029, Spain [2] Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid 28029, Spain
| | - Jonine D Figueroa
- Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Bethesda, Maryland 20850, USA
| | - Fergus J Couch
- 1] Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Douglas F Easton
- 1] Centre for Genetic Epidemiology, University of Cambridge, Cambridge CB1 8RN, UK [2] Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [3] Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Norman F Boyd
- Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, Toronto, Ontario, Canada M5G 2M9
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Rulla M Tamimi
- 1] Program in Genetic Epidemiology and Statistical Genetics, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [2] Department of Epidemiology, Harvard School Of Public Health, Boston, Massachusetts 02115, USA [3] Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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237
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Howell A, Anderson AS, Clarke RB, Duffy SW, Evans DG, Garcia-Closas M, Gescher AJ, Key TJ, Saxton JM, Harvie MN. Risk determination and prevention of breast cancer. Breast Cancer Res 2014; 16:446. [PMID: 25467785 PMCID: PMC4303126 DOI: 10.1186/s13058-014-0446-2] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is an increasing public health problem. Substantial advances have been made in the treatment of breast cancer, but the introduction of methods to predict women at elevated risk and prevent the disease has been less successful. Here, we summarize recent data on newer approaches to risk prediction, available approaches to prevention, how new approaches may be made, and the difficult problem of using what we already know to prevent breast cancer in populations. During 2012, the Breast Cancer Campaign facilitated a series of workshops, each covering a specialty area of breast cancer to identify gaps in our knowledge. The risk-and-prevention panel involved in this exercise was asked to expand and update its report and review recent relevant peer-reviewed literature. The enlarged position paper presented here highlights the key gaps in risk-and-prevention research that were identified, together with recommendations for action. The panel estimated from the relevant literature that potentially 50% of breast cancer could be prevented in the subgroup of women at high and moderate risk of breast cancer by using current chemoprevention (tamoxifen, raloxifene, exemestane, and anastrozole) and that, in all women, lifestyle measures, including weight control, exercise, and moderating alcohol intake, could reduce breast cancer risk by about 30%. Risk may be estimated by standard models potentially with the addition of, for example, mammographic density and appropriate single-nucleotide polymorphisms. This review expands on four areas: (a) the prediction of breast cancer risk, (b) the evidence for the effectiveness of preventive therapy and lifestyle approaches to prevention, (c) how understanding the biology of the breast may lead to new targets for prevention, and (d) a summary of published guidelines for preventive approaches and measures required for their implementation. We hope that efforts to fill these and other gaps will lead to considerable advances in our efforts to predict risk and prevent breast cancer over the next 10 years.
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Affiliation(s)
- Anthony Howell
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M29 9LT Manchester, UK
- The Christie, NHS Foundation Trust, Wilmslow Road, Manchester, M20 2QJ UK
- Breakthrough Breast Cancer Research Unit, Institute of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester, M20 2QJ UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Level 7, University of Dundee, Ninewells Hospital & Medical School, Mailbox 7, George Pirie Way, Dundee, DD1 9SY UK
| | - Robert B Clarke
- Breakthrough Breast Cancer Research Unit, Institute of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester, M20 2QJ UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - D Gareth Evans
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M29 9LT Manchester, UK
- The Christie, NHS Foundation Trust, Wilmslow Road, Manchester, M20 2QJ UK
- Manchester Centre for Genomic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, St. Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Montserat Garcia-Closas
- Division of Genetics and Epidemiology, Institute of Cancer Research, Cotswold Road, Sutton, SM2 5NG London, UK
| | - Andy J Gescher
- Department of Cancer Studies and Molecular Medicine, University of Leicester, University Road, Leicester, LE2 7LX UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF UK
| | - John M Saxton
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, University Drive, Norwich, NR4 7TJ UK
| | - Michelle N Harvie
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M29 9LT Manchester, UK
- The Christie, NHS Foundation Trust, Wilmslow Road, Manchester, M20 2QJ UK
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238
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Yochum L, Tamimi RM, Hankinson SE. Birthweight, early life body size and adult mammographic density: a review of epidemiologic studies. Cancer Causes Control 2014; 25:1247-59. [PMID: 25053404 DOI: 10.1007/s10552-014-0432-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/01/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the association between birth weight and early life body size with adult mammographic density in the peer-reviewed literature. METHODS A comprehensive literature search was conducted through January, 2014. English language articles that assessed adult mammographic density (MD) in relation to early life body size (≤18 years old), or birthweight were included. RESULTS Nine studies reported results for early life body size and %MD. Both exposure and outcome were assessed at different ages using multiple methods. In premenopausal women, findings were inconsistent; two studies reported significant, inverse associations, one reported a non-significant, inverse association, and two observed no association. Reasons for these inconsistencies were not obvious. In postmenopausal women, four of five studies supported an inverse association. Two of three studies that adjusted for menopausal status found significant, inverse associations. Birthweight and %MD was evaluated in nine studies. No association was seen in premenopausal women and two of three studies reported positive associations in postmenopausal women. Three of four studies that adjusted for menopausal status found no association. DISCUSSION Early life body size and birthweight appear unrelated to %MD in premenopausal women while an inverse association in postmenopausal women is more likely. Although based on limited data, birthweight and %MD appear positively associated in postmenopausal women. Given the small number of studies, the multiple methods of data collection and analysis, other methodologic issues, and lack of consistency in results, additional research is needed to clarify this complex association and develop a better understanding of the underlying biologic mechanisms.
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Affiliation(s)
- Laura Yochum
- University of Massachusetts Amherst, 426 Arnold House, 716 North Pleasant Street, Amherst, MA, 01003, USA,
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239
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Pettersson A, Tamimi RM. Breast Density and Breast Cancer Risk: Understanding of Biology and Risk. CURR EPIDEMIOL REP 2014. [DOI: 10.1007/s40471-014-0018-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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240
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Fuhrman BJ, Byrne C. Comparing mammographic measures across populations. J Natl Cancer Inst 2014; 106:dju109. [PMID: 24816205 DOI: 10.1093/jnci/dju109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Barbara J Fuhrman
- Affiliations of authors: Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR (BJF); Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD (CB).
| | - Celia Byrne
- Affiliations of authors: Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR (BJF); Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD (CB)
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