1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Gabrielson M, Hammarström M, Bäcklund M, Bergqvist J, Lång K, Rosendahl AH, Borgquist S, Hellgren R, Czene K, Hall P. Effects of tamoxifen on normal breast tissue histological composition: Results from a randomised six-arm placebo-controlled trial in healthy women. Int J Cancer 2023; 152:2362-2372. [PMID: 36637153 DOI: 10.1002/ijc.34430] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023]
Abstract
Tamoxifen prevents recurrence of breast cancer and is suggested for preventive risk-reducing therapy. Tamoxifen reduces mammographic density, a proxy for therapy response, but little is known about its effects in remodelling normal breast tissue. Our study, a substudy within the double-blinded dose-determination trial KARISMA, investigated tamoxifen-specific changes in breast tissue composition and histological markers in healthy women. We included 83 healthy women randomised to 6 months daily intake of 20, 10, 5, 2.5, 1 mg of tamoxifen or placebo. The groups were combined to "no dose" (0-1 mg), "low-dose" (2.5-5 mg) or "high-dose" (10-20 mg) of tamoxifen. Ultrasound-guided biopsies were collected before and after tamoxifen exposure. In each biopsy, epithelial, stromal and adipose tissues was quantified, and expression of epithelial and stromal Ki67, oestrogen receptor (ER) and progesterone receptor (PR) analysed. Mammographic density using STRATUS was measured at baseline and end-of-tamoxifen-exposure. We found that different doses of tamoxifen reduced mammographic density and glandular-epithelial area in premenopausal women and associated with reduced epithelium and increased adipose tissue. High-dose tamoxifen also decreased epithelial ER and PR expressions in premenopausal women. Premenopausal women with the greatest reduction in proliferation also had the greatest epithelial reduction. In postmenopausal women, high-dose tamoxifen decreased the epithelial area with no measurable density decrease. Tamoxifen at both low and high doses influences breast tissue composition and expression of histological markers in the normal breast. Our findings connect epithelial proliferation with tissue remodelling in premenopausal women and provide novel insights to understanding biological mechanisms of primary prevention with tamoxifen.
Collapse
Affiliation(s)
- Marike Gabrielson
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Hammarström
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäcklund
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Bergqvist
- Department of Medical Epidemiology and Biostatics, 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 Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Eriksson M, Czene K, Conant EF, Hall P. Use of Low-Dose Tamoxifen to Increase Mammographic Screening Sensitivity in Premenopausal Women. Cancers (Basel) 2021; 13:302. [PMID: 33467653 PMCID: PMC7830894 DOI: 10.3390/cancers13020302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Increased breast density decreases mammographic sensitivity due to masking of cancers by dense tissue. Tamoxifen exposure reduces mammographic density and, therefore, should improve screening sensitivity. We modelled how low-dose tamoxifen exposure could be used to increase mammographic sensitivity. Mammographic sensitivity was calculated using the KARMA prospective screening cohort. Two models were fitted to estimate screening sensitivity and detected tumor size based on baseline mammographic density. BI-RADS-dependent sensitivity was estimated. The results of the 2.5 mg tamoxifen arm of the KARISMA trial were used to define expected changes in mammographic density after six months exposure and to predict changes in mammographic screening sensitivity and detected tumor size. Rates of interval cancers and detection of invasive tumors were estimated for women with mammographic density relative decreases by 10-50%. In all, 517 cancers in premenopausal women were diagnosed in KARMA: 287 (56%) screen-detected and 230 (44%) interval cancers. Screening sensitivities prior to tamoxifen, were 76%, 69%, 53%, and 46% for BI-RADS density categories A, B, C, and D, respectively. After exposure to tamoxifen, modelled screening sensitivities were estimated to increase by 0% (p = 0.35), 2% (p < 0.01), 5% (p < 0.01), and 5% (p < 0.01), respectively. An estimated relative density decrease by ≥20% resulted in an estimated reduction of interval cancers by 24% (p < 0.01) and reduction in tumors >20 mm at detection by 4% (p < 0.01). Low-dose tamoxifen has the potential to increase mammographic screening sensitivity and thereby reduce the proportion of interval cancers and larger screen-detected cancers.
Collapse
Affiliation(s)
- Mikael Eriksson
- Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden; (K.C.); (P.H.)
| | - Kamila Czene
- Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden; (K.C.); (P.H.)
| | - Emily F. Conant
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Per Hall
- Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden; (K.C.); (P.H.)
- Department of Oncology, Södersjukhuset University Hospital, Karolinska Institutet, 118 83 Stockholm, Sweden
| |
Collapse
|
8
|
Dunphy KA, Black AL, Roberts AL, Sharma A, Li Z, Suresh S, Browne EP, Arcaro KF, Ser-Dolansky J, Bigelow C, Troester MA, Schneider SS, Makari-Judson G, Crisi GM, Jerry DJ. Inter-Individual Variation in Response to Estrogen in Human Breast Explants. J Mammary Gland Biol Neoplasia 2020; 25:51-68. [PMID: 32152951 PMCID: PMC7147970 DOI: 10.1007/s10911-020-09446-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
Exposure to estrogen is strongly associated with increased breast cancer risk. While all women are exposed to estrogen, only 12% are expected to develop breast cancer during their lifetime. These women may be more sensitive to estrogen, as rodent models have demonstrated variability in estrogen sensitivity. Our objective was to determine individual variation in expression of estrogen receptor (ER) and estrogen-induced responses in the normal human breast. Human breast tissue from female donors undergoing reduction mammoplasty surgery were collected for microarray analysis of ER expression. To examine estrogen-induced responses, breast tissue from 23 female donors were cultured ex- vivo in basal or 10 nM 17β-estradiol (E2) media for 4 days. Expression of ER genes (ESR1 and ESR2) increased significantly with age. E2 induced consistent increases in global gene transcription, but expression of target genes AREG, PGR, and TGFβ2 increased significantly only in explants from nulliparous women. E2-treatment did not induce consistent changes in proliferation or radiation induced apoptosis. Responses to estrogen are highly variable among women and not associated with levels of ER expression, suggesting differences in intracellular signaling among individuals. The differences in sensitivity to E2-stimulated responses may contribute to variation in risk of breast cancer.
Collapse
Affiliation(s)
- Karen A Dunphy
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA.
| | - Amye L Black
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Amy L Roberts
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Aman Sharma
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Zida Li
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Sneha Suresh
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Eva P Browne
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Kathleen F Arcaro
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | | | - Carol Bigelow
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sallie S Schneider
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
- Pioneer Valley Life Sciences, Springfield, MA, USA
| | - Grace Makari-Judson
- Division of Hematology-Oncology, University of Massachusetts Medical School/Baystate, Springfield, MA, USA
| | - Giovanna M Crisi
- Department of Pathology, University of Massachusetts Medical School/Baystate, Springfield, MA, USA
| | - D Joseph Jerry
- The Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA, USA
- Pioneer Valley Life Sciences, Springfield, MA, USA
| |
Collapse
|
9
|
Stromal Cell Signature Associated with Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer. Cells 2019; 8:cells8121566. [PMID: 31817155 PMCID: PMC6953077 DOI: 10.3390/cells8121566] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 01/26/2023] Open
Abstract
Breast cancer stromal compartment, may influence responsiveness to chemotherapy. Our aim was to detect a stromal cell signature (using a direct approach of microdissected stromal cells) associated with response to neoadjuvant chemotherapy (neoCT) in locally advanced breast cancer (LABC). The tumor samples were collected from 44 patients with LABC (29 estrogen receptor (ER) positive and 15 ER negative) before the start of any treatment. Neoadjuvant chemotherapy consisted of doxorubicin and cyclophosphamide, followed by paclitaxel. Response was defined as downstaging to maximum ypT1a-b/ypN0. The stromal cells, mainly composed of fibroblast and immune cells, were microdissected from fresh frozen tumor samples and gene expression profile was determined using Agilent SurePrint G3 Human Gene Expression microarrays. Expression levels were compared using MeV (MultiExperiment Viewer) software, applying SAM (significance analysis of microarrays). To classify samples according to tumor response, the order of median based on confidence statements (MedOr) was used, and to identify gene sets correlated with the phenotype downstaging, gene set enrichment analysis (GSEA). Nine patients presented disease downstaging. Eleven sequences (FDR 17) were differentially expressed, all of which (except H2AFJ) more expressed in responsive tumors, including PTCHD1 and genes involved in abnormal cytotoxic T cell physiology, TOX, LY75, and SH2D1A. The following four pairs of markers could correctly classify all tumor samples according to response: PTCHD1/PDXDC2P, LOC100506731/NEURL4, SH2D1A/ENST00000478672, and TOX/H2AFJ. Gene sets correlated with tumor downstaging (FDR < 0.01) were mainly involved in immune response or lymphocyte activation, including CD47, LCK, NCK1, CD24, CD3E, ZAP70, FOXP3, and CD74, among others. In locally advanced breast cancer, stromal cells may present specific features of immune response that may be associated with chemotherapy response.
Collapse
|
10
|
Li E, Guida JL, Tian Y, Sung H, Koka H, Li M, Chan A, Zhang H, Tang E, Guo C, Deng J, Hu N, Lu N, Gierach GL, Li J, Yang XR. Associations between mammographic density and tumor characteristics in Chinese women with breast cancer. Breast Cancer Res Treat 2019; 177:527-536. [PMID: 31254158 DOI: 10.1007/s10549-019-05325-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Mammographic density (MD) is a strong risk factor for breast cancer, yet its relationship with tumor characteristics is not well established, particularly in Asian populations. METHODS MD was assessed from a total of 2001 Chinese breast cancer patients using Breast Imaging Reporting and Data System (BI-RADS) categories. Molecular subtypes were defined using immunohistochemical status on ER, PR, HER2, and Ki-67, as well as tumor grade. Multinomial logistic regression was used to test associations between MD and molecular subtype (luminal A = reference) adjusting for age, body mass index (BMI), menopausal status, parity, and nodal status. RESULTS The mean age at diagnosis was 51.7 years (SD = 10.7) and the average BMI was 24.7 kg/m2 (SD = 3.8). The distribution of BI-RADS categories was 7.4% A = almost entirely fat, 24.2% B = scattered fibroglandular dense, 49.4% C = heterogeneously dense, and 19.0% D = extremely dense. Compared to women with BI-RADS = A/B, women with BI-RADS = D were more likely to have HER2-enriched tumors (OR = 1.81, 95% CI 1.08-3.06, p = 0.03), regardless of menopausal status. The association was only observed in women with normal (< 25 kg/m2) BMI (OR = 2.43, 95% CI 1.24-4.76, p < 0.01), but not among overweight/obese women (OR: 0.98, 95% CI 0.38-2.52, p = 0.96). CONCLUSIONS Among Chinese women with normal BMI, higher breast density was associated with HER2-enriched tumors. The results may partially explain the higher proportion of HER2+ tumors previously reported in Asian women.
Collapse
Affiliation(s)
- Erni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jennifer L Guida
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.,Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Yuan Tian
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hyuna Sung
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.,Cancer Surveillance and Health Services Program, American Cancer Society, Atlanta, GA, 30303, USA
| | - Hela Koka
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Mengjie Li
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.,Vanderbilt University, Nashville, TN, USA
| | - Ariane Chan
- Volpara Health Technologies Ltd, Wellington, New Zealand
| | - Han Zhang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Eric Tang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Changyuan Guo
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Joseph Deng
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Nan Hu
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Ning Lu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Gretchen L Gierach
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Jing Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Xiaohong R Yang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.
| |
Collapse
|
11
|
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.
Collapse
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: )
| | | | | | | | | | | |
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
Gabrielson M, Chiesa F, Behmer C, Rönnow K, Czene K, Hall P. Association of reproductive history with breast tissue characteristics and receptor status in the normal breast. Breast Cancer Res Treat 2018; 170:487-497. [PMID: 29603032 PMCID: PMC6022521 DOI: 10.1007/s10549-018-4768-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/26/2018] [Indexed: 01/08/2023]
Abstract
Introduction Reproductive history has been associated with breast cancer risk, but more knowledge of the underlying biological mechanisms is needed. Because of limited data on normal breast tissue from healthy women, we examined associations of reproductive history and established breast cancer risk factors with breast tissue composition and markers of hormone receptors and proliferation in a nested study within the Karolinska Mammography project for risk prediction for breast cancer (Karma). Materials and methods Tissues from 153 women were obtained by ultrasound-guided core needle biopsy as part of the Karma project. Immunohistochemical staining was used to assessed histological composition of epithelial, stromal and adipose tissue, epithelial and stromal oestrogen receptor (ER) and progesterone receptor (PR) status, and Ki-67 proliferation status. An individualised reproductive score including parity, number of pregnancies without birth, number of births, age at first birth, and duration of breastfeeding, was calculated based on self-reported reproductive history at the time of the Karma study entry. All analyses were adjusted for age and BMI. Results Cumulated reproductive score was associated with increased total epithelial content and greater expression of epithelial ER. Parity was associated with greater epithelial area, increased epithelial–stromal ratio, greater epithelial ER expression and a lower extent of stromal proliferation. Increasing numbers of pregnancies and births were associated with a greater epithelial area in the entire study set, which remained significant among postmenopausal women. Increasing numbers of pregnancies and births were also associated with a greater expression of epithelial ER among postmenopausal women. Longer duration of breastfeeding was associated with greater epithelial area and greater expression of epithelial PR both in the entire study set and among postmenopausal women. Breastfeeding was also positively associated with greater epithelial ER expression among postmenopausal women. Prior use of oral contraceptives was associated with lower epithelial–stromal ratio amongst all participants and among pre- and postmenopausal women separately. Conclusion Reproductive risk factors significantly influence the epithelial tissue compartment and expression of hormone receptors in later life. These changes remain after menopause. This study provides deeper insights of the biological mechanisms by which reproductive history influences epithelial area and expression of hormone receptors, and as a consequence the risk of breast cancer. Electronic supplementary material The online version of this article (10.1007/s10549-018-4768-0) contains supplementary material, which is available to authorized users.
Collapse
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
| | - 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
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77, Stockholm, Sweden
- Department of Oncology, South General Hospital, 118 83, Stockholm, Sweden
| |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
Roeke T, Sobral-Leite M, Dekker TJA, Wesseling J, Smit VTHBM, Tollenaar RAEM, Schmidt MK, Mesker WE. The prognostic value of the tumour-stroma ratio in primary operable invasive cancer of the breast: a validation study. Breast Cancer Res Treat 2017; 166:435-445. [PMID: 28795248 DOI: 10.1007/s10549-017-4445-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/05/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE The primary aim of the current study is to validate the prognostic relevance of the relative amount of tumour-associated stroma, the tumour-stroma ratio, in a large cohort of primary operable breast cancer patients. METHODS A retrospective cohort study was performed on women diagnosed and treated for primarily operable invasive breast cancer in the period from 1 January 1990 till 31 December 1999. Tumour-stroma ratio was estimated by microscopic evaluation of haematoxylin and eosin tumour slides. Two independent observers (k = 0.68) performed tumour-stroma ratio evaluation in a significant part of the cohort. The prognostic potential with respect to overall, recurrence-free and distant metastasis-free survival was evaluated. RESULTS A total of n = 737 women were evaluated. Median follow-up time was 11.5 years. High stromal content was an independent prognosticator for worse overall (hazard ratio 1.56, p = 0.002, 95% confidence interval 1.18-2.05), distant metastasis-free (hazard ratio 1.52, p = 0.008, 95% confidence interval 1.12-2.06) and recurrence-free survival (hazard ratio 1.35, p = 0.046, 95% confidence interval 1.01-1.81). In subgroups of hormone receptor-positive and lymph node-negative cases, high stromal content was also an independent prognosticator for worse outcome. CONCLUSION Tumour-stroma ratio is an independent risk factor for worse overall, distant metastasis-free and recurrence-free survival in primarily operable breast cancer. However, detailed prospective studies with respect to tumour-stroma ratio are necessary to gain more insight in its prognostic potential in clinical practice.
Collapse
Affiliation(s)
- Toni Roeke
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Marcelo Sobral-Leite
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Tim J A Dekker
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| |
Collapse
|