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Mburu W, Guo C, Tian Y, Koka H, Fu S, Lu N, Li E, Li J, Cora R, Chan A, Guida JL, Sung H, Gierach GL, Abubakar M, Yu K, Yang XR. Associations between quantitative measures of mammographic density and terminal ductal lobular unit involution in Chinese breast cancer patients. Breast Cancer Res 2024; 26:116. [PMID: 39010116 PMCID: PMC11247848 DOI: 10.1186/s13058-024-01856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 06/06/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Higher mammographic density (MD), a radiological measure of the proportion of fibroglandular tissue in the breast, and lower terminal duct lobular unit (TDLU) involution, a histological measure of the amount of epithelial tissue in the breast, are independent breast cancer risk factors. Previous studies among predominantly white women have associated reduced TDLU involution with higher MD. METHODS In this cohort of 611 invasive breast cancer patients (ages 23-91 years [58.4% ≥ 50 years]) from China, where breast cancer incidence rates are lower and the prevalence of dense breasts is higher compared with Western countries, we examined the associations between TDLU involution assessed in tumor-adjacent normal breast tissue and quantitative MD assessed in the contralateral breast obtained from the VolparaDensity software. Associations were estimated using generalized linear models with MD measures as the outcome variables (log-transformed), TDLU measures as explanatory variables (categorized into quartiles or tertiles), and adjusted for age, body mass index, parity, age at menarche and breast cancer subtype. RESULTS We found that, among all women, percent dense volume (PDV) was positively associated with TDLU count (highest tertile vs. zero: Expbeta = 1.28, 95% confidence interval [CI] 1.08-1.51, ptrend = < .0001), TDLU span (highest vs. lowest tertile: Expbeta = 1.23, 95% CI 1.11-1.37, ptrend = < .0001) and acini count/TDLU (highest vs. lowest tertile: Expbeta = 1.22, 95% CI 1.09-1.37, ptrend = 0.0005), while non-dense volume (NDV) was inversely associated with these measures. Similar trend was observed for absolute dense volume (ADV) after the adjustment of total breast volume, although the associations for ADV were in general weaker than those for PDV. The MD-TDLU associations were generally more pronounced among breast cancer patients ≥ 50 years and those with luminal A tumors compared with patients < 50 years and with luminal B tumors. CONCLUSIONS Our findings based on quantitative MD and TDLU involution measures among Chinese breast cancer patients are largely consistent with those reported in Western populations and may provide additional insights into the complexity of the relationship, which varies by age, and possibly breast cancer subtype.
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Affiliation(s)
- Waruiru Mburu
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Changyuan Guo
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuan Tian
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hela Koka
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Sheng Fu
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Ning Lu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Erni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Renata Cora
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Ariane Chan
- Volpara Health Technologies Ltd, Wellington, New Zealand
- Institute of Environmental Science and Research, Porirua, GA, 5022, New Zealand
| | - Jennifer L Guida
- Division of Cancer Control and Population Sciences, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, 30303, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Kai Yu
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.
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2
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Wang C, Che Y. A ultrasonic nomogram of quantitative parameters for diagnosing breast cancer. Sci Rep 2023; 13:12340. [PMID: 37524926 PMCID: PMC10390567 DOI: 10.1038/s41598-023-39686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/29/2023] [Indexed: 08/02/2023] Open
Abstract
This study aimed to develop a nomogram through the collection of quantitative ultrasound parameters to predict breast cancer. From March 2021 to September 2022, a total of 313 breast tumors were included with pathological results. Through collecting quantitative ultrasound parameters of breast tumors and multivariate regression analysis, a nomogram was developed. The diagnostic performances, calibration and clinical usefulness of the nomogram for predicting breast cancer were assessed. A total of 182 benign and 131 malignant breast tumors were included in this study. The nomogram indicated excellent predictive properties with an AUC of 0.934, sensitivity of 0.881, specificity of 0.848, PPV of 0.795 and NPV of 0.841. The calibration curve showed the predicted values are basically consistent with the actual observed values. The optimum cut-off for the nomogram was 0.310 for predicting cancer. The decision curve analysis results corroborated good clinical usefulness. The model including BI-RADS score, SWE and VI is potentially useful for predicting breast cancer.
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Affiliation(s)
- Cong Wang
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, No.222 Zhongshan Road, Xigang District, Dalian City, Liaoning Province, China
| | - Ying Che
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, No.222 Zhongshan Road, Xigang District, Dalian City, Liaoning Province, China.
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Lin J, Ye S, Ke H, Lin L, Wu X, Guo M, Jiao B, Chen C, Zhao L. Changes in the mammary gland during aging and its links with breast diseases. Acta Biochim Biophys Sin (Shanghai) 2023. [PMID: 37184281 DOI: 10.3724/abbs.2023073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The functional capacity of organisms declines in the process of aging. In the case of breast tissue, abnormal mammary gland development can lead to dysfunction in milk secretion, a primary function, as well as the onset of various diseases, such as breast cancer. In the process of aging, the terminal duct lobular units (TDLUs) within the breast undergo gradual degeneration, while the proportion of adipose tissue in the breast continues to increase and hormonal levels in the breast change accordingly. Here, we review changes in morphology, internal structure, and cellular composition that occur in the mammary gland during aging. We also explore the emerging mechanisms of breast aging and the relationship between changes during aging and breast-related diseases, as well as potential interventions for delaying mammary gland aging and preventing breast disease.
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Affiliation(s)
- Junqiang Lin
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Shihui Ye
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Hao Ke
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Liang Lin
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Xia Wu
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Mengfei Guo
- Huankui Academy, Nanchang University, Nanchang 330031, China
| | - Baowei Jiao
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650201, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
| | - Ceshi Chen
- Academy of Biomedical Engineering, Kunming Medical University, Kunming 650500, China
- Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
- the Third Affiliated Hospital, Kunming Medical University, Kunming 650118, China
| | - Limin Zhao
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
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4
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Davis Lynn BC, Lord BD, Cora R, Pfeiffer RM, Lawrence S, Zirpoli G, Bethea TN, Palmer JR, Gierach GL. Associations between quantitative measures of TDLU involution and breast tumor molecular subtypes among breast cancer cases in the Black Women's Health Study: a case-case analysis. Breast Cancer Res 2022; 24:86. [PMID: 36471360 PMCID: PMC9720909 DOI: 10.1186/s13058-022-01577-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/07/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Terminal duct lobular units (TDLUs) are the structures in the breast that give rise to most breast cancers. Previous work has shown that TDLU involution is inversely associated with TDLU metrics, such as TDLU count/100mm2, TDLU span (µm), and number of acini/TDLU, and that these metrics may be elevated in the normal breast tissue of women diagnosed with triple-negative (TN) compared with luminal A breast tumors. It is unknown whether this relationship exists in Black women, who have the highest incidence of TN breast cancer and the highest overall breast cancer mortality rate. We examined relationships between TDLU metrics and breast cancer molecular subtype among breast cancer cases in the Black Women's Health Study (BWHS). METHODS We assessed quantitative TDLU metrics (TDLU count/100mm2, TDLU span (µm), and number of acini/TDLU) in digitized 247 hematoxylin and eosin-stained adjacent normal tissue sections from 223 BWHS breast cancer cases, including 65 triple negative (TN) cancers (estrogen receptor (ER) negative, progesterone receptor (PR) negative, human epidermal growth factor-2 (HER2) negative) and 158 luminal A cancers (ER positive, HER2 negative). We evaluated associations of least square mean TDLU metrics adjusted for age and body mass index (BMI) with patient and clinical characteristics. In logistic regression models, we evaluated associations between TDLU metrics and breast cancer subtype, adjusting for age, BMI, and tumor size. RESULTS Older age and higher BMI were associated with lower TDLU metrics and larger tumor size and lymph node invasion with higher TDLU metrics. The odds of TN compared with luminal A breast cancer increased with increasing tertiles of TDLU metrics, with odds ratios (95% confidence intervals) for tertile 3 versus tertile 1 of 2.18 (0.99, 4.79), 2.77 (1.07, 7.16), and 1.77 (0.79, 3.98) for TDLU count, TDLU span, and acini count/TDLU, respectively. CONCLUSION Associations of TDLU metrics with breast cancer subtypes in the BWHS are consistent with previous studies of White and Asian women, demonstrating reduced TDLU involution in TN compared with luminal A breast cancers. Further investigation is needed to understand the factors that influence TDLU involution and the mechanisms that mediate TDLU involution and breast cancer subtype.
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Affiliation(s)
- Brittny C Davis Lynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA
| | - Brittany D Lord
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA
| | | | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA
| | - Scott Lawrence
- Molecular and Digital Pathology Laboratory, Leidos Biomedical Research, Inc., 9615 Medical Center Drive, Rockville, MD, USA
| | - Gary Zirpoli
- Slone Epidemiology Center, Boston University, 72 East Concord Street L-7, Boston, MA, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, 1000 New Jersey Ave SE, Washington, DC, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, 72 East Concord Street L-7, Boston, MA, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA.
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5
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Sung H, Koka H, Marino N, Pfeiffer RM, Cora R, Figueroa JD, Sherman ME, Gierach GL, Yang XR. Associations of Genetic Ancestry with Terminal Duct Lobular Unit Involution among Healthy Women. J Natl Cancer Inst 2022; 114:1420-1424. [PMID: 35333343 DOI: 10.1093/jnci/djac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Reduced age-related terminal duct lobular unit (TDLU) involution has been linked to increased breast cancer risk and triple-negative breast cancer (TNBC). Associations of TDLU involution levels with race and ethnicity remain incompletely explored. Herein, we examined associations between genetic ancestry and TDLU involution in normal breast tissue donated by 2,014 healthy women in the US. Women of African ancestry were more likely than European women to have increased TDLU counts (odds ratio [OR]trend=1.36; 95% CI = 1.07-1.74), acini counts/TDLU (OR = 1.47; 95% CI = 1.06-2.03), and median TDLU span (ORtrend=1.44; 95% CI = 1.08-1.91), indicating lower involution; whereas East Asian descendants were associated with decreased TDLU counts (ORtrend=0.52; 95% CI = 0.35-0.78) after controlling for potential confounders. These associations are consistent with the racial variations in incidence rates of TNBC in the US and suggest opportunities for future work examining whether TDLU involution may mediate the racial differences in subtype-specific breast cancer risk.
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Affiliation(s)
- Hyuna Sung
- Surveillance and Health Equity Science,American Cancer Society, Atlanta, Georgia, USA
| | - Hela Koka
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Natascia Marino
- Susan G. Komen Tissue Bank at the IU Simon Comprehensive Cancer Center, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Renata Cora
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jonine D Figueroa
- Usher institute, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Mark E Sherman
- Quantitative Health Sciences,Mayo Clinic, Jacksonville, Florida, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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6
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Vellal AD, Sirinukunwattan K, Kensler KH, Baker GM, Stancu AL, Pyle ME, Collins LC, Schnitt SJ, Connolly JL, Veta M, Eliassen AH, Tamimi RM, Heng YJ. Deep Learning Image Analysis of Benign Breast Disease to Identify Subsequent Risk of Breast Cancer. JNCI Cancer Spectr 2021; 5:pkaa119. [PMID: 33644680 PMCID: PMC7898083 DOI: 10.1093/jncics/pkaa119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/04/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background New biomarkers of risk may improve breast cancer (BC) risk prediction. We developed a computational pathology method to segment benign breast disease (BBD) whole slide images into epithelium, fibrous stroma, and fat. We applied our method to the BBD BC nested case-control study within the Nurses' Health Studies to assess whether computer-derived tissue composition or a morphometric signature was associated with subsequent risk of BC. Methods Tissue segmentation and nuclei detection deep-learning networks were established and applied to 3795 whole slide images from 293 cases who developed BC and 1132 controls who did not. Percentages of each tissue region were calculated, and 615 morphometric features were extracted. Elastic net regression was used to create a BC morphometric signature. Associations between BC risk factors and age-adjusted tissue composition among controls were assessed using analysis of covariance. Unconditional logistic regression, adjusting for the matching factors, BBD histological subtypes, parity, menopausal status, and body mass index evaluated the relationship between tissue composition and BC risk. All statistical tests were 2-sided. Results Among controls, direction of associations between BBD subtypes, parity, and number of births with breast composition varied by tissue region; select regions were associated with childhood body size, body mass index, age of menarche, and menopausal status (all P < .05). A higher proportion of epithelial tissue was associated with increased BC risk (odds ratio = 1.39, 95% confidence interval = 0.91 to 2.14, for highest vs lowest quartiles, P trend = .047). No morphometric signature was associated with BC. Conclusions The amount of epithelial tissue may be incorporated into risk assessment models to improve BC risk prediction.
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Affiliation(s)
- Adithya D Vellal
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Korsuk Sirinukunwattan
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Engineering Science, Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - Kevin H Kensler
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Gabrielle M Baker
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andreea L Stancu
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Pyle
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Laura C Collins
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stuart J Schnitt
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Dana-Farber Cancer Institute-Brigham and Women's Hospital, Boston, MA, USA
| | - James L Connolly
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mitko Veta
- Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yujing J Heng
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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7
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Niehoff NM, Keil AP, Jones RR, Fan S, Gierach GL, White AJ. Outdoor air pollution and terminal duct lobular involution of the normal breast. Breast Cancer Res 2020; 22:100. [PMID: 32972455 PMCID: PMC7513536 DOI: 10.1186/s13058-020-01339-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Exposure to certain outdoor air pollutants may be associated with a higher risk of breast cancer, though potential underlying mechanisms are poorly understood. We examined whether outdoor air pollution was associated with involution of terminal duct lobular units (TDLUs), the histologic site where most cancers arise and an intermediate marker of breast cancer risk. Methods Pathologist-enumerated TDLUs were assessed in H&E (hematoxylin and eosin)-stained breast tissue sections from 1904 US women ages 18–75 who donated to the Susan G. Komen Tissue Bank (2009–2012). The 2009 annual fine particulate matter < 2.5 μm in diameter (PM2.5) total mass (μg/m3) at each woman’s residential address was estimated from the Environmental Protection Agency’s Downscaler Model combining Community Multiscale Air Quality (CMAQ) System modeling with air quality monitoring data. We secondarily considered CMAQ-modeled components of PM2.5 and gaseous pollutants. We used K-means clustering to identify groups of individuals with similar levels of PM2.5 components, selecting groups via cluster stability analysis. Relative rates (RRs) and 95% confidence intervals (95% CIs) for the association between air pollutants and TDLU counts were estimated from a zero-inflated negative binomial regression model adjusted for potential confounders. Results PM2.5 total mass was associated with higher TDLU counts among all women (interquartile range (IQR) increase, RR = 1.06; 95% CI: 1.01–1.11). This association was evident among both premenopausal and postmenopausal women (premenopausal RR = 1.05, 95% CI: 1.00–1.11; postmenopausal RR = 1.11, 95% CI: 1.00–1.23). We identified 3 groups corresponding to clusters that varied geographically and roughly represented high, medium, and low levels of PM2.5 components relative to population mean levels. Compared to the cluster with low levels, the clusters with both high (RR = 1.74; 95% CI: 1.08–2.80) and medium (RR = 1.82; 95% CI: 1.13–2.93) levels were associated with higher TDLU counts; although not significantly different, the magnitude of the associations was stronger among postmenopausal women. Conclusions Higher PM2.5 levels were associated with reduced TDLU involution as measured by TDLU counts. Air pollution exposure may influence the histologic characteristics of normal tissue which could in turn affect breast cancer risk.
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Affiliation(s)
- Nicole M Niehoff
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Drive, Research Triangle Park, NC, 27709, USA.
| | - Alexander P Keil
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Drive, Research Triangle Park, NC, 27709, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Shaoqi Fan
- Integrative Tumor Biology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Gretchen L Gierach
- Integrative Tumor Biology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
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8
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Kensler KH, Liu EZF, Wetstein SC, Onken AM, Luffman CI, Baker GM, Collins LC, Schnitt SJ, Bret-Mounet VC, Veta M, Pluim JPW, Liu Y, Colditz GA, Eliassen AH, Hankinson SE, Tamimi RM, Heng YJ. Automated Quantitative Measures of Terminal Duct Lobular Unit Involution and Breast Cancer Risk. Cancer Epidemiol Biomarkers Prev 2020; 29:2358-2368. [PMID: 32917665 DOI: 10.1158/1055-9965.epi-20-0723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/02/2020] [Accepted: 09/04/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Manual qualitative and quantitative measures of terminal duct lobular unit (TDLU) involution were previously reported to be inversely associated with breast cancer risk. We developed and applied a deep learning method to yield quantitative measures of TDLU involution in normal breast tissue. We assessed the associations of these automated measures with breast cancer risk factors and risk. METHODS We obtained eight quantitative measures from whole slide images from a benign breast disease (BBD) nested case-control study within the Nurses' Health Studies (287 breast cancer cases and 1,083 controls). Qualitative assessments of TDLU involution were available for 177 cases and 857 controls. The associations between risk factors and quantitative measures among controls were assessed using analysis of covariance adjusting for age. The relationship between each measure and risk was evaluated using unconditional logistic regression, adjusting for the matching factors, BBD subtypes, parity, and menopausal status. Qualitative measures and breast cancer risk were evaluated accounting for matching factors and BBD subtypes. RESULTS Menopausal status and parity were significantly associated with all eight measures; select TDLU measures were associated with BBD histologic subtype, body mass index, and birth index (P < 0.05). No measure was correlated with body size at ages 5-10 years, age at menarche, age at first birth, or breastfeeding history (P > 0.05). Neither quantitative nor qualitative measures were associated with breast cancer risk. CONCLUSIONS Among Nurses' Health Studies women diagnosed with BBD, TDLU involution is not a biomarker of subsequent breast cancer. IMPACT TDLU involution may not impact breast cancer risk as previously thought.
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Affiliation(s)
- Kevin H Kensler
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Emily Z F Liu
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Suzanne C Wetstein
- Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Allison M Onken
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christina I Luffman
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gabrielle M Baker
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Laura C Collins
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stuart J Schnitt
- Department of Pathology, Harvard Medical School and Brigham and Women's Hospital; Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vanessa C Bret-Mounet
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mitko Veta
- Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Josien P W Pluim
- Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Alvin J. Siteman Cancer Center, St Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Alvin J. Siteman Cancer Center, St Louis, Missouri
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Susan E Hankinson
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Yujing J Heng
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Involution of Breast Lobules, Mammographic Breast Density and Prognosis Among Tamoxifen-Treated Estrogen Receptor-Positive Breast Cancer Patients. J Clin Med 2019; 8:jcm8111868. [PMID: 31689948 PMCID: PMC6912285 DOI: 10.3390/jcm8111868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Mammographic breast density (MD) reflects breast fibroglandular content. Its decline following adjuvant tamoxifen treated, estrogen receptor (ER)-positive breast cancer has been associated with improved outcomes. Breast cancers arise from structures termed lobules, and lower MD is associated with increased age-related lobule involution. We assessed whether pre-treatment involution influenced associations between MD decline and risk of breast cancer-specific death. ER-positive tamoxifen treated patients diagnosed at Kaiser Permanente Northwest (1990-2008) were defined as cases who died of breast cancer (n = 54) and matched controls (remained alive over similar follow-up; n = 180). Lobule involution was assessed by examining terminal duct lobular units (TDLUs) in benign tissues surrounding cancers as TDLU count/mm2, median span and acini count/TDLU. MD (%) was measured in the unaffected breast at baseline (median 6-months before) and follow-up (median 12-months after tamoxifen initiation). TDLU measures and baseline MD were positively associated among controls (p < 0.05). In multivariable regression models, MD decline (≥10%) was associated with reduced risk of breast cancer-specific death before (odds ratio (OR): 0.41, 95% CI: 0.18-0.92) and after (OR: 0.41, 95% CI: 0.18-0.94) adjustment for TDLU count/mm2, TDLU span (OR: 0.34, 95% CI: 0.14-0.84), and acini count/TDLU (OR: 0.33, 95% CI: 0.13-0.81). MD decline following adjuvant tamoxifen is associated with reduced risk of breast cancer-specific death, irrespective of pre-treatment lobule involution.
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