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Gabrielson M, Hammarström M, Bergqvist J, Lång K, Rosendahl AH, Borgquist S, Hellgren R, Czene K, Hall P. Baseline breast tissue characteristics determine the effect of tamoxifen on mammographic density change. Int J Cancer 2024; 155:339-351. [PMID: 38554131 DOI: 10.1002/ijc.34939] [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: 11/20/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 04/01/2024]
Abstract
Tamoxifen prevents recurrence of breast cancer and is also approved for preventive, risk-reducing, therapy. Tamoxifen alters the breast tissue composition and decreases the mammographic density. We aimed to test if baseline breast tissue composition influences tamoxifen-associated density change. This biopsy-based study included 83 participants randomised to 6 months daily intake of placebo, 20, 10, 5, 2.5, or 1 mg tamoxifen. The study is nested within the double-blinded tamoxifen dose-determination trial Karolinska Mammography Project for Risk Prediction of Breast Cancer Intervention (KARISMA) Study. Ultrasound-guided core-needle breast biopsies were collected at baseline before starting treatment. Biopsies were quantified for epithelial, stromal, and adipose distributions, and epithelial and stromal expression of proliferation marker Ki67, oestrogen receptor (ER) and progesterone receptor (PR). Mammographic density was measured using STRATUS. We found that greater mammographic density at baseline was positively associated with stromal area and inversely associated with adipose area and stromal expression of ER. Premenopausal women had greater mammographic density and epithelial tissue, and expressed more epithelial Ki67, PR, and stromal PR, compared to postmenopausal women. In women treated with tamoxifen (1-20 mg), greater density decrease was associated with higher baseline density, epithelial Ki67, and stromal PR. Women who responded to tamoxifen with a density decrease had on average 17% higher baseline density and a 2.2-fold higher PR expression compared to non-responders. Our results indicate that features in the normal breast tissue before tamoxifen exposure influences the tamoxifen-associated density decrease, and that the age-associated difference in density change may be related to age-dependant differences in expression of Ki67 and PR.
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Affiliation(s)
- Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Hammarström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Bergqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Breast Centre, Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden
| | - Kristina Lång
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Ann H Rosendahl
- Department of Clinical Sciences Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Signe Borgquist
- Department of Clinical Sciences Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, South General Hospital, Stockholm, Sweden
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Abrahamsson A, Boroojeni FR, Naeimipour S, Reustle N, Selegård R, Aili D, Dabrosin C. Increased matrix stiffness enhances pro-tumorigenic traits in a physiologically relevant breast tissue- monocyte 3D model. Acta Biomater 2024; 178:160-169. [PMID: 38382828 DOI: 10.1016/j.actbio.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
High mammographic density, associated with increased tissue stiffness, is a strong risk factor for breast cancer per se. In postmenopausal women there is no differences in the occurrence of ductal carcinoma in situ (DCIS) depending on breast density. Preliminary data suggest that dense breast tissue is associated with a pro-inflammatory microenvironment including infiltrating monocytes. However, the underlying mechanism(s) remains largely unknown. A major roadblock to understanding this risk factor is the lack of relevant in vitro models. A biologically relevant 3D model with tunable stiffness was developed by cross-linking hyaluronic acid. Breast cancer cells were cultured with and without freshly isolated human monocytes. In a unique clinical setting, extracellular proteins were sampled using microdialysis in situ from women with various breast densities. We show that tissue stiffness resembling high mammographic density increases the attachment of monocytes to the cancer cells, increase the expression of adhesion molecules and epithelia-mesenchymal-transition proteins in estrogen receptor (ER) positive breast cancer. Increased tissue stiffness results in increased secretion of similar pro-tumorigenic proteins as those found in human dense breast tissue including inflammatory cytokines, proteases, and growth factors. ER negative breast cancer cells were mostly unaffected suggesting that diverse cancer cell phenotypes may respond differently to tissue stiffness. We introduce a biological relevant model with tunable stiffness that resembles the densities found in normal breast tissue in women. The model will be key for further mechanistic studies. Additionally, our data revealed several pro-tumorigenic pathways that may be exploited for prevention and therapy against breast cancer. STATEMENT OF SIGNIFICANCE: Women with mammographic high-density breasts have a 4-6-fold higher risk of breast cancer than low-density breasts. Biological mechanisms behind this increase are not fully understood and no preventive therapeutics are available. One major reason being a lack of suitable experimental models. Having such models available would greatly enhance the discovery of relevant targets for breast cancer prevention. We present a biologically relevant 3D-model for studies of human dense breasts, providing a platform for investigating both biophysical and biochemical properties that may affect cancer progression. This model will have a major scientific impact on studies for identification of novel targets for breast cancer prevention.
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Affiliation(s)
- Annelie Abrahamsson
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fatemeh Rasti Boroojeni
- Laboratory of Molecular Materials, Division of Biophysics and Bioengineering, Department of Physics, Chemistry and Biology, Linköping University, 581 83 Linköping, Sweden
| | - Sajjad Naeimipour
- Laboratory of Molecular Materials, Division of Biophysics and Bioengineering, Department of Physics, Chemistry and Biology, Linköping University, 581 83 Linköping, Sweden
| | - Nina Reustle
- Laboratory of Molecular Materials, Division of Biophysics and Bioengineering, Department of Physics, Chemistry and Biology, Linköping University, 581 83 Linköping, Sweden
| | - Robert Selegård
- Laboratory of Molecular Materials, Division of Biophysics and Bioengineering, Department of Physics, Chemistry and Biology, Linköping University, 581 83 Linköping, Sweden
| | - Daniel Aili
- Laboratory of Molecular Materials, Division of Biophysics and Bioengineering, Department of Physics, Chemistry and Biology, Linköping University, 581 83 Linköping, Sweden.
| | - Charlotta Dabrosin
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Mullooly M, Fan S, Pfeiffer RM, Bowles EA, Duggan MA, Falk RT, Richert-Boe K, Glass AG, Kimes TM, Figueroa JD, Rohan TE, Abubakar M, Gierach GL. Temporal changes in mammographic breast density and breast cancer risk among women with benign breast disease. Breast Cancer Res 2024; 26:52. [PMID: 38532516 DOI: 10.1186/s13058-024-01764-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/06/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Benign breast disease (BBD) and high mammographic breast density (MBD) are prevalent and independent risk factors for invasive breast cancer. It has been suggested that temporal changes in MBD may impact future invasive breast cancer risk, but this has not been studied among women with BBD. METHODS We undertook a nested case-control study within a cohort of 15,395 women with BBD in Kaiser Permanente Northwest (KPNW; 1970-2012, followed through mid-2015). Cases (n = 261) developed invasive breast cancer > 1 year after BBD diagnosis, whereas controls (n = 249) did not have breast cancer by the case diagnosis date. Cases and controls were individually matched on BBD diagnosis age and plan membership duration. Standardized %MBD change (per 2 years), categorized as stable/any increase (≥ 0%), minimal decrease of less than 5% or a decrease greater than or equal to 5%, was determined from baseline and follow-up mammograms. Associations between MBD change and breast cancer risk were examined using adjusted unconditional logistic regression. RESULTS Overall, 64.5% (n = 329) of BBD patients had non-proliferative and 35.5% (n = 181) had proliferative disease with/without atypia. Women with an MBD decrease (≤ - 5%) were less likely to develop breast cancer (Odds Ratio (OR) 0.64; 95% Confidence Interval (CI) 0.38, 1.07) compared with women with minimal decreases. Associations were stronger among women ≥ 50 years at BBD diagnosis (OR 0.48; 95% CI 0.25, 0.92) and with proliferative BBD (OR 0.32; 95% CI 0.11, 0.99). DISCUSSION Assessment of temporal MBD changes may inform risk monitoring among women with BBD, and strategies to actively reduce MBD may help decrease future breast cancer risk.
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Affiliation(s)
- Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Shaoqi Fan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Erin Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Máire A Duggan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, T2N2Y9, Canada
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Andrew G Glass
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Teresa M Kimes
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Gatta G, Somma F, Sardu C, De Chiara M, Massafra R, Fanizzi A, La Forgia D, Cuccurullo V, Iovino F, Clemente A, Marfella R, Grezia GD. Automated 3D Ultrasound as an Adjunct to Screening Mammography Programs in Dense Breast: Literature Review and Metanalysis. J Pers Med 2023; 13:1683. [PMID: 38138910 PMCID: PMC10744838 DOI: 10.3390/jpm13121683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Purpose: The purpose of this meta-analysis is to investigate the effectiveness of supplementing screening mammography with three-dimensional automated breast ultrasonography (3D ABUS) in improving breast cancer detection rates in asymptomatic women with dense breasts. Materials and Methods: We conducted a thorough review of scientific publications comparing 3D ABUS and mammography. Articles for inclusion were sourced from peer-reviewed journal databases, namely MEDLINE (PubMed) and Scopus, based on an initial screening of their titles and abstracts. To ensure a sufficient sample size for meaningful analysis, only studies evaluating a minimum of 20 patients were retained. Eligibility for evaluation was further limited to articles written in English. Additionally, selected studies were required to have participants aged 18 or above at the time of the study. We analyzed 25 studies published between 2000 and 2021, which included a total of 31,549 women with dense breasts. Among these women, 229 underwent mammography alone, while 347 underwent mammography in combination with 3D ABUS. The average age of the women was 50.86 years (±10 years standard deviation), with a range of 40-56 years. In our efforts to address and reduce bias, we applied a range of statistical analyses. These included assessing study variation through heterogeneity assessment, accounting for potential study variability using a random-effects model, exploring sources of bias via meta-regression analysis, and checking for publication bias through funnel plots and the Egger test. These methods ensured the reliability of our study findings. Results: According to the 25 studies included in this metanalysis, out of the total number of women, 27,495 were diagnosed with breast cancer. Of these, 211 were diagnosed through mammography alone, while an additional 329 women were diagnosed through the combination of full-field digital mammography (FFDSM) and 3D ABUS. This represents an increase of 51.5%. The rate of cancers detected per 1000 women screened was 23.25‱ (95% confidence interval [CI]: 21.20, 25.60; p < 0.001) with mammography alone. In contrast, the addition of 3D ABUS to mammography increased the number of tumors detected to 20.95‱ (95% confidence interval [CI]: 18.50, 23; p < 0.001) per 1000 women screened. Discussion: Even though variability in study results, lack of long-term outcomes, and selection bias may be present, this systematic review and meta-analysis confirms that supplementing mammography with 3D ABUS increases the accuracy of breast cancer detection in women with ACR3 to ACR4 breasts. Our findings suggest that the combination of mammography and 3D ABUS should be considered for screening women with dense breasts. Conclusions: Our research confirms that adding 3D automated breast ultrasound to mammography-only screening in patients with dense breasts (ACR3 and ACR4) significantly (p < 0.05) increases the cancer detection rate.
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Affiliation(s)
- Gianluca Gatta
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80131 Napoli, Italy; (G.G.); (M.D.C.); (A.C.)
| | - Francesco Somma
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy;
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138 Naples, Italy; (C.S.); (R.M.)
| | - Marco De Chiara
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80131 Napoli, Italy; (G.G.); (M.D.C.); (A.C.)
| | - Raffaella Massafra
- Department of Breast Radiology, Giovanni Paolo II/I.R.C.C.S. Cancer Institute, 70124 Bari, Italy; (R.M.); (A.F.); (D.L.F.)
| | - Annarita Fanizzi
- Department of Breast Radiology, Giovanni Paolo II/I.R.C.C.S. Cancer Institute, 70124 Bari, Italy; (R.M.); (A.F.); (D.L.F.)
| | - Daniele La Forgia
- Department of Breast Radiology, Giovanni Paolo II/I.R.C.C.S. Cancer Institute, 70124 Bari, Italy; (R.M.); (A.F.); (D.L.F.)
| | - Vincenzo Cuccurullo
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80131 Napoli, Italy; (G.G.); (M.D.C.); (A.C.)
| | - Francesco Iovino
- Department of Translational Medical Science, School of Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Alfredo Clemente
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80131 Napoli, Italy; (G.G.); (M.D.C.); (A.C.)
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138 Naples, Italy; (C.S.); (R.M.)
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Reis YN, Mota BS, Mota RMS, Shimizu C, Ricci MD, Aguiar FN, Soares-Jr JM, Baracat EC, Filassi JR. Pathological macroscopic evaluation of breast density versus mammographic breast density in breast cancer conserving surgery. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100243. [PMID: 37780817 PMCID: PMC10539930 DOI: 10.1016/j.eurox.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
Correlation between imaging and anatomopathological breast density has been superficially explored and is heterogeneous in current medical literature. It is possible that mammographic and pathological findings are divergent. The aim of this study is to evaluate the association between breast density classified by mammography and breast density of pathological macroscopic examination in specimens of breast cancer conservative surgeries. Post-hoc, exploratory analysis of a prospective randomized clinical trial of patients with breast cancer candidates for breast conservative surgery. Breast mammographic density (MD) was analyzed according to ACR BI-RADS® criteria, and pathologic macroscopic evaluation of breast density (PMBD) was estimated by visually calculating the ratio between stromal and fatty tissue. From 412 patients, MD was A in 291 (70,6%), B in 80 (19,4%) B, C in 35 (8,5%), and D in 6 (1,5%). Ninety-nine percent (201/203) of patients classified as A+B in MD were correspondently classified in PMBD. Conversely, only 18.7% (39/209) of patients with MD C+D were classified correspondently in PMBD (p < 0.001). Binary logistic regression showed age (OR 1.06, 1.01-1.12 95% CI, p 0.013) and nulliparity (OR 0.39, 0.17-0.96 95% CI, p 0.039) as predictors of A+B PMBD. Conclusion Mammographic and pathologic macroscopic breast density showed no association in our study for breast C or D in breast image. The fatty breast was associated with older patients and the nulliparity decreases the chance of fatty breasts nearby 60%.
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Affiliation(s)
- Yedda Nunes Reis
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP) / ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
| | - Bruna Salani Mota
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP) / ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
| | | | - Carlos Shimizu
- Departamento de Radiologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP)/ ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
| | - Marcos Desiderio Ricci
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP) / ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
| | - Fernando Nalesso Aguiar
- Departamento de Patologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP) / ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
| | - José Maria Soares-Jr
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP) / ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
| | - Edmund Chada Baracat
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP) / ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
| | - José Roberto Filassi
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP) / ICESP – Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
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Aljawder AAA, Li JJX, Ng JKM, Chan RCK, Lui PCW, Poon IK, Tsang JYS, Tse GM. Idiopathic granulomatous mastitis and cystic neutrophilic granulomatous mastitis: two sides of the same coin or distinct entities? Pathology 2023; 55:335-341. [PMID: 36503636 DOI: 10.1016/j.pathol.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/10/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a benign mimic of breast carcinomas. It is defined histologically by the presence of granulomas and inflammation. The closely related cystic neutrophilic granulomatous mastitis (CNGM) shows lipogranulomas, with a reported association with corynebacteria. A large cohort of IGM was reviewed to compare clinical, microbiological and histological features between non-CNGM IGM and CNGM. Cases of IGM were reviewed for histological parameters including the presence of lipogranulomas and composition of inflammatory cells. Clinical data were obtained through hospital records. The cohort included 79 cases, including 51 non-CNGM IGM and 28 CNGM. Comparing non-CNGM IGM and CNGM, there were no differences in clinical or demographical data, other than a younger age of presentation (36.2 vs 41.5 years, p=0.012) for CNGM. Most IGM resolved within the follow-up period (n=57/64, 89.1%), with similar outcomes regardless of treatment (p>0.05). In CNGM, there were more infiltrates of neutrophils (p=0.001), histiocytes (p=0.047), and multinucleated giant cells (p=0.006), but less lymphocytes (p=0.008). Corynebacteria was cultured in two (25%) cases of CNGM, and one non-CNGM IGM (14.3%). Gram-positive bacilli were identified in two cases of CNGM. 'Early' lipogranulomas were observed closely associated to inflamed ducts in three cases of CNGM. Apart from age, there was no distinct clinical or microbiological feature for CNGM. These findings do not support CNGM as a distinct entity. Rather, CNGM-pattern may represent a continuum of IGM, possibly age-related and attributable to ductal inflammation and cystic changes in the breast parenchyma.
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Affiliation(s)
- Aysha A A Aljawder
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Joanna K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ronald C K Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | | | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Julia Y S Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Breast density is strongly associated with multiparametric magnetic resonance imaging biomarkers and pro-tumorigenic proteins in situ. Br J Cancer 2022; 127:2025-2033. [PMID: 36138072 PMCID: PMC9681775 DOI: 10.1038/s41416-022-01976-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND High mammographic density is an independent risk factor for breast cancer by poorly understood molecular mechanisms. Women with dense breasts often undergo conventional magnetic resonance imaging (MRI) despite its limited specificity, which may be increased by diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) and contrast. How these modalities are affected by breast density per se and their association with the local microenvironment are undetermined. METHODS Healthy postmenopausal women attending mammography screen with extremely dense or entirely fatty breasts underwent multiparametric MRI for analyses of lean tissue fraction (LTF), ADC and perfusion dynamics. Microdialysis was used for extracellular proteomics in situ. RESULTS Significantly increased LTF and ADC and delayed perfusion were detected in dense breasts. In total, 270 proteins were quantified, whereof 124 related to inflammation, angiogenesis, and cellular growth were significantly upregulated in dense breasts. Most of these correlated significantly with LTF, ADC and the perfusion data. CONCLUSIONS ADC and perfusion characteristics depend on breast density, which should be considered during the implementation of thresholds for malignant lesions. Dense and nondense breasts are two essentially different biological entities, with a pro-tumorigenic microenvironment in dense breasts. Our data reveal several novel pathways that may be explored for breast cancer prevention strategies.
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Patel BK, Pepin K, Brandt KR, Mazza GL, Pockaj BA, Chen J, Zhou Y, Northfelt DW, Anderson K, Kling JM, Vachon CM, Swanson KR, Nikkhah M, Ehman R. Association of breast cancer risk, density, and stiffness: global tissue stiffness on breast MR elastography (MRE). Breast Cancer Res Treat 2022; 194:79-89. [PMID: 35501423 PMCID: PMC9538705 DOI: 10.1007/s10549-022-06607-2] [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: 06/10/2021] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Quantify in vivo biomechanical tissue properties in various breast densities and in average risk and high-risk women using Magnetic Resonance Imaging (MRI)/MRE and examine the association between breast biomechanical properties and cancer risk based on patient demographics and clinical data. METHODS Patients with average risk or high-risk of breast cancer underwent 3.0 T breast MR imaging and elastography. Breast parenchymal enhancement (BPE), density (from most recent mammogram), stiffness, elasticity, and viscosity were recorded. Within each breast density group (non-dense versus dense), stiffness, elasticity, and viscosity were compared across risk groups (average versus high). Separately for stiffness, elasticity, and viscosity, a multivariable logistic regression model was used to evaluate whether the MRE parameter predicted risk status after controlling for clinical factors. RESULTS 50 average risk and 86 high-risk patients were included. Risk groups were similar in age, density, and menopausal status. Among patients with dense breasts, mean stiffness, elasticity, and viscosity were significantly higher in high-risk patients (N = 55) compared to average risk patients (N = 34; all p < 0.001). Stiffness remained a significant predictor of risk status (OR = 4.26, 95% CI [1.96, 9.25]) even after controlling for breast density, BPE, age, and menopausal status. Similar results were seen for elasticity and viscosity. CONCLUSION A structurally based, quantitative biomarker of tissue stiffness obtained from MRE is associated with differences in breast cancer risk in dense breasts. Tissue stiffness could provide a novel prognostic marker to help identify high-risk women with dense breasts who would benefit from increased surveillance and/or risk reduction measures.
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Affiliation(s)
- Bhavika K Patel
- Diagnostic Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA.
| | - Kay Pepin
- Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Gina L Mazza
- Department of Biostatistics, Mayo Clinic, Phoenix, AZ, USA
| | | | - Jun Chen
- Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | - Yuxiang Zhou
- Diagnostic Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | | | | | - Juliana M Kling
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Mehdi Nikkhah
- School of Biological and Health Systems Engineering, Arizona State University, Phoenix, AZ, USA
- Biodesign Virginia G. Piper Center for Personalized Diagnostics, Arizona State University, Tempe, AZ, USA
| | - Richard Ehman
- Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
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Coradini D, Ambrogi F. Differential expression of the genes coding for adipokines and epithelial cell polarity components in women with low and high mammographic density. Clin Breast Cancer 2022; 22:715-723. [DOI: 10.1016/j.clbc.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
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10
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Ekstrand J, Zemmler M, Abrahamsson A, Lundberg P, Forsgren M, Dabrosin C. Breast Density and Estradiol Are Major Determinants for Soluble TNF-TNF-R Proteins in vivo in Human Breast Tissue. Front Immunol 2022; 13:850240. [PMID: 35432372 PMCID: PMC9005790 DOI: 10.3389/fimmu.2022.850240] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023] Open
Abstract
High mammographic density and exposure to sex steroids are independent risk factors for breast cancer by yet unknown mechanisms. Inflammation is one hallmark of cancer and the tumor necrosis factor family of proteins (TNFSFs) and receptors (TNFRSFs) are key determinants of tissue inflammation. The relationship between TNFSFs/TNFRSFs and breast tissue density or local breast estradiol levels is unknown. We investigated whether TNFSFs and soluble TNFRSFs (sTNFRSFs) are dysregulated in vivo in human breast cancer and dense breast tissue of postmenopausal women. We explored TNFSF/TNFRSF correlations with breast density and estradiol, both locally in the breast and in abdominal subcutaneous (s.c.) fat as a measure of systemic effects. Microdialysis was used for local sampling of in vivo proteins and estradiol in a total of 73 women; 12 with breast cancer, 42 healthy postmenopausal women with different breast densities, and 19 healthy premenopausal women. Breast density was determined as lean tissue fraction (LTF) using magnetic resonance imaging. Microdialysis was also performed in estrogen receptor (ER) positive breast cancer in mice treated with the pure anti-estrogen fulvestrant and tumor tissue was subjected to immunohistochemistry. 23 members of the TNFSF/sTNFRSF families were quantified using proximity extension assay.Our data revealed upregulation of TNFSF10, 13 and 13B, TNFRSF6, 6B, 9, 11A, 11B, 13B, 14, and 19, and TNFR-1 and -2 in ER+ breast cancer in women. In dense breast tissue TNFSF10, 13, and 14, TNFRSF3, 6, 9, 10B, 13B, 14, 19, and TNFR-1 and -2 were upregulated. Certain TNFSFs/TNFRSFs were increased in premenopausal breasts relative to postmenopausal breasts. Furthermore, estradiol correlated with most of the TNFSF/sTNFRSF members, though LTF only correlated with some of the proteins. Several of these associations were breast tissue-specific, as very few correlated with estradiol in abdominal s.c. fat. Estrogen dependent regulations of TNFSF2 (TNF-α) and TNF-R2 were corroborated in ER+ breast cancer in mice. Taken together, our data indicate TNFSFs/sTNFRSFs may represent potential targetable pathways for treatment of breast cancer patients and in prevention of breast cancer development in women with dense breasts.
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Affiliation(s)
- Jimmy Ekstrand
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maja Zemmler
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annelie Abrahamsson
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Department of Radiology, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Mikael Forsgren
- Department of Radiology, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Charlotta Dabrosin
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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11
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Alqurashi M, Momot KI, Aamry A, Almohammed H, Aamri H, Johary YH, Abolaban FA, Sulieman A. Sensing mammographic density using single-sided portable Nuclear Magnetic Resonance. Saudi J Biol Sci 2022; 29:2447-2454. [PMID: 35531236 PMCID: PMC9073015 DOI: 10.1016/j.sjbs.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 12/28/2022] Open
Abstract
This research paper presents a quantitative approach to sensing mammographic density (MD) using single-sided portable Nuclear Magnetic Resonance (NMR). It focuses on three main techniques: spin-lattice relaxation (recovery) time (T1), spin-spin relaxation (decay) time (T2), and Diffusion (D) techniques by testing whether or not the aforementioned techniques are in agreement with the gold standard and with each other when used for scanning breast tissue specimens with a variety of mammographic densities (MDs). The high mammographic density (HMD), intermediate MD, and low mammographic density (LMD) regions of each slice were identified according to the mammogram images. Subsequently, the grayscale values for these regions were quantified. One region was measured from the first sample while the remaining ones were measured from the second sample. The same areas were then exposed to portable NMR, and the sequences used as following: the stimulated echo sequence for diffusion (D), the Carr-Purcell-Meiboom-Gill (CPMG) sequence for T2, and saturation recovery sequence for T1. The correlations between the grayscale values and NMR techniques were strongly correlated. The Pearson correlation coefficient, R, of T1 (%) versus grayscale value, D (%) versus grayscale value, and T2 (%) versus grayscale value, was 0.91, 0.91, and 0.93, respectively. Furthermore, the relative water content of the breast slices based on T1, T2, and diffusion (D) measurements were strongly in agreement with each other. The Pearson correlation coefficient, R, of D (%) versus T1 (%), D (%) versus T2 (%), and T1 (%) versus T2 (%), was 0.984, 0.966, and 0.9868, respectively. The three pulse sequences can be employed in a portable NMR device to deliver continuous quantitative measurements of MD in breast tissue samples. As a result, the method demonstrated to be acceptable for determining the distribution of MDs among breast tissue samples without the need for additional qualitative analysis.
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Affiliation(s)
- Maher Alqurashi
- Radiology Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Konstantin I. Momot
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology (QUT), Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
| | - Ali Aamry
- Nuclear Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - H.I. Almohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O Box 84428, Riyadh 11671, Saudi Arabia
| | - Hussin Aamri
- Medical Physics Department, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Yehia H. Johary
- Medical Physics Department, General Directorate of Health Affairs in Aseer Region, Abha, Saudi Arabia
| | - Fouad A. Abolaban
- Nuclear Engineering Department, Faculty of Engineering, King Abdulaziz University, P. O. Box 80221, Jeddah 21589, Saudi Arabia
| | - Abdelmoneim Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O. Box 422, Alkharj 11942, Saudi Arabia
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12
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Hieken TJ, Chen J, Chen B, Johnson S, Hoskin TL, Degnim AC, Walther-Antonio MR, Chia N. The breast tissue microbiome, stroma, immune cells and breast cancer. Neoplasia 2022; 27:100786. [PMID: 35366464 PMCID: PMC8971327 DOI: 10.1016/j.neo.2022.100786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Stromal and immune cell composition alterations in benign breast tissue associate with future cancer risk. Pilot data suggest the innate microbiome of normal breast tissue differs between women with and without breast cancer. Microbiome alterations might explain tissue microenvironment variations associated with disease status. METHODS Prospectively-collected sterile normal breast tissues from women with benign (n=16) or malignant (n=17) disease underwent 16SrRNA sequencing with Illumina MiSeq and Hybrid-denovo pipeline processing. Breast tissue was scored for fibrosis and fat percentages and immune cell infiltrates (lobulitis) classified as absent/mild/moderate/severe. Alpha and beta diversity were calculated on rarefied OTU data and associations analyzed with multiple linear regression and PERMANOVA. RESULTS Breast tissue stromal fat% was lower and fibrosis% higher in benign disease versus cancer (median 30% versus 60%, p=0.01, 70% versus 30%, p=0.002, respectively). The microbiome varied with stromal composition. Alpha diversity (Chao1) correlated with fat% (r=0.38, p=0.02) and fibrosis% (r=-0.32, p=0.05) and associated with different microbial populations as indicated by beta diversity metrics (weighted UniFrac, p=0.08, fat%, p=0.07, fibrosis%). Permutation testing with FDR control revealed taxa differences for fat% in Firmicutes, Bacilli, Bacillales, Staphylococcaceae and genus Staphylococcus, and fibrosis% in Firmicutes, Spirochaetes, Bacilli, Bacillales, Spirochaetales, Proteobacteria RF32, Sphingomonadales, Staphylococcaceae, and genera Clostridium, Staphylococcus, Spirochaetes, Actinobacteria Adlercreutzia. Moderate/severe lobulitis was more common in cancer (73%) than benign disease (13%), p=0.003, but no significant microbial associations were seen. CONCLUSION These data suggest a link between breast tissue stromal alterations and its microbiome, further supporting a connection between the breast tissue microenvironment and breast cancer.
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Affiliation(s)
- Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Jun Chen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Beiyun Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Stephen Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Tanya L Hoskin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Nicholas Chia
- Department of Surgery, Mayo Clinic, Rochester, MN, United States; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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13
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Thomas CE, Dahl L, Byström S, Chen Y, Uhlén M, Mälarstig A, Czene K, Hall P, Schwenk JM, Gabrielson M. Circulating proteins reveal prior use of menopausal hormonal therapy and increased risk of breast cancer. Transl Oncol 2022; 17:101339. [PMID: 35033985 PMCID: PMC8760550 DOI: 10.1016/j.tranon.2022.101339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/18/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Accessible risk predictors are crucial for improving the early detection and prognosis of breast cancer. Blood samples are widely available and contain proteins that provide important information about human health and disease, however, little is still known about the contribution of circulating proteins to breast cancer risk prediction. We profiled EDTA plasma samples collected before diagnosis from the Swedish KARMA breast cancer cohort to evaluate circulating proteins as molecular predictors. A data-driven analysis strategy was applied to the molecular phenotypes built on 700 circulating proteins to identify and annotate clusters of women. The unsupervised analysis of 183 future breast cancer cases and 366 age-matched controls revealed five stable clusters with distinct proteomic plasma profiles. Among these women, those in the most stable cluster (N = 19; mean Jaccard index: 0.70 ± 0.29) were significantly more likely to have used menopausal hormonal therapy (MHT), get a breast cancer diagnosis, and were older compared to the remaining clusters. The circulating proteins associated with this cluster (FDR < 0.001) represented physiological processes related to cell junctions (F11R, CLDN15, ITGAL), DNA repair (RBBP8), cell replication (TJP3), and included proteins found in female reproductive tissue (PTCH1, ZP4). Using a data-driven approach on plasma proteomics data revealed the potential long-lasting molecular effects of menopausal hormonal therapy (MHT) on the circulating proteome, even after women had ended their treatment. This provides valuable insights concerning proteomics efforts to identify molecular markers for breast cancer risk prediction.
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Affiliation(s)
- Cecilia E Thomas
- Science for Life Laboratory, Department of Protein Science School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Tomtebodavägen 23, Solna, Stockholm 171 65, Sweden
| | - Leo Dahl
- Science for Life Laboratory, Department of Protein Science School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Tomtebodavägen 23, Solna, Stockholm 171 65, Sweden
| | - Sanna Byström
- Science for Life Laboratory, Department of Protein Science School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Tomtebodavägen 23, Solna, Stockholm 171 65, Sweden
| | - Yan Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet Nobels väg 12A, Stockholm SE-171 77, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mathias Uhlén
- Science for Life Laboratory, Department of Protein Science School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Tomtebodavägen 23, Solna, Stockholm 171 65, Sweden
| | - Anders Mälarstig
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet Nobels väg 12A, Stockholm SE-171 77, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet Nobels väg 12A, Stockholm SE-171 77, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet Nobels väg 12A, Stockholm SE-171 77, Sweden; Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Jochen M Schwenk
- Science for Life Laboratory, Department of Protein Science School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Tomtebodavägen 23, Solna, Stockholm 171 65, Sweden.
| | - Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet Nobels väg 12A, Stockholm SE-171 77, Sweden.
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14
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Biological Mechanisms and Therapeutic Opportunities in Mammographic Density and Breast Cancer Risk. Cancers (Basel) 2021; 13:cancers13215391. [PMID: 34771552 PMCID: PMC8582527 DOI: 10.3390/cancers13215391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
Mammographic density is an important risk factor for breast cancer; women with extremely dense breasts have a four to six fold increased risk of breast cancer compared to women with mostly fatty breasts, when matched with age and body mass index. High mammographic density is characterised by high proportions of stroma, containing fibroblasts, collagen and immune cells that suggest a pro-tumour inflammatory microenvironment. However, the biological mechanisms that drive increased mammographic density and the associated increased risk of breast cancer are not yet understood. Inflammatory factors such as monocyte chemotactic protein 1, peroxidase enzymes, transforming growth factor beta, and tumour necrosis factor alpha have been implicated in breast development as well as breast cancer risk, and also influence functions of stromal fibroblasts. Here, the current knowledge and understanding of the underlying biological mechanisms that lead to high mammographic density and the associated increased risk of breast cancer are reviewed, with particular consideration to potential immune factors that may contribute to this process.
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15
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Janan F, Brady M. RICE: A method for quantitative mammographic image enhancement. Med Image Anal 2021; 71:102043. [PMID: 33813287 DOI: 10.1016/j.media.2021.102043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
We introduce Region of Interest Contrast Enhancement (RICE) to identify focal densities in mammograms. It aims to help radiologists: 1) enhancing the contrast of mammographic images; and 2) detecting regions of interest (such as focal densities) that are candidate masses potentially masked behind dense parenchyma. Cancer masking is an unsolved issue, particularly in breast density categories BI-RADS C and D. RICE suppresses normal breast parenchyma in order to highlight focal densities. Unlike methods that enhance mammograms by modifying the dynamic range of an image; RICE relies on the actual tissue composition of the breast. It segments Volumetric Breast Density (VBD) maps into smaller regions and then applies a recursive mechanism to estimate the 'neighbourhood' for each segment. The method then subtracts and updates the neighbourhood, or the encompassing tissue, from each piecewise constant component of the breast image. This not only enhances the appearance of a candidate mass but also helps in estimating the mass density. In extensive experiments, RICE enhances focal densities in all breast density types including the most challenging category BI-RADS D. Suitably adapted, RICE can be used as a precursor to any computer-aided diagnostics and detection system.
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Affiliation(s)
- Faraz Janan
- School of Computer Science, University of Lincoln, Issac Newton Building, Bradyford Pool LN6 7TS, United Kingdom.
| | - Michael Brady
- Department of Oncological Imaging, University of Oxford, Old Road Campus Research Building, Headington, Oxford OX3 7DQ, United Kingdom.
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16
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Northey JJ, Barrett AS, Acerbi I, Hayward MK, Talamantes S, Dean IS, Mouw JK, Ponik SM, Lakins JN, Huang PJ, Wu J, Shi Q, Samson S, Keely PJ, Mukhtar RA, Liphardt JT, Shepherd JA, Hwang ES, Chen YY, Hansen KC, Littlepage LE, Weaver VM. Stiff stroma increases breast cancer risk by inducing the oncogene ZNF217. J Clin Invest 2021; 130:5721-5737. [PMID: 32721948 DOI: 10.1172/jci129249] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
Women with dense breasts have an increased lifetime risk of malignancy that has been attributed to a higher epithelial density. Quantitative proteomics, collagen analysis, and mechanical measurements in normal tissue revealed that stroma in the high-density breast contains more oriented, fibrillar collagen that is stiffer and correlates with higher epithelial cell density. microRNA (miR) profiling of breast tissue identified miR-203 as a matrix stiffness-repressed transcript that is downregulated by collagen density and reduced in the breast epithelium of women with high mammographic density. Culture studies demonstrated that ZNF217 mediates a matrix stiffness- and collagen density-induced increase in Akt activity and mammary epithelial cell proliferation. Manipulation of the epithelium in a mouse model of mammographic density supported a causal relationship between stromal stiffness, reduced miR-203, higher levels of the murine homolog Zfp217, and increased Akt activity and mammary epithelial proliferation. ZNF217 was also increased in the normal breast epithelium of women with high mammographic density, correlated positively with epithelial proliferation and density, and inversely with miR-203. The findings identify ZNF217 as a potential target toward which preexisting therapies, such as the Akt inhibitor triciribine, could be used as a chemopreventive agent to reduce cancer risk in women with high mammographic density.
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Affiliation(s)
- Jason J Northey
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Alexander S Barrett
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Irene Acerbi
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Mary-Kate Hayward
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Stephanie Talamantes
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Ivory S Dean
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Janna K Mouw
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Suzanne M Ponik
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jonathon N Lakins
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Po-Jui Huang
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA
| | - Junmin Wu
- Harper Cancer Research Institute, Department of Chemistry and Biochemistry, University of Notre Dame, South Bend, Indiana, USA
| | - Quanming Shi
- Department of Bioengineering, Stanford University, Palo Alto, California, USA
| | - Susan Samson
- Helen Diller Comprehensive Cancer Center, UCSF, San Francisco, California, USA
| | - Patricia J Keely
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Jan T Liphardt
- Department of Bioengineering, Stanford University, Palo Alto, California, USA
| | - John A Shepherd
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at Manoa, Manoa, Hawaii, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Yunn-Yi Chen
- Department of Pathology, UCSF, San Francisco, California, USA
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.,Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laurie E Littlepage
- Harper Cancer Research Institute, Department of Chemistry and Biochemistry, University of Notre Dame, South Bend, Indiana, USA
| | - Valerie M Weaver
- Department of Surgery.,Center for Bioengineering and Tissue Regeneration, UCSF, San Francisco, California, USA.,Helen Diller Comprehensive Cancer Center, UCSF, San Francisco, California, USA.,Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at Manoa, Manoa, Hawaii, USA.,Radiation Oncology, Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, UCSF, San Francisco, California, USA
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17
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Andreassen MMS, Rodríguez-Soto AE, Conlin CC, Vidić I, Seibert TM, Wallace AM, Zare S, Kuperman J, Abudu B, Ahn GS, Hahn M, Jerome NP, Østlie A, Bathen TF, Ojeda-Fournier H, Goa PE, Rakow-Penner R, Dale AM. Discrimination of Breast Cancer from Healthy Breast Tissue Using a Three-component Diffusion-weighted MRI Model. Clin Cancer Res 2021; 27:1094-1104. [PMID: 33148675 PMCID: PMC8174004 DOI: 10.1158/1078-0432.ccr-20-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/29/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Diffusion-weighted MRI (DW-MRI) is a contrast-free modality that has demonstrated ability to discriminate between predefined benign and malignant breast lesions. However, how well DW-MRI discriminates cancer from all other breast tissue voxels in a clinical setting is unknown. Here we explore the voxelwise ability to distinguish cancer from healthy breast tissue using signal contributions from the newly developed three-component multi-b-value DW-MRI model. EXPERIMENTAL DESIGN Patients with pathology-proven breast cancer from two datasets (n = 81 and n = 25) underwent multi-b-value DW-MRI. The three-component signal contributions C 1 and C 2 and their product, C 1 C 2, and signal fractions F 1, F 2, and F 1 F 2 were compared with the image defined on maximum b-value (DWI max), conventional apparent diffusion coefficient (ADC), and apparent diffusion kurtosis (K app). The ability to discriminate between cancer and healthy breast tissue was assessed by the false-positive rate given a sensitivity of 80% (FPR80) and ROC AUC. RESULTS Mean FPR80 for both datasets was 0.016 [95% confidence interval (CI), 0.008-0.024] for C 1 C 2, 0.136 (95% CI, 0.092-0.180) for C 1, 0.068 (95% CI, 0.049-0.087) for C 2, 0.462 (95% CI, 0.425-0.499) for F 1 F 2, 0.832 (95% CI, 0.797-0.868) for F 1, 0.176 (95% CI, 0.150-0.203) for F 2, 0.159 (95% CI, 0.114-0.204) for DWI max, 0.731 (95% CI, 0.692-0.770) for ADC, and 0.684 (95% CI, 0.660-0.709) for K app. Mean ROC AUC for C 1 C 2 was 0.984 (95% CI, 0.977-0.991). CONCLUSIONS The C 1 C 2 parameter of the three-component model yields a clinically useful discrimination between cancer and healthy breast tissue, superior to other DW-MRI methods and obliviating predefining lesions. This novel DW-MRI method may serve as noncontrast alternative to standard-of-care dynamic contrast-enhanced MRI.
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Affiliation(s)
- Maren M Sjaastad Andreassen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ana E Rodríguez-Soto
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Christopher C Conlin
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Igor Vidić
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tyler M Seibert
- Department of Radiology, University of California San Diego, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
- Department of Bioengineering, University of California San Diego, La Jolla, California
| | - Anne M Wallace
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Somaye Zare
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Joshua Kuperman
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Boya Abudu
- School of Medicine, University of California San Diego, La Jolla, California
| | - Grace S Ahn
- School of Medicine, University of California San Diego, La Jolla, California
| | - Michael Hahn
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Neil P Jerome
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Agnes Østlie
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
| | | | - Pål Erik Goa
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, California.
| | - Anders M Dale
- Department of Radiology, University of California San Diego, La Jolla, California
- Department of Neuroscience, University of California San Diego, La Jolla, California
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18
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McBride RB, Fei K, Rothstein JH, Alexeeff SE, Song X, Sakoda LC, McGuire V, Achacoso N, Acton L, Liang RY, Lipson JA, Yaffe MJ, Rubin DL, Whittemore AS, Habel LA, Sieh W. Alcohol and Tobacco Use in Relation to Mammographic Density in 23,456 Women. Cancer Epidemiol Biomarkers Prev 2020; 29:1039-1048. [PMID: 32066618 PMCID: PMC7196522 DOI: 10.1158/1055-9965.epi-19-0348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/27/2019] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Percent density (PD) is a strong risk factor for breast cancer that is potentially modifiable by lifestyle factors. PD is a composite of the dense (DA) and nondense (NDA) areas of a mammogram, representing predominantly fibroglandular or fatty tissues, respectively. Alcohol and tobacco use have been associated with increased breast cancer risk. However, their effects on mammographic density (MD) phenotypes are poorly understood. METHODS We examined associations of alcohol and tobacco use with PD, DA, and NDA in a population-based cohort of 23,456 women screened using full-field digital mammography machines manufactured by Hologic or General Electric. MD was measured using Cumulus. Machine-specific effects were estimated using linear regression, and combined using random effects meta-analysis. RESULTS Alcohol use was positively associated with PD (P trend = 0.01), unassociated with DA (P trend = 0.23), and inversely associated with NDA (P trend = 0.02) adjusting for age, body mass index, reproductive factors, physical activity, and family history of breast cancer. In contrast, tobacco use was inversely associated with PD (P trend = 0.0008), unassociated with DA (P trend = 0.93), and positively associated with NDA (P trend<0.0001). These trends were stronger in normal and overweight women than in obese women. CONCLUSIONS These findings suggest that associations of alcohol and tobacco use with PD result more from their associations with NDA than DA. IMPACT PD and NDA may mediate the association of alcohol drinking, but not tobacco smoking, with increased breast cancer risk. Further studies are needed to elucidate the modifiable lifestyle factors that influence breast tissue composition, and the important role of the fatty tissues on breast health.
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Affiliation(s)
- Russell B McBride
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kezhen Fei
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph H Rothstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Xiaoyu Song
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Valerie McGuire
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Rhea Y Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Jafi A Lipson
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Martin J Yaffe
- Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Daniel L Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Weiva Sieh
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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19
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Lindahl G, Rzepecka A, Dabrosin C. Increased Extracellular Osteopontin Levels in Normal Human Breast Tissue at High Risk of Developing Cancer and Its Association With Inflammatory Biomarkers in situ. Front Oncol 2019; 9:746. [PMID: 31475105 PMCID: PMC6707004 DOI: 10.3389/fonc.2019.00746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/25/2019] [Indexed: 01/13/2023] Open
Abstract
Mammographic breast density is a strong independent risk factor for breast cancer (BC), but the molecular mechanisms behind this risk is yet undetermined and prevention strategies for these women are lacking. The anti-estrogen tamoxifen may reduce the risk of BC but this treatment is associated with severe side effects. Thus, other means for BC prevention, such as diet interventions, need to be developed. Osteopontin (OPN) is a major mediator of inflammation which is key in carcinogenesis. OPN may be cleaved by proteases in the tissue and cleaved OPN may in turn induce an inflammatory cascade in the extracellular microenvironment. We aimed to determine if extracellular OPN was altered in BC and in normal breast tissue with different densities and if tamoxifen or a diet of flaxseed could modify OPN levels. The study comprised 103 women; 13 diagnosed with BC, 42 healthy post-menopausal women with different breast densities at their mammography screen, and 34 post-menopausal women who added 25 g of ground flaxseed/day or were treated with tamoxifen 20 mg/day and were investigated before and after 6 weeks of exposure. Additionally, 10 premenopausal women who added flaxseed for one menstrual cycle and four who were investigated in two unexposed consecutive luteal phases of the menstrual cycle. Microdialysis was used to sample extracellular proteins in vivo in breast tissue and proteins were quantified using a multiplex proximity extension assay. We found that, similar to BC, extracellular in vivo OPN levels were significantly increased in dense breast tissue. Additionally, significant correlations were found between OPN and chemokine (C-X-C motif) ligand (CXCL)-1, −8, −9, −10, and −11, interleukin-6, vascular endothelial growth factor, matrix metalloproteinase (MMP)-1, −2, −3, 7, and −12 and urokinase-type plasminogen activator whereas no correlations were found with MMP-9, chemokine (C-C motif) ligand (CCL)-2, and −5. Estradiol did not affect OPN levels in breast tissue. None of the interventions altered OPN levels. The pro-tumorigenic protein OPN may indeed be a molecular target for BC prevention in women with increased breast density but other means than tamoxifen or flaxseed i.e., more potent anti-inflammatory approaches, need to be evaluated for this purpose.
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Affiliation(s)
- Gabriel Lindahl
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna Rzepecka
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Radiology, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Charlotta Dabrosin
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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20
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A review of the influence of mammographic density on breast cancer clinical and pathological phenotype. Breast Cancer Res Treat 2019; 177:251-276. [PMID: 31177342 DOI: 10.1007/s10549-019-05300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE It is well established that high mammographic density (MD), when adjusted for age and body mass index, is one of the strongest known risk factors for breast cancer (BC), and also associates with higher incidence of interval cancers in screening due to the masking of early mammographic abnormalities. Increasing research is being undertaken to determine the underlying histological and biochemical determinants of MD and their consequences for BC pathogenesis, anticipating that improved mechanistic insights may lead to novel preventative or treatment interventions. At the same time, technological advances in digital and contrast mammography are such that the validity of well-established relationships needs to be re-examined in this context. METHODS With attention to old versus new technologies, we conducted a literature review to summarise the relationships between clinicopathologic features of BC and the density of the surrounding breast tissue on mammography, including the associations with BC biological features inclusive of subtype, and implications for the clinical disease course encompassing relapse, progression, treatment response and survival. RESULTS AND CONCLUSIONS There is reasonable evidence to support positive relationships between high MD (HMD) and tumour size, lymph node positivity and local relapse in the absence of radiotherapy, but not between HMD and LVI, regional relapse or distant metastasis. Conflicting data exist for associations of HMD with tumour location, grade, intrinsic subtype, receptor status, second primary incidence and survival, which need further confirmatory studies. We did not identify any relationships that did not hold up when data involving newer imaging techniques were employed in analysis.
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21
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Alexeeff SE, Odo NU, McBride R, McGuire V, Achacoso N, Rothstein JH, Lipson JA, Liang RY, Acton L, Yaffe MJ, Whittemore AS, Rubin DL, Sieh W, Habel LA. Reproductive Factors and Mammographic Density: Associations Among 24,840 Women and Comparison of Studies Using Digitized Film-Screen Mammography and Full-Field Digital Mammography. Am J Epidemiol 2019; 188:1144-1154. [PMID: 30865217 DOI: 10.1093/aje/kwz033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
Breast density is a modifiable factor that is strongly associated with breast cancer risk. We sought to understand the influence of newer technologies of full-field digital mammography (FFDM) on breast density research and to determine whether results are comparable across studies using FFDM and previous studies using traditional film-screen mammography. We studied 24,840 screening-age (40-74 years) non-Hispanic white women who were participants in the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California and underwent screening mammography with either Hologic (Hologic, Inc., Marlborough, Massachusetts) or General Electric (General Electric Company, Boston, Massachusetts) FFDM machines between 2003 and 2013. We estimated the associations of parity, age at first birth, age at menarche, and menopausal status with percent density and dense area as measured by a single radiological technologist using Cumulus software (Canto Software, Inc., San Francisco, California). We found that associations between reproductive factors and mammographic density measured using processed FFDM images were generally similar in magnitude and direction to those from prior studies using film mammography. Estimated associations for both types of FFDM machines were in the same direction. There was some evidence of heterogeneity in the magnitude of the effect sizes by machine type, which we accounted for using random-effects meta-analysis when combining results. Our findings demonstrate the robustness of quantitative mammographic density measurements across FFDM and film mammography platforms.
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Affiliation(s)
- Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Russell McBride
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, School of Medicine, Stanford University, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Joseph H Rothstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jafi A Lipson
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Rhea Y Liang
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Martin J Yaffe
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alice S Whittemore
- Department of Health Research and Policy, Division of Epidemiology, School of Medicine, Stanford University, Stanford, California
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
| | - Daniel L Rubin
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
| | - Weiva Sieh
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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22
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Gooch JC, Chun J, Kaplowitz E, Kurz E, Guth A, Lee J, Schnabel F. Breast Density in a Contemporary Cohort of Women With Ductal Carcinoma In Situ (DCIS). Ann Surg Oncol 2019; 26:3472-3477. [PMID: 31147991 DOI: 10.1245/s10434-019-07479-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mammographic breast density (MBD) is an independent risk factor for breast cancer. Information regarding the relationship of MBD and breast cancer biology in women with ductal carcinoma in situ (DCIS) is currently lacking. This study aimed to examine the clinicopathologic characteristics of DCIS in women stratified by MBD. METHODS A retrospective review was performed to identify women with pure DCIS who underwent preoperative mammography between 2010 and 2018. Clinicopathologic and demographic data were collected. For the purpose of analysis, MBD was categorized as "non-dense" (Breast Imaging-Reporting and Data System [BI-RADS] density categories A and B) or "dense" (BI-RADS C and D) according to its identification in radiology reports. RESULTS Of 3227 patients with a breast cancer diagnosis enrolled in the institutional Breast Cancer Database during the study period, 658 (20%) had pure DCIS. Of these 658 patients, 42% had non-dense breasts, and 58% had dense breasts. Most lesions were non-palpable (92%) and detected by mammography (84%). Patients with dense breasts were more likely to be younger at the time of diagnosis (p < 0.001), premenopausal (p < 0.001), and Asian (p = 0.018), and to have higher-grade disease (p = 0.006; Table 2). Family history, BRCA status, parity, mammogram frequency, palpability, method of presentation, lesion size, hormone receptor status, comedo histology, and recurrence did not differ significantly between the two groups (Table 1). The median follow-up period was 7.1 years. CONCLUSION Women with pure DCIS and higher MBD are more likely to be younger at the time of diagnosis, premenopausal, and Asian, and to present with higher-grade disease. Further research on the relationship of age, MBD, and tumor biology in DCIS is warranted.
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Affiliation(s)
- Jessica C Gooch
- Division of Breast Surgical Oncology, Department of Surgery, New York University Langone Health, New York, USA.,Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer Chun
- Division of Breast Surgical Oncology, Department of Surgery, New York University Langone Health, New York, USA
| | - Elianna Kaplowitz
- Division of Breast Surgical Oncology, Department of Surgery, New York University Langone Health, New York, USA
| | - Emma Kurz
- New York University School of Medicine, New York, USA
| | - Amber Guth
- Division of Breast Surgical Oncology, Department of Surgery, New York University Langone Health, New York, USA
| | - Jiyon Lee
- Department of Radiology, New York University Langone Health, New York, USA
| | - Freya Schnabel
- Division of Breast Surgical Oncology, Department of Surgery, New York University Langone Health, New York, USA.
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23
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Eriksson L, He W, Eriksson M, Humphreys K, Bergh J, Hall P, Czene K. Adjuvant Therapy and Mammographic Density Changes in Women With Breast Cancer. JNCI Cancer Spectr 2019; 2:pky071. [PMID: 31360886 PMCID: PMC6649795 DOI: 10.1093/jncics/pky071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/23/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Tamoxifen decreases mammographic density. Whether compliance affects this relationship is unclear as is the relationship between other types of adjuvant treatment and changes in mammographic density. Methods This prospective cohort study included 2490 women diagnosed with breast cancer during 2001-2015 in Sweden. Mammographic density was assessed within 3 months of diagnosis and 6-36 months post diagnosis. Logistic regression was performed to study the association between each respective adjuvant treatment and mammographic density reduction (annual dense area decrease >15%). Results Intention-to-treat analyses using treatment information from the regional cancer registries showed that tamoxifen-treated patients more frequently experienced mammographic density reductions compared with nontreated patients (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.25 to 1.99), as did chemotherapy-treated patients (OR = 1.28, 95% CI = 1.06 to 1.54). For chemotherapy, the association was mainly seen in premenopausal women. Neither aromatase inhibitors nor radiotherapy was associated with density change. Tamoxifen use based on prescription and dispensation data from the Swedish Prescribed Drug Register showed that users were more likely to have density reductions compared with nonusers (adjusted OR = 2.24, 95% CI = 1.40 to 3.59). Moreover, among tamoxifen users, tamoxifen continuers were more likely than discontinuers to experience density reductions (adjusted OR = 1.50, 95% CI = 1.04 to 2.17). Conclusions Our results indicate that adherence influences the association between tamoxifen and mammographic density reduction. We further found that chemotherapy was associated with density reductions and propose that this is largely secondary to chemotherapy-induced ovarian failure.
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Affiliation(s)
| | - Wei He
- Correspondence to: Wei He, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, Stockholm 171 77, Sweden (e-mail: )
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24
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Maskarinec G, Ju D, Fong J, Horio D, Chan O, Loo LWM, Hernandez BY. Mammographic density and breast tissue expression of inflammatory markers, growth factors, and vimentin. BMC Cancer 2018; 18:1191. [PMID: 30497427 PMCID: PMC6267911 DOI: 10.1186/s12885-018-5088-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 11/13/2018] [Indexed: 02/06/2023] Open
Abstract
Background Mammographic density is a known risk factor for breast cancer, but the underlying pathologic characteristics are not well understood. The current analysis investigated the expression of several markers of interest, e.g., inflammation and growth, with mammographic density (MD) in normal and malignant breast tissue specimens from 279 women of the Multiethnic Cohort (MEC). Methods Breast cancer cases, recruited from a nested case-control study within the MEC, provided mammograms for density evaluation. Protein expression (COX-2, TNF-α, TGF-β, IGF-1R, IGFBP-2, and vimentin) was assessed by immunohistochemical detection. Linear regression was applied to evaluate the relation between marker expression and percent density and to compute adjusted means with 95% confidence intervals (CI) by marker status while adjusting for confounders. Results Due to missing cores and tissue, normal tissue could only be evaluated for COX-2 and vimentin. No significant associations with mammographic density were detected for all markers analyzed. For inflammatory markers (TNF-α, COX-2, and TGF-β) in tumor tissue, MD were non-significantly higher with stronger expression but the differences were very small. For example, the mean MD values for no, weak, and strong TNF-α expression were 35% (95% CI 24–47%), 39% (95% CI 29–48%), and 38% (95% CI 27–50%). In a posthoc analysis among postmenopausal women only, the difference across categories of TNF-α expression increased to 25% (95% CI 12–39%), 35% (95% CI 23–48%), and 35% (95% CI 20–49%). Conclusions The current analysis offers little support for an involvement of immunohistochemical markers representing inflammatory and growth factor pathways as predictors of breast density. Electronic supplementary material The online version of this article (10.1186/s12885-018-5088-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gertraud Maskarinec
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA.
| | - Dan Ju
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Jaimie Fong
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - David Horio
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Owen Chan
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Lenora W M Loo
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brenda Y Hernandez
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
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25
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Huo CW, Hill P, Chew G, Neeson PJ, Halse H, Williams ED, Henderson MA, Thompson EW, Britt KL. High mammographic density in women is associated with protumor inflammation. Breast Cancer Res 2018; 20:92. [PMID: 30092832 PMCID: PMC6085707 DOI: 10.1186/s13058-018-1010-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/27/2018] [Indexed: 01/27/2023] Open
Abstract
Background Epidemiological studies have consistently shown that increased mammographic density (MD) is a strong risk factor for breast cancer. We previously observed an elevated number of vimentin+/CD45+ leukocytes in high MD (HMD) epithelium. In the present study, we aimed to investigate the subtypes of immune cell infiltrates in HMD and low MD (LMD) breast tissue. Methods Fifty-four women undergoing prophylactic mastectomy at Peter MacCallum Cancer Centre or St. Vincent’s Hospital were enrolled. Upon completion of mastectomy, HMD and LMD areas were resected under radiological guidance in collaboration with BreastScreen Victoria and were subsequently fixed, processed, and sectioned. Fifteen paired HMD and LMD specimens were further selected according to their fibroglandular characteristics (reasonable amount [> 20%] of tissue per block on H&E stains) for subsequent IHC analysis of immune cell infiltration. Results Overall, immune cell infiltrates were predominantly present in breast ducts and lobules rather than in the stroma, with CD68+ macrophages and CD20+ B lymphocytes also surrounding the vasculature. Macrophages, dendritic cells (DCs), B lymphocytes, and programmed cell death protein 1 (PD-1) expression were significantly increased in HMD epithelium compared with LMD. Moreover, significantly higher levels of DCs, CD4+ T cells, and PD-1 were also observed in HMD stroma than in LMD stroma. The increased expression of interleukin (IL)-6 and IL-4, with unaltered interferon-γ, indicate a proinflammatory microenvironment. Conclusions Our work indicates that the immune system may be activated very early in breast cancer development and may in part underpin the breast cancer risk associated with HMD. Electronic supplementary material The online version of this article (10.1186/s13058-018-1010-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia W Huo
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Prue Hill
- Department of Pathology, St Vincent's Hospital, Melbourne, Australia
| | - Grace Chew
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Paul J Neeson
- Pathology Department, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Elizabeth D Williams
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Michael A Henderson
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Erik W Thompson
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Kara L Britt
- Peter MacCallum Cancer Centre, Melbourne, Australia. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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26
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Deep learning in mammography and breast histology, an overview and future trends. Med Image Anal 2018; 47:45-67. [DOI: 10.1016/j.media.2018.03.006] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022]
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Chollet-Hinton L, Puvanesarajah S, Sandhu R, Kirk EL, Midkiff BR, Ghosh K, Brandt KR, Scott CG, Gierach GL, Sherman ME, Vachon CM, Troester MA. Stroma modifies relationships between risk factor exposure and age-related epithelial involution in benign breast. Mod Pathol 2018; 31:1085-1096. [PMID: 29463881 PMCID: PMC6076344 DOI: 10.1038/s41379-018-0033-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 12/01/2022]
Abstract
Delayed age-related lobular involution has been previously associated with elevated breast cancer risk. However, intraindividual variability in epithelial involution status within a woman is undefined. We developed a novel measure of age-related epithelial involution, density of epithelial nuclei in epithelial areas using digital image analysis in combination with stromal characteristics (percentage of section area comprising stroma). Approximately 1800 hematoxylin and eosin stained sections of benign breast tissue were evaluated from 416 participants having breast surgery for cancer or benign conditions. Two to sixteen slides per woman from different regions of the breast were studied. Epithelial involution status varied within a woman and as a function of stromal area. Percentage stromal area varied between samples from the same woman (median difference between highest and lowest stromal area within a woman was 7.5%, but ranged from 0.01 to 86.7%). Restricting to women with at least 10% stromal area (N = 317), epithelial nuclear density decreased with age (-637.1 cells/mm2 per decade of life after age 40, p < 0.0001), increased with mammographic density (457.8 cells/mm2 per increasing BI-RADs density category p = 0.002), and increased non-significantly with recent parity, later age at first pregnancy, and longer and more recent oral contraceptive use. These associations were attenuated in women with mostly fat samples (<10% stroma (N = 99)). Thirty-one percent of women evaluated had both adequate stroma (≥10%) and mostly fat (<10% stroma) regions of breast tissue, with the probability of having both types increasing with the number breast tissue samplings. Several breast cancer risk factors are associated with elevated age-related epithelial content, but associations depend upon stromal context. Stromal characteristics appear to modify relationships between risk factor exposures and breast epithelial involution.
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Affiliation(s)
| | | | - Rupninder Sandhu
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Erin L. Kirk
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
| | - Bentley R. Midkiff
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Karthik Ghosh
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Christopher G. Scott
- Division of Biostatistics, Department of Health Sciences, Mayo Clinic College of Medicine, Rochester, MN
| | - Gretchen L. Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Mark E. Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Celine M. Vachon
- Division of Epidemiology, Department of Health Sciences, Mayo Clinic College of Medicine, Rochester, MN
| | - Melissa A. Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC,Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
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Partain N, Mokdad A, Puzziferri N, Porembka J, Seiler S, Christie A, Farr D, Rivers A, Marilyn Leitch A, Wooldridge R, Huth J, Rao R. Mammographic density changes in surgical weight loss-an indication for personalized screening. BMC Med Imaging 2018; 18:10. [PMID: 29743035 PMCID: PMC5941592 DOI: 10.1186/s12880-017-0242-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/15/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Obesity and high radiologic breast density independently increase breast cancer risk. We evaluated the effect of surgical weight loss on mammographic density (MD). METHODS Patients undergoing bariatric surgery and screening mammography (MG) were identified, data regarding demographics, comorbidities, calculated and genetic breast cancer risk was collected. Patients had a MG before and after surgery. Fellowship-trained breast radiologists assigned Breast Imaging Reporting and Data System density categories. RESULTS Patients underwent sleeve gastrectomy (n = 56) or gastric bypass (n = 7), 78% had hypertension, 48% had diabetes. Four had deleterious BRCA mutations, four were calculated high risk. Mean weight loss = 28.7 kg. Mean initial BMI = 44.3 kg/m2 (range:33-77), final BMI = 33.6 kg/m2 (range:20-62;p < 0.01). Density was unchanged in 53, decreased in 1, increased in 9. Of these 9(14%), 5 changed from almost entirely fatty to scattered MD, and 4 changed from scattered MD to heterogeneously dense. Mean weight loss of the 9 with increased MD was greater than the cohort (37.7vs.28.7 kg;p < 0.01). CONCLUSIONS Surgical weight loss increased MD in 14%. Increased MD masks malignancies, patients may benefit from additional screening based on calculated risk assessments that include MD.
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Affiliation(s)
- Natalia Partain
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Ali Mokdad
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Nancy Puzziferri
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Jessica Porembka
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Stephen Seiler
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Alana Christie
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Deborah Farr
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Aeisha Rivers
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - A Marilyn Leitch
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Rachel Wooldridge
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - James Huth
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Roshni Rao
- Division of Breast Surgery, Columbia University Medical Center/New York Presbyterian, 161 Fort Washington Ave 10th floor, New York, NY, 10032, USA.
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Boyd N, Berman H, Zhu J, Martin LJ, Yaffe MJ, Chavez S, Stanisz G, Hislop G, Chiarelli AM, Minkin S, Paterson AD. The origins of breast cancer associated with mammographic density: a testable biological hypothesis. Breast Cancer Res 2018. [PMID: 29514672 PMCID: PMC5842598 DOI: 10.1186/s13058-018-0941-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Our purpose is to develop a testable biological hypothesis to explain the known increased risk of breast cancer associated with extensive percent mammographic density (PMD), and to reconcile the apparent paradox that although PMD decreases with increasing age, breast cancer incidence increases. Methods We used the Moolgavkar model of carcinogenesis as a framework to examine the known biological properties of the breast tissue components associated with PMD that includes epithelium and stroma, in relation to the development of breast cancer. In this model, normal epithelial cells undergo a mutation to become intermediate cells, which, after further mutation, become malignant cells. A clone of such cells grows to become a tumor. The model also incorporates changes with age in the number of susceptible epithelial cells associated with menarche, parity, and menopause. We used measurements of the radiological properties of breast tissue in 4454 healthy subjects aged from 15 to 80+ years to estimate cumulative exposure to PMD (CBD) in the population, and we examined the association of CBD with the age-incidence curve of breast cancer in the population. Results Extensive PMD is associated with a greater number of breast epithelial cells, lobules, and fibroblasts, and greater amounts of collagen and extracellular matrix. The known biological properties of these tissue components may, singly or in combination, promote the acquisition of mutations by breast epithelial cells specified by the Moolgavkar model, and the subsequent growth of a clone of malignant cells to form a tumor. We also show that estimated CBD in the population from ages 15 to 80+ years is closely associated with the age-incidence curve of breast cancer in the population. Conclusions These findings are consistent with the hypothesis that the biological properties of the breast tissue components associated with PMD increase the probability of the transition of normal epithelium to malignant cells, and that the accumulation of mutations with CBD may influence the age-incidence curve of breast cancer. This hypothesis gives rise to several testable predictions. Electronic supplementary material The online version of this article (10.1186/s13058-018-0941-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Norman Boyd
- Princess Margaret Cancer Centre, 610 University Avenue, Room 9-502, Toronto, ON, M5G 2M9, Canada.
| | - Hal Berman
- Princess Margaret Cancer Centre, 610 University Avenue, Room 9-502, Toronto, ON, M5G 2M9, Canada
| | - Jie Zhu
- Princess Margaret Cancer Centre, 610 University Avenue, Room 9-502, Toronto, ON, M5G 2M9, Canada
| | - Lisa J Martin
- Princess Margaret Cancer Centre, 610 University Avenue, Room 9-502, Toronto, ON, M5G 2M9, Canada
| | - Martin J Yaffe
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sofia Chavez
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Greg Stanisz
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Salomon Minkin
- Princess Margaret Cancer Centre, 610 University Avenue, Room 9-502, Toronto, ON, M5G 2M9, Canada
| | - Andrew D Paterson
- Genetics and Genome Biology, Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Moshina N, Sebuødegård S, Holen ÅS, Waade GG, Tsuruda K, Hofvind S. The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program. Prev Med 2018; 108:129-136. [PMID: 29337068 DOI: 10.1016/j.ypmed.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/15/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
Adherence to screening may indirectly help assess whether a prior screening examination deters women from returning for a subsequent examination. We investigated whether compression force and pressure in mammography were associated with re-attendance among prevalently screened women in the organized breast cancer screening program in Norway. Data on compression force (kg) and pressure (kPa) from women's first screening examination in the program (prevalent screening) and subsequent re-attendance were available for 31,225 women aged 50-68, screened during 2007-2013. Crude re-attendance rates and log-binomial regression models estimating the prevalence ratio of re-attendance were used to identify the association between compression force or pressure and re-attendance two-years later. Age and year at prevalent screening, county of residence, screening result (negative or false positive), breast volume, and breast density were included in analyses. Overall, 27,197 (87.1%) women re-attended the program. Re-attendance was highest for women who received a compression force of 10.0-13.9 kg (87.5%) or pressure of 9.0-17.9 kPa (87.8%) and lowest for those who received a compression force of <10.0 kg (85.0%) or pressure of <9.0 kPa (84.7%). The adjusted prevalence of re-attendance was 3% lower for women who received low compression force (<10.0 kg) and 2% lower for women who received low compression pressure (<9.0 kPa) relative to the reference groups (10.0-13.9 kg and 9.0-17.9 kPa, respectively). Future research related to re-attendance should also include information about women's experience of pain, anxiety and stress, as well as image quality.
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Affiliation(s)
- Nataliia Moshina
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Sofie Sebuødegård
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Åsne S Holen
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Gunvor G Waade
- Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs plass, 0130 Oslo, Norway.
| | - Kaitlyn Tsuruda
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway.
| | - Solveig Hofvind
- Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304 Oslo, Norway; Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs plass, 0130 Oslo, Norway.
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Byström S, Eklund M, Hong MG, Fredolini C, Eriksson M, Czene K, Hall P, Schwenk JM, Gabrielson M. Affinity proteomic profiling of plasma for proteins associated to area-based mammographic breast density. Breast Cancer Res 2018; 20:14. [PMID: 29444691 PMCID: PMC5813412 DOI: 10.1186/s13058-018-0940-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/29/2018] [Indexed: 02/08/2023] Open
Abstract
Background Mammographic breast density is one of the strongest risk factors for breast cancer, but molecular understanding of how breast density relates to cancer risk is less complete. Studies of proteins in blood plasma, possibly associated with mammographic density, are well-suited as these allow large-scale analyses and might shed light on the association between breast cancer and breast density. Methods Plasma samples from 1329 women in the Swedish KARMA project, without prior history of breast cancer, were profiled with antibody suspension bead array (SBA) assays. Two sample sets comprising 729 and 600 women were screened by two different SBAs targeting a total number of 357 proteins. Protein targets were selected through searching the literature, for either being related to breast cancer or for being linked to the extracellular matrix. Association between proteins and absolute area-based breast density (AD) was assessed by quantile regression, adjusting for age and body mass index (BMI). Results Plasma profiling revealed linear association between 20 proteins and AD, concordant in the two sets of samples (p < 0.05). Plasma levels of seven proteins were positively associated and 13 proteins negatively associated with AD. For eleven of these proteins evidence for gene expression in breast tissue existed. Among these, ABCC11, TNFRSF10D, F11R and ERRF were positively associated with AD, and SHC1, CFLAR, ACOX2, ITGB6, RASSF1, FANCD2 and IRX5 were negatively associated with AD. Conclusions Screening proteins in plasma indicates associations between breast density and processes of tissue homeostasis, DNA repair, cancer development and/or progression in breast cancer. Further validation and follow-up studies of the shortlisted protein candidates in independent cohorts will be needed to infer their role in breast density and its progression in premenopausal and postmenopausal women. Electronic supplementary material The online version of this article (10.1186/s13058-018-0940-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sanna Byström
- Science for Life Laboratory, School of Biotechnology, KTH - Royal Institute of Technology, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, -171 77, Stockholm, SE, Sweden
| | - Mun-Gwan Hong
- Science for Life Laboratory, School of Biotechnology, KTH - Royal Institute of Technology, Stockholm, Sweden
| | - Claudia Fredolini
- Science for Life Laboratory, School of Biotechnology, KTH - Royal Institute of Technology, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, -171 77, Stockholm, SE, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, -171 77, Stockholm, SE, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, -171 77, Stockholm, SE, Sweden.,Department of Oncology, South General Hospital, Stockholm, Sweden
| | - Jochen M Schwenk
- Science for Life Laboratory, School of Biotechnology, KTH - Royal Institute of Technology, Stockholm, Sweden
| | - Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, -171 77, Stockholm, SE, Sweden.
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Pinkert MA, Salkowski LR, Keely PJ, Hall TJ, Block WF, Eliceiri KW. Review of quantitative multiscale imaging of breast cancer. J Med Imaging (Bellingham) 2018; 5:010901. [PMID: 29392158 PMCID: PMC5777512 DOI: 10.1117/1.jmi.5.1.010901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022] Open
Abstract
Breast cancer is the most common cancer among women worldwide and ranks second in terms of overall cancer deaths. One of the difficulties associated with treating breast cancer is that it is a heterogeneous disease with variations in benign and pathologic tissue composition, which contributes to disease development, progression, and treatment response. Many of these phenotypes are uncharacterized and their presence is difficult to detect, in part due to the sparsity of methods to correlate information between the cellular microscale and the whole-breast macroscale. Quantitative multiscale imaging of the breast is an emerging field concerned with the development of imaging technology that can characterize anatomic, functional, and molecular information across different resolutions and fields of view. It involves a diverse collection of imaging modalities, which touch large sections of the breast imaging research community. Prospective studies have shown promising results, but there are several challenges, ranging from basic physics and engineering to data processing and quantification, that must be met to bring the field to maturity. This paper presents some of the challenges that investigators face, reviews currently used multiscale imaging methods for preclinical imaging, and discusses the potential of these methods for clinical breast imaging.
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Affiliation(s)
- Michael A. Pinkert
- Morgridge Institute for Research, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Laboratory for Optical and Computational Instrumentation, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
| | - Lonie R. Salkowski
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Radiology, Madison, Wisconsin, United States
| | - Patricia J. Keely
- University of Wisconsin–Madison, Department of Cell and Regenerative Biology, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Biomedical Engineering, Madison, Wisconsin, United States
| | - Timothy J. Hall
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Biomedical Engineering, Madison, Wisconsin, United States
| | - Walter F. Block
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Radiology, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Biomedical Engineering, Madison, Wisconsin, United States
| | - Kevin W. Eliceiri
- Morgridge Institute for Research, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Laboratory for Optical and Computational Instrumentation, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
- University of Wisconsin–Madison, Department of Biomedical Engineering, Madison, Wisconsin, United States
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33
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Vinnicombe SJ. Breast density: why all the fuss? Clin Radiol 2017; 73:334-357. [PMID: 29273225 DOI: 10.1016/j.crad.2017.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/17/2017] [Indexed: 01/06/2023]
Abstract
The term "breast density" or mammographic density (MD) denotes those components of breast parenchyma visualised at mammography that are denser than adipose tissue. MD is composed of a mixture of epithelial and stromal components, notably collagen, in variable proportions. MD is most commonly assessed in clinical practice with the time-honoured method of visual estimation of area-based percent density (PMD) on a mammogram, with categorisation into quartiles. The computerised semi-automated thresholding method, Cumulus, also yielding area-based percent density, is widely used for research purposes; however, the advent of fully automated volumetric methods developed as a consequence of the widespread use of digital mammography (DM) and yielding both absolute and percent dense volumes, has resulted in an explosion of interest in MD recently. Broadly, the importance of MD is twofold: firstly, the presence of marked MD significantly reduces mammographic sensitivity for breast cancer, even with state-of-the-art DM. Recognition of this led to the formation of a powerful lobby group ('Are You Dense') in the US, as a consequence of which 32 states have legislated for mandatory disclosure of MD to women undergoing mammography. Secondly, it is now widely accepted that MD is in itself a risk factor for breast cancer, with a four-to sixfold increased relative risk in women with PMD in the highest quintile compared to those with PMD in the lowest quintile. Consequently, major research efforts are underway to assess whether use of MD could provide a major step forward towards risk-adapted, personalised breast cancer prevention, imaging, and treatment.
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Affiliation(s)
- S J Vinnicombe
- Cancer Research, School of Medicine, Level 7, Mailbox 4, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
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Association between mammographic breast density and histologic features of benign breast disease. Breast Cancer Res 2017; 19:134. [PMID: 29258587 PMCID: PMC5735506 DOI: 10.1186/s13058-017-0922-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/15/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Over 40% of women undergoing breast screening have mammographically dense breasts. Elevated mammographic breast density (MBD) is an established breast cancer risk factor and is known to mask tumors within the dense tissue. However, the association of MBD with high risk benign breast disease (BBD) is unknown. METHOD We analyzed data for 3400 women diagnosed with pathologically confirmed BBD in the Mayo Clinic BBD cohort from 1985-2001, with a clinical MBD measure (either parenchymal pattern (PP) or Breast Imaging Reporting and Data Systems (BI-RADS) density) and expert pathology review. Risk factor information was collected from medical records and questionnaires. MBD was dichotomized as dense (PP classification P2 or DY, or BI-RADS classification c or d) or non-dense (PP classification N1 or P1, or BI-RADS classification a or b). Associations of clinical and histologic characteristics with MBD were examined using logistic regression analysis to estimate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Of 3400 women in the study, 2163 (64%) had dense breasts. Adjusting for age and body mass index (BMI), there were positive associations of dense breasts with use of hormone therapy (HT), lack of lobular involution, presence of atypical lobular hyperplasia (ALH), histologic fibrosis, columnar cell hyperplasia/flat epithelia atypia (CCH/FEA), sclerosing adenosis (SA), cyst, usual ductal hyperplasia, and calcifications. In fully adjusted multivariate models, HT (1.3, 95% CI 1.1-1.5), ALH (1.5, 95% CI 1.0-2.2), lack of lobular involution (OR 1.6, 95% CI 1.2-2.1, compared to complete involution), fibrosis (OR 2.2, 95% CI 1.9-2.6) and CCH/FEA (OR 1.3, 95% CI 1.0-1.6) remained significantly associated with high MBD. CONCLUSION Our findings support an association between high risk BBD and high MBD, suggesting that risks associated with the latter may act early in breast carcinogenesis.
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Yaghjyan L, Stoll E, Ghosh K, Scott CG, Jensen MR, Brandt KR, Visscher D, Vachon CM. Tissue-based associations of mammographic breast density with breast stem cell markers. Breast Cancer Res 2017; 19:100. [PMID: 28851411 PMCID: PMC5576318 DOI: 10.1186/s13058-017-0889-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/04/2017] [Indexed: 12/15/2022] Open
Abstract
Background Mammographic breast density is a well-established, strong breast cancer risk factor but the biology underlying this association remains unclear. Breast density may reflect underlying alterations in the size and activity of the breast stem cell pool. We examined, for the first time, associations of CD44, CD24, and aldehyde dehydrogenase family 1 member A1 (ALDH1A1) breast stem cell markers with breast density. Methods We included in this study 64 asymptomatic healthy women who previously volunteered for a unique biopsy study of normal breast tissue at the Mayo Clinic (2006-2008). Mammographically identified dense and non-dense areas were confirmed/localized by ultrasound and biopsied. Immunohistochemical analysis of the markers was performed according to a standard protocol and the staining was assessed by a single blinded pathologist. In core biopsy samples retrieved from areas of high vs. low density within the same woman, we compared staining extent and an expression score (the product of staining intensity and extent), using the signed rank test. All tests of statistical significance were two-sided. Results A total of 64, 28, and 10 women were available for CD44, CD24, and ALDH1A1 staining, respectively. For all three markers, we found higher levels of staining extent in dense as compared to non-dense tissue, though for CD24 and ALDH1A1 the difference did not reach statistical significance (CD44, 6.3% vs. 2.0%, p < 0.001; CD24, 8.0% vs. 5.6%, p = 0.10; and ALDH1A1, 0.5% vs. 0.3%, p = 0.12). The expression score for CD44 was significantly greater in dense as compared to non-dense tissue (9.8 vs.3.0, p < 0.001). Conclusions Our findings suggest an increased presence and/or activity of stem cells in dense as compared to non-dense breast tissue. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0889-3) contains supplementary material, which is available to authorized users.
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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 Rd, Gainesville, FL, 32610, USA.
| | - Ethan Stoll
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Karthik Ghosh
- Division of General Internal Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, 55902, USA
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - Matthew R Jensen
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - Kathleen R Brandt
- Department of Radiology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel Visscher
- Department of Anatomic Pathology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - Celine M Vachon
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
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Alexeeff SE, Odo NU, Lipson JA, Achacoso N, Rothstein JH, Yaffe MJ, Liang RY, Acton L, McGuire V, Whittemore AS, Rubin DL, Sieh W, Habel LA. Age at Menarche and Late Adolescent Adiposity Associated with Mammographic Density on Processed Digital Mammograms in 24,840 Women. Cancer Epidemiol Biomarkers Prev 2017; 26:1450-1458. [PMID: 28698185 DOI: 10.1158/1055-9965.epi-17-0264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/15/2017] [Accepted: 06/28/2017] [Indexed: 12/21/2022] Open
Abstract
Background: High mammographic density is strongly associated with increased breast cancer risk. Some, but not all, risk factors for breast cancer are also associated with higher mammographic density.Methods: The study cohort (N = 24,840) was drawn from the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California and included non-Hispanic white females ages 40 to 74 years with a full-field digital mammogram (FFDM). Percent density (PD) and dense area (DA) were measured by a radiological technologist using Cumulus. The association of age at menarche and late adolescent body mass index (BMI) with PD and DA were modeled using linear regression adjusted for confounders.Results: Age at menarche and late adolescent BMI were negatively correlated. Age at menarche was positively associated with PD (P value for trend <0.0001) and DA (P value for trend <0.0001) in fully adjusted models. Compared with the reference category of ages 12 to 13 years at menarche, menarche at age >16 years was associated with an increase in PD of 1.47% (95% CI, 0.69-2.25) and an increase in DA of 1.59 cm2 (95% CI, 0.48-2.70). Late adolescent BMI was inversely associated with PD (P < 0.0001) and DA (P < 0.0001) in fully adjusted models.Conclusions: Age at menarche and late adolescent BMI are both associated with Cumulus measures of mammographic density on processed FFDM images.Impact: Age at menarche and late adolescent BMI may act through different pathways. The long-term effects of age at menarche on cancer risk may be mediated through factors besides mammographic density. Cancer Epidemiol Biomarkers Prev; 26(9); 1450-8. ©2017 AACR.
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Affiliation(s)
- Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Nnaemeka U Odo
- Data Mining & Analytics, Encounter Information Operations, Kaiser Permanente Northern California, Oakland, California.,Optum360, United Health Group, Las Vegas, Nevada
| | - Jafi A Lipson
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Joseph H Rothstein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Rhea Y Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Daniel L Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Weiva Sieh
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, California
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Impact of Different Analytic Approaches on the Analysis of the Breast Fibroglandular Tissue Using Diffusion Weighted Imaging. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1094354. [PMID: 28349054 PMCID: PMC5352872 DOI: 10.1155/2017/1094354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/15/2017] [Indexed: 12/27/2022]
Abstract
Purpose. This study investigated the impact of the different region of interest (ROI) approaches on measurement of apparent diffusion coefficient (ADC) values in the breast firbroglandular tissue (FT). Methods. Breast MR images of 38 women diagnosed with unilateral breast cancer were studied. Percent density (PD) and ADC were measured from the contralateral normal breast. Four different ROIs were used for ADC measurement. The measured PD and ADC were correlated. Results. Among the four ROIs, the manually placed small ROI on FT gave the highest mean ADC (ADC = 1839 ± 343 [×10−6 mm2/s]), while measurement from the whole breast gave the lowest mean ADC (ADC = 933 ± 383 [×10−6 mm2/s]). The ADC measured from the whole breast was highly correlated with PD with r = 0.95. In slice-to-slice comparison, the central slices with more FT had higher ADC values than the peripheral slices did, presumably due to less partial volume effect from fat. Conclusions. Our results indicated that the measured ADC heavily depends on the composition of breast tissue contained in the ROI used for the ADC measurements. Women with low breast density showing lower ADC values were most likely due to the partial volume effect of fatty tissues.
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Sun X, Glynn DJ, Hodson LJ, Huo C, Britt K, Thompson EW, Woolford L, Evdokiou A, Pollard JW, Robertson SA, Ingman WV. CCL2-driven inflammation increases mammary gland stromal density and cancer susceptibility in a transgenic mouse model. Breast Cancer Res 2017; 19:4. [PMID: 28077158 PMCID: PMC5225654 DOI: 10.1186/s13058-016-0796-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 12/07/2016] [Indexed: 12/16/2022] Open
Abstract
Background Macrophages play diverse roles in mammary gland development and breast cancer. CC-chemokine ligand 2 (CCL2) is an inflammatory cytokine that recruits macrophages to sites of injury. Although CCL2 has been detected in human and mouse mammary epithelium, its role in regulating mammary gland development and cancer risk has not been explored. Methods Transgenic mice were generated wherein CCL2 is driven by the mammary epithelial cell-specific mouse mammary tumour virus 206 (MMTV) promoter. Estrous cycles were tracked in adult transgenic and non-transgenic FVB mice, and mammary glands collected at the four different stages of the cycle. Dissected mammary glands were assessed for cyclical morphological changes, proliferation and apoptosis of epithelium, macrophage abundance and collagen deposition, and mRNA encoding matrix remodelling enzymes. Another cohort of control and transgenic mice received carcinogen 7,12-Dimethylbenz(a)anthracene (DMBA) and tumour development was monitored weekly. CCL2 protein was also quantified in paired samples of human breast tissue with high and low mammographic density. Results Overexpression of CCL2 in the mammary epithelium resulted in an increased number of macrophages, increased density of stroma and collagen and elevated mRNA encoding matrix remodelling enzymes lysyl oxidase (LOX) and tissue inhibitor of matrix metalloproteinases (TIMP)3 compared to non-transgenic controls. Transgenic mice also exhibited increased susceptibility to development of DMBA-induced mammary tumours. In a paired sample cohort of human breast tissue, abundance of epithelial-cell-associated CCL2 was higher in breast tissue of high mammographic density compared to tissue of low mammographic density. Conclusions Constitutive expression of CCL2 by the mouse mammary epithelium induces a state of low level chronic inflammation that increases stromal density and elevates cancer risk. We propose that CCL2-driven inflammation contributes to the increased risk of breast cancer observed in women with high mammographic density.
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Affiliation(s)
- Xuan Sun
- Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, Adelaide, Australia.,The Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Danielle J Glynn
- Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, Adelaide, Australia.,The Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, DX465702, 28 Woodville Rd, Woodville, 5011, Australia
| | - Leigh J Hodson
- The Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, DX465702, 28 Woodville Rd, Woodville, 5011, Australia
| | - Cecilia Huo
- The University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Kara Britt
- Metastasis Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Erik W Thompson
- The University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology and Translational Research Institute, Queensland, Australia
| | - Lucy Woolford
- School of Veterinary Sciences, University of Adelaide, Roseworthy, SA, Australia
| | - Andreas Evdokiou
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, DX465702, 28 Woodville Rd, Woodville, 5011, Australia
| | - Jeffrey W Pollard
- MRC and University of Edinburgh Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah A Robertson
- Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, Adelaide, Australia.,The Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Wendy V Ingman
- The Robinson Research Institute, University of Adelaide, Adelaide, Australia. .,Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, DX465702, 28 Woodville Rd, Woodville, 5011, Australia.
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Maskarinec G, Ju D, Horio D, Loo LWM, Hernandez BY. Involution of breast tissue and mammographic density. Breast Cancer Res 2016; 18:128. [PMID: 27978856 PMCID: PMC5159985 DOI: 10.1186/s13058-016-0792-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/02/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mammographic density decreases and involution of breast tissue increases with age; both are thought to be risk factors for breast cancer. The current study investigated the relationship between involution or hormone treatment (HT) and breast density among multiethnic patients with breast cancer in Hawaii. METHODS Patients with breast cancer cases were recruited from a nested case-control study within the Multiethnic Cohort. HT use was self-reported at cohort entry and at the time of the density study. Mammographic density and involution in adjacent non-tumor breast tissue were assessed using established methods. Linear regression was applied to evaluate the correlation between involution and four density measures and to compute adjusted means by involution status while adjusting for confounders. RESULTS In the 173 patients with breast cancer, mean percent breast density was 41.2% in mammograms taken approximately 1 year before diagnosis. The respective proportions of women with no, partial, and complete involution were 18.5, 51.4, and 30.1%, respectively and the adjusted density values for these categories were 32.5, 39.2, and 40.2% (p = 0.15). In contrast, the size of the dense area was significantly associated with involution (p = 0.001); the values ranged from 29.7 cm2 for no involution to 48.0 cm2 for complete involution. The size of the total breast area but not of the non-dense areas was also larger with progressive involution. Percent density and dense area were significantly higher in women with combined HT use. CONCLUSIONS Contrary to previous reports, greater lobular involution was not related to lower mammographic density but to higher dense area. Possibly, percent density during the involution process depends on the timing of mammographic density assessment, as epithelial tissue is first replaced with radiographically dense stromal tissue and only later with fat.
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Affiliation(s)
- Gertraud Maskarinec
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA.
| | - Dan Ju
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - David Horio
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Lenora W M Loo
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brenda Y Hernandez
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
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Hou XY, Niu HY, Huang XL, Gao Y. Correlation of Breast Ultrasound Classifications with Breast Cancer in Chinese Women. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2616-2621. [PMID: 27554070 DOI: 10.1016/j.ultrasmedbio.2016.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/17/2016] [Accepted: 07/09/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to identify potential links between ultrasonographic breast parenchymal patterns and the risk of breast cancer in Chinese women. The population of Chinese women at high risk for breast cancer was explored using the ultrasonographic classification. Ultrasonographic parenchymal patterns were classified into four types: heterogeneous type, ductal type, mixed type and fibrous type. A total of 5879 Chinese women underwent breast ultrasound examination from May 2010 to April 2014. Of the 5879 women, 256 women had pathology-confirmed breast cancer. Among the remaining 5623 women, 512 randomly selected, age-matched women were recruited into the present study. The correlation between ultrasonographic type and breast cancer revealed that the odds ratio (OR) was highest for the heterogeneous type (odds ratio = 4.11, 95% confidence interval: 2.01-8.41, p < 0.001), followed by the fibrous type (odds ratio = 2.05, 95% confidence interval: 1.51-2.78, p < 0.001). The odds ratios of the ductal and mixed types were both less than 1 (p < 0.05). This study indicates that the heterogeneous and fibrous types in the ultrasonographic classification are associated with an increased risk of breast cancer and, therefore, can be used as a marker of breast cancer risk in the female population of China.
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Affiliation(s)
- Xin-Yan Hou
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China.
| | - Hai-Yan Niu
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China
| | - Xiao-Ling Huang
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China
| | - Yu Gao
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China
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41
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Abrahamsson A, Rzepecka A, Romu T, Borga M, Leinhard OD, Lundberg P, Kihlberg J, Dabrosin C. Dense breast tissue in postmenopausal women is associated with a pro-inflammatory microenvironment in vivo. Oncoimmunology 2016; 5:e1229723. [PMID: 27853653 PMCID: PMC5087296 DOI: 10.1080/2162402x.2016.1229723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 12/26/2022] Open
Abstract
Inflammation is one of the hallmarks of carcinogenesis. High mammographic density has been associated with increased risk of breast cancer but the mechanisms behind are poorly understood. We evaluated whether breasts with different mammographic densities exhibited differences in the inflammatory microenvironment. Postmenopausal women attending the mammography-screening program were assessed having extreme dense, n = 20, or entirely fatty breasts (nondense), n = 19, on their regular mammograms. Thereafter, the women were invited for magnetic resonance imaging (MRI), microdialysis for the collection of extracellular molecules in situ and a core tissue biopsy for research purposes. On the MRI, lean tissue fraction (LTF) was calculated for a continuous measurement of breast density. LTF confirmed the selection from the mammograms and gave a continuous measurement of breast density. Microdialysis revealed significantly increased extracellular in vivo levels of IL-6, IL-8, vascular endothelial growth factor, and CCL5 in dense breast tissue as compared with nondense breasts. Moreover, the ratio IL-1Ra/IL-1β was decreased in dense breasts. No differences were found in levels of IL-1β, IL-1Ra, CCL2, leptin, adiponectin, or leptin:adiponectin ratio between the two breast tissue types. Significant positive correlations between LTF and the pro-inflammatory cytokines as well as between the cytokines were detected. Stainings of the core biopsies exhibited increased levels of immune cells in dense breast tissue. Our data show that dense breast tissue in postmenopausal women is associated with a pro-inflammatory microenvironment and, if confirmed in a larger cohort, suggests novel targets for prevention therapies for women with dense breast tissue.
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Affiliation(s)
- Annelie Abrahamsson
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna Rzepecka
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Thobias Romu
- Department of Biomedical Engineering and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Magnus Borga
- Department of Biomedical Engineering and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Department of Medical and Health Sciences, and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Department of Medical and Health Sciences, and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Johan Kihlberg
- Department of Radiology and Department of Medical and Health Sciences and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Charlotta Dabrosin
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Bowles D, Quinton A. The Use of Ultrasound in Breast Cancer Screening of Asymptomatic Women with Dense Breast Tissue: A Narrative Review. J Med Imaging Radiat Sci 2016; 47:S21-S28. [PMID: 31047483 DOI: 10.1016/j.jmir.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Mammography is the standard screening modality for breast cancer; however, sensitivity reduces with increasing breast density, resulting in the potential for masking of cancer. Ultrasound is a potential supplemental screening tool, but its routine use is controversial. METHODS A database search was performed with keywords "ultrasound" and "breast density and screening", including variations. Articles were included if they assessed the use of hand-held ultrasound as a supplemental screening modality in women with dense breasts. DISCUSSION Twelve articles were identified. No high-level evidence articles were identified. Cancer detection rates increased with the addition of ultrasound-to-mammography screening protocols. However, this was associated with increased costs per cancer detected, an increased biopsy rate, and a low positive predictive value. The survival benefit, cost versus benefit, and psychological impact of the addition of ultrasound is unknown. CONCLUSIONS The addition of ultrasound to a screening program in an asymptomatic population of women with dense breast tissue detects additional cancers compared with mammography alone. Knowledge regarding a survival or cost benefit associated with increased cancer detection, and the psychological impact of the addition of ultrasound is unknown. Further research is needed to assess whether the addition of ultrasound is cost-effective with respect to clinical outcome and survival.
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Affiliation(s)
- Danielle Bowles
- Medical Sonography, School of Medical and Applied Science, CQ University, Brisbane, Queensland, Australia.
| | - Ann Quinton
- School of Medical and Applied Sciences, Sydney Campus, CQUniversity, Sydney, New South Wales, Australia
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Gabrielson M, Chiesa F, Paulsson J, Strell C, Behmer C, Rönnow K, Czene K, Östman A, Hall P. Amount of stroma is associated with mammographic density and stromal expression of oestrogen receptor in normal breast tissues. Breast Cancer Res Treat 2016; 158:253-61. [PMID: 27349429 DOI: 10.1007/s10549-016-3877-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/18/2016] [Indexed: 02/07/2023]
Abstract
Following female sex and age, mammographic density is considered one of the strongest risk factors for breast cancer. Despite the association between mammographic density and breast cancer risk, little is known about the underlying histology and biological basis of breast density. To better understand the mechanisms behind mammographic density we assessed morphology, proliferation and hormone receptor status in relation to mammographic density in breast tissues from healthy women. Tissues were obtained from 2012-2013 by ultrasound-guided core needle biopsy from 160 women as part of the Karma (Karolinska mammography project for risk prediction for breast cancer) project. Mammograms were collected through routine mammography screening and mammographic density was calculated using STRATUS. The histological composition, epithelial and stromal proliferation status and hormone receptor status were assessed through immunohistochemical staining. Higher mammographic density was significantly associated with a greater proportion of stromal and epithelial tissue and a lower proportion of adipose tissue. Epithelial expression levels of Ki-67, oestrogen receptor (ER) and progesterone receptor (PR) were not associated with mammographic density. Epithelial Ki-67 was associated with a greater proportion of epithelial tissue, and epithelial PR was associated with a greater proportion of stromal and a lower proportion of adipose tissue. Epithelial ER was not associated with any tissues. In contrast, expression of ER in the stroma was significantly associated with a greater proportion of stroma, and negatively associated with the amount of adipose tissue. High mammographic density is associated with higher amount of stroma and epithelium and less amount of fat, but is not associated with a change in epithelial proliferation or receptor status. Increased expressions of both epithelial PR and stromal ER are associated with a greater proportion of stroma, suggesting hormonal involvement in regulating breast tissue composition.
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Affiliation(s)
- Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77, Stockholm, Sweden.
| | - Flaminia Chiesa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77, Stockholm, Sweden
| | - Janna Paulsson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Z1:00, 171 76, Stockholm, Sweden
| | - Carina Strell
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Z1:00, 171 76, Stockholm, Sweden
| | - Catharina Behmer
- Department of Mammography, Unilabs, Jan Waldenströms gata 22, 205 02, Malmö, Sweden
| | - Katarina Rönnow
- Department of Mammography, Unilabs, Hospital of Helsingborg, 251 87, Helsingborg, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77, Stockholm, Sweden
| | - Arne Östman
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Z1:00, 171 76, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77, Stockholm, Sweden
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McConnell JC, O'Connell OV, Brennan K, Weiping L, Howe M, Joseph L, Knight D, O'Cualain R, Lim Y, Leek A, Waddington R, Rogan J, Astley SM, Gandhi A, Kirwan CC, Sherratt MJ, Streuli CH. Increased peri-ductal collagen micro-organization may contribute to raised mammographic density. Breast Cancer Res 2016; 18:5. [PMID: 26747277 PMCID: PMC4706673 DOI: 10.1186/s13058-015-0664-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High mammographic density is a therapeutically modifiable risk factor for breast cancer. Although mammographic density is correlated with the relative abundance of collagen-rich fibroglandular tissue, the causative mechanisms, associated structural remodelling and mechanical consequences remain poorly defined. In this study we have developed a new collaborative bedside-to-bench workflow to determine the relationship between mammographic density, collagen abundance and alignment, tissue stiffness and the expression of extracellular matrix organising proteins. METHODS Mammographic density was assessed in 22 post-menopausal women (aged 54-66 y). A radiologist and a pathologist identified and excised regions of elevated non-cancerous X-ray density prior to laboratory characterization. Collagen abundance was determined by both Masson's trichrome and Picrosirius red staining (which enhances collagen birefringence when viewed under polarised light). The structural specificity of these collagen visualisation methods was determined by comparing the relative birefringence and ultrastructure (visualised by atomic force microscopy) of unaligned collagen I fibrils in reconstituted gels with the highly aligned collagen fibrils in rat tail tendon. Localised collagen fibril organisation and stiffness was also evaluated in tissue sections by atomic force microscopy/spectroscopy and the abundance of key extracellular proteins was assessed using mass spectrometry. RESULTS Mammographic density was positively correlated with the abundance of aligned periductal fibrils rather than with the abundance of amorphous collagen. Compared with matched tissue resected from the breasts of low mammographic density patients, the highly birefringent tissue in mammographically dense breasts was both significantly stiffer and characterised by large (>80 μm long) fibrillar collagen bundles. Subsequent proteomic analyses not only confirmed the absence of collagen fibrosis in high mammographic density tissue, but additionally identified the up-regulation of periostin and collagen XVI (regulators of collagen fibril structure and architecture) as potential mediators of localised mechanical stiffness. CONCLUSIONS These preliminary data suggest that remodelling, and hence stiffening, of the existing stromal collagen microarchitecture promotes high mammographic density within the breast. In turn, this aberrant mechanical environment may trigger neoplasia-associated mechanotransduction pathways within the epithelial cell population.
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Affiliation(s)
- James C McConnell
- Centre for Tissue Injury & Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
| | - Oliver V O'Connell
- Wellcome Trust Centre for Cell-Matrix Research and Manchester Breast Centre, Faculty of Life Sciences, University of Manchester, Manchester, UK.
| | - Keith Brennan
- Wellcome Trust Centre for Cell-Matrix Research and Manchester Breast Centre, Faculty of Life Sciences, University of Manchester, Manchester, UK.
| | - Lisa Weiping
- Wellcome Trust Centre for Cell-Matrix Research and Manchester Breast Centre, Faculty of Life Sciences, University of Manchester, Manchester, UK.
| | - Miles Howe
- University Hospital of South Manchester, Manchester, UK.
| | - Leena Joseph
- University Hospital of South Manchester, Manchester, UK.
| | - David Knight
- Wellcome Trust Centre for Cell-Matrix Research and Manchester Breast Centre, Faculty of Life Sciences, University of Manchester, Manchester, UK.
| | - Ronan O'Cualain
- Wellcome Trust Centre for Cell-Matrix Research and Manchester Breast Centre, Faculty of Life Sciences, University of Manchester, Manchester, UK. ronan.o'
| | - Yit Lim
- University Hospital of South Manchester, Manchester, UK.
| | - Angela Leek
- Manchester Cancer Research Centre Tissue Biobank, University of Manchester, Manchester, UK.
| | - Rachael Waddington
- Manchester Cancer Research Centre Tissue Biobank, University of Manchester, Manchester, UK.
| | - Jane Rogan
- Manchester Cancer Research Centre Tissue Biobank, University of Manchester, Manchester, UK.
| | - Susan M Astley
- Centre for Imaging Sciences, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
| | - Ashu Gandhi
- University Hospital of South Manchester, Manchester, UK.
| | - Cliona C Kirwan
- Institute of Cancer Sciences, Manchester Academic Health Sciences Centre, University Hospital of South Manchester, University of Manchester, Manchester, UK.
| | - Michael J Sherratt
- Centre for Tissue Injury & Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
| | - Charles H Streuli
- Wellcome Trust Centre for Cell-Matrix Research and Manchester Breast Centre, Faculty of Life Sciences, University of Manchester, Manchester, UK.
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Sandhu R, Chollet-Hinton L, Kirk EL, Midkiff B, Troester MA. Digital histologic analysis reveals morphometric patterns of age-related involution in breast epithelium and stroma. Hum Pathol 2015; 48:60-8. [PMID: 26772400 DOI: 10.1016/j.humpath.2015.09.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/11/2015] [Accepted: 09/23/2015] [Indexed: 12/29/2022]
Abstract
Complete age-related regression of mammary epithelium, often termed postmenopausal involution, is associated with decreased breast cancer risk. However, most studies have qualitatively assessed involution. We quantitatively analyzed epithelium, stroma, and adipose tissue from histologically normal breast tissue of 454 patients in the Normal Breast Study. High-resolution digital images of normal breast hematoxylin and eosin-stained slides were partitioned into epithelium, adipose tissue, and nonfatty stroma. Percentage area and nuclei per unit area (nuclear density) were calculated for each component. Quantitative data were evaluated in association with age using linear regression and cubic spline models. Stromal area decreased (P = 0.0002), and adipose tissue area increased (P < 0.0001), with an approximate 0.7% change in area for each component, until age 55 years when these area measures reached a steady state. Although epithelial area did not show linear changes with age, epithelial nuclear density decreased linearly beginning in the third decade of life. No significant age-related trends were observed for stromal or adipose nuclear density. Digital image analysis offers a high-throughput method for quantitatively measuring tissue morphometry and for objectively assessing age-related changes in adipose tissue, stroma, and epithelium. Epithelial nuclear density is a quantitative measure of age-related breast involution that begins to decline in the early premenopausal period.
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Affiliation(s)
- Rupninder Sandhu
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, 27599
| | - Lynn Chollet-Hinton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Erin L Kirk
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Bentley Midkiff
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, 27599
| | - Melissa A Troester
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, 27599; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599; Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, 27599.
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Quantification of Regional Breast Density in Four Quadrants Using 3D MRI-A Pilot Study. Transl Oncol 2015; 8:250-7. [PMID: 26310370 PMCID: PMC4562976 DOI: 10.1016/j.tranon.2015.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/21/2015] [Accepted: 04/24/2015] [Indexed: 12/03/2022] Open
Abstract
PURPOSE: This study presented a three-dimensional magnetic resonance (MR)–based method to separate a breast into four quadrants for quantitative measurements of the quadrant breast volume (BV) and density. METHODS: Breast MR images from 58 healthy women were studied. The breast and the fibroglandular tissue were segmented by using a computer-based algorithm. A breast was divided into four quadrants using two perpendicular planes intersecting at the nipple or the nipple-centroid line. After the separation, the BV, the fibroglandular tissue volume, and the percent density (PD) were calculated. The symmetry of the quadrant BV in the left and right breasts separated by using the nipple alone, or the nipple-centroid line, was compared. RESULTS: The quadrant separation made on the basis of the nipple-centroid line showed closer BVs in four quadrants than using the nipple alone. The correlation and agreement for the BV in corresponding quadrants of the left and the right breasts were improved after the nipple-centroid reorientation. Among the four quadrants, PD was the highest in the lower outer and the lowest in the upper outer (significant than the other three) quadrants (P < .05). CONCLUSIONS: We presented a quantitative method to divide a breast into four quadrants. The reorientation based on the nipple-centroid line improved the left to right quadrant symmetry, and this may provide a better standardized method to measure quantitative quadrant density. The cancer occurrence rates are known to vary in different sites of a breast, and our method may provide a tool for investigating its association with the quantitative breast density.
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47
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Chew GL, Huo CW, Huang D, Hill P, Cawson J, Frazer H, Hopper JL, Haviv I, Henderson MA, Britt K, Thompson EW. Increased COX-2 expression in epithelial and stromal cells of high mammographic density tissues and in a xenograft model of mammographic density. Breast Cancer Res Treat 2015; 153:89-99. [PMID: 26227474 DOI: 10.1007/s10549-015-3520-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
Mammographic density (MD) adjusted for age and body mass index is one of the strongest known risk factors for breast cancer. Given the high attributable risk of MD for breast cancer, chemoprevention with a safe and available agent that reduces MD and breast cancer risk would be beneficial. Cox-2 has been implicated in MD-related breast cancer risk, and was increased in stromal cells in high MD tissues in one study. Our study assessed differential Cox-2 expression in epithelial and stromal cells in paired samples of high and low MD human breast tissue, and in a validated xenograft biochamber model of MD. We also examined the effects of endocrine treatment upon Cox-2 expression in high and low MD tissues in the MD xenograft model. Paired high and low MD human breast tissue samples were immunostained for Cox-2, then assessed for differential expression and staining intensity in epithelial and stromal cells. High and low MD human breast tissues were separately maintained in biochambers in mice treated with Tamoxifen, oestrogen or placebo implants, then assessed for percentage Cox-2 staining in epithelial and stromal cells. Percentage Cox-2 staining was greater for both epithelial (p = 0.01) and stromal cells (p < 0.0001) of high compared with low MD breast tissues. In high MD biochamber tissues, percentage Cox-2 staining was greater in stromal cells of oestrogen-treated versus placebo-treated tissues (p = 0.05).
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Affiliation(s)
- G L Chew
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, VIC, Australia,
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Breast Tissue Composition and Immunophenotype and Its Relationship with Mammographic Density in Women at High Risk of Breast Cancer. PLoS One 2015; 10:e0128861. [PMID: 26110820 PMCID: PMC4481506 DOI: 10.1371/journal.pone.0128861] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/03/2015] [Indexed: 12/02/2022] Open
Abstract
Aim To investigate the cellular and immunophenotypic basis of mammographic density in women at high risk of breast cancer. Methods Mammograms and targeted breast biopsies were accrued from 24 women at high risk of breast cancer. Mammographic density was classified into Wolfe categories and ranked by increasing density. The histological composition and immunophenotypic profile were quantified from digitized haematoxylin and eosin-stained and immunohistochemically-stained (ERα, ERβ, PgR, HER2, Ki-67, and CD31) slides and correlated to mammographic density. Results Increasing mammographic density was significantly correlated with increased fibrous stroma proportion (rs (22) = 0.5226, p = 0.0088) and significantly inversely associated with adipose tissue proportion (rs (22) = -0.5409, p = 0.0064). Contrary to previous reports, stromal expression of ERα was common (19/20 cases, 95%). There was significantly higher stromal PgR expression in mammographically-dense breasts (p=0.026). Conclusions The proportion of stroma and fat underlies mammographic density in women at high risk of breast cancer. Increased expression of PgR in the stroma of mammographically dense breasts and frequent and unexpected presence of stromal ERα expression raises the possibility that hormone receptor expression in breast stroma may have a role in mediating the effects of exogenous hormonal therapy on mammographic density.
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Huo CW, Chew G, Hill P, Huang D, Ingman W, Hodson L, Brown KA, Magenau A, Allam AH, McGhee E, Timpson P, Henderson MA, Thompson EW, Britt K. High mammographic density is associated with an increase in stromal collagen and immune cells within the mammary epithelium. Breast Cancer Res 2015; 17:79. [PMID: 26040322 PMCID: PMC4485361 DOI: 10.1186/s13058-015-0592-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Mammographic density (MD), after adjustment for a women's age and body mass index, is a strong and independent risk factor for breast cancer (BC). Although the BC risk attributable to increased MD is significant in healthy women, the biological basis of high mammographic density (HMD) causation and how it raises BC risk remain elusive. We assessed the histological and immunohistochemical differences between matched HMD and low mammographic density (LMD) breast tissues from healthy women to define which cell features may mediate the increased MD and MD-associated BC risk. METHODS Tissues were obtained between 2008 and 2013 from 41 women undergoing prophylactic mastectomy because of their high BC risk profile. Tissue slices resected from the mastectomy specimens were X-rayed, then HMD and LMD regions were dissected based on radiological appearance. The histological composition, aromatase immunoreactivity, hormone receptor status and proliferation status were assessed, as were collagen amount and orientation, epithelial subsets and immune cell status. RESULTS HMD tissue had a significantly greater proportion of stroma, collagen and epithelium, as well as less fat, than LMD tissue did. Second harmonic generation imaging demonstrated more organised stromal collagen in HMD tissues than in LMD tissues. There was significantly more aromatase immunoreactivity in both the stromal and glandular regions of HMD tissues than in those regions of LMD tissues, although no significant differences in levels of oestrogen receptor, progesterone receptor or Ki-67 expression were detected. The number of macrophages within the epithelium or stroma did not change; however, HMD stroma exhibited less CD206(+) alternatively activated macrophages. Epithelial cell maturation was not altered in HMD samples, and no evidence of epithelial-mesenchymal transition was seen; however, there was a significant increase in vimentin(+)/CD45(+) immune cells within the epithelial layer in HMD tissues. CONCLUSIONS We confirmed increased proportions of stroma and epithelium, increased aromatase activity and no changes in hormone receptor or Ki-67 marker status in HMD tissue. The HMD region showed increased collagen deposition and organisation as well as decreased alternatively activated macrophages in the stroma. The HMD epithelium may be a site for local inflammation, as we observed a significant increase in CD45(+)/vimentin(+) immune cells in this area.
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Affiliation(s)
- Cecilia W Huo
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia.
| | - Grace Chew
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia.
| | - Prue Hill
- Department of Pathology, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Dexing Huang
- St. Vincent's Institute, 9 Princes Street, Fitzroy, VIC, 3065, Australia.
| | - Wendy Ingman
- Discipline of Surgery, Faculty of Health Sciences, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia. .,Robinson Research Institute, University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA, 5006, Australia.
| | - Leigh Hodson
- Discipline of Surgery, Faculty of Health Sciences, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia. .,Robinson Research Institute, University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA, 5006, Australia.
| | - Kristy A Brown
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, VIC, 3168, Australia.
| | - Astrid Magenau
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Clayton, Australia.
| | - Amr H Allam
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Clayton, Australia.
| | - Ewan McGhee
- St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia.
| | - Paul Timpson
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Clayton, Australia.
| | - Michael A Henderson
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia. .,Peter MacCallum Cancer Centre, 2 St. Andrews Place, East Melbourne, VIC, 3002, Australia.
| | - Erik W Thompson
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia. .,St. Vincent's Institute, 9 Princes Street, Fitzroy, VIC, 3065, Australia. .,Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| | - Kara Britt
- The Beatson Institute for Cancer Research, Switchback Road, Bearsden Glasgow, G61 1BD, UK. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, St. Andrews Place, East Melbourne, VIC, 3002, Australia. .,Department of Anatomy and Developmental Biology, Monash University, 19 Innovation Walk, Clayton, VIC, s, Australia.
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Taroni P, Quarto G, Pifferi A, Abbate F, Balestreri N, Menna S, Cassano E, Cubeddu R. Breast tissue composition and its dependence on demographic risk factors for breast cancer: non-invasive assessment by time domain diffuse optical spectroscopy. PLoS One 2015; 10:e0128941. [PMID: 26029912 PMCID: PMC4452361 DOI: 10.1371/journal.pone.0128941] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 05/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breast tissue composition is recognized as a strong and independent risk factor for breast cancer. It is a heritable feature, but is also significantly affected by several other elements (e.g., age, menopause). Nowadays it is quantified by mammographic density, thus requiring the use of ionizing radiation. Optical techniques are absolutely non-invasive and have already proved effective in the investigation of biological tissues, as they are sensitive to tissue composition and structure. METHODS Time domain diffuse optical spectroscopy was performed at 7 wavelengths (635-1060 nm) on 200 subjects to derive their breast tissue composition (in terms of water, lipid and collagen content), blood parameters (total hemoglobin content and oxygen saturation level), and information on the microscopic structure (scattering amplitude and power). The dependence of all optically-derived parameters on age, menopausal status, body mass index, and use of oral contraceptives, and the correlation with mammographic density were investigated. RESULTS Younger age, premenopausal status, lower body mass index values, and use of oral contraceptives all correspond to significantly higher water, collagen and total hemoglobin content, and lower lipid content (always p < 0.05 and often p < 10-4), while oxygen saturation level and scattering parameters show significant dependence only on some conditions. Even when age-adjusted groups of subjects are compared, several optically derived parameters (and in particular always collagen and total hemoglobin content) remain significantly different. CONCLUSIONS Time domain diffuse optical spectroscopy can probe non-invasively breast tissue composition and physiologic blood parameters, and provide information on tissue structure. The measurement is suitable for in vivo studies and monitoring of changes in breast tissue (e.g., with age, lifestyle, chemotherapy, etc.) and to gain insight into related processes, like the origin of cancer risk associated with breast density.
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Affiliation(s)
- Paola Taroni
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
- * E-mail:
| | - Giovanna Quarto
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
| | - Antonio Pifferi
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Francesca Abbate
- European Institute of Oncology, Breast Imaging Unit, Milano, Italy
| | - Nicola Balestreri
- European Institute of Oncology, Department of Radiology, Milano, Italy
| | - Simona Menna
- European Institute of Oncology, Breast Imaging Unit, Milano, Italy
| | - Enrico Cassano
- European Institute of Oncology, Breast Imaging Unit, Milano, Italy
| | - Rinaldo Cubeddu
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milano, Italy
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