Prospective estimation of rates of change in mammographic parenchymal patterns: influence of age and of hormone replacement therapy

Longitudinal Study of Mammographic Density Measures That Predict Breast Cancer Risk

Background: After adjusting for age and body mass index (BMI), mammographic measures-dense area (DA), percent dense area (PDA), and nondense area (NDA)-are associated with breast cancer risk. Our aim was to use longitudinal data to estimate the extent to which these risk-predicting measures track over time.Methods: We collected 4,320 mammograms (age range, 24-83 years) from 970 women in the Melbourne Collaborative Cohort Study and the Australian Breast Cancer Family Registry. Women had on average 4.5 mammograms (range, 1-14). DA, PDA, and NDA were measured using the Cumulus software and normalized using the Box-Cox method. Correlations in the normalized risk-predicting measures over time intervals of different lengths were estimated using nonlinear mixed-effects modeling of Gompertz curves.Results: Mean normalized DA and PDA were constant with age to the early 40s, decreased over the next two decades, and were almost constant from the mid-60s onward. Mean normalized NDA increased nonlinearly with age. After adjusting for age and BMI, the within-woman correlation estimates for normalized DA were 0.94, 0.93, 0.91, 0.91, and 0.91 for mammograms taken 2, 4, 6, 8, and 10 years apart, respectively. Similar correlations were estimated for the age- and BMI-adjusted normalized PDA and NDA.Conclusions: The mammographic measures that predict breast cancer risk are highly correlated over time.Impact: This has implications for etiologic research and clinical management whereby women at increased risk could be identified at a young age (e.g., early 40s or even younger) and recommended appropriate screening and prevention strategies. Cancer Epidemiol Biomarkers Prev; 26(4); 651-60. ©2017 AACR.

Recording of hormone therapy and breast density in breast screening programs: summary and recommendations of the International Cancer Screening Network

Breast density and the use of hormone therapy (HT) for menopausal symptoms alter the risk of breast cancer and both factors influence screening mammography performance. The International Cancer Screening Network (ICSN) surveyed its 29 member countries and found that few programs record breast density or the use of HT among screening participants. This may affect the ability of programs to assess their effectiveness in reducing breast cancer mortality. Seven countries recorded the use of HT at screening, and some were able to link screening records to individual prescribing records of HT. Eight countries reported recording breast density at screening mammography for some or all women screened. The recommendations of the ICSN for recording information about breast density and HT are presented.

A Longitudinal Investigation of Mammographic Density: The Multiethnic Cohort

Mammographic densities are hypothesized to reflect the cumulative exposure to risk factors that influence breast cancer incidence. This report analyzed percent densities over time and explored predictors of density change in relation to age. The study population consisted of 607 breast cancer cases and 667 frequency matched controls with 1,956 and 1,619 mammographic readings, respectively. Mammograms done over >20 years and before a diagnosis of breast cancer were assessed for densities using a computer-assisted method. Using multilevel modeling to allow for repeated measurements, we estimated the effect of ethnicity, case status, reproductive characteristics, hormonal therapy, body mass index, and soy intake on initial status and longitudinal change. After integrating the area under the percent density curve, cumulative percent density was compared with age-specific breast cancer rates in Hawaii. Percent densities decreased approximately 5.6% per 10 years but a nonlinear effect indicated a faster decline earlier in life. Cumulative percent densities and age-specific breast cancer rates increased at very similar rates; both standardized regression coefficients were >0.9. Japanese ancestry, overweight, estrogen/progestin treatment, and, to a lesser degree, estrogen-only therapy predicted a slower decline in densities with age. Case status and adult soy intake were related to higher densities whereas overweight and having any child were associated with lower densities at initial status. Risk factors that influence the decline in mammographic densities over time may be important for breast cancer prevention because cumulative percent densities may reflect the age-related increase in breast cancer risk.

Impact of hormone therapy on false-positive recall and costs among women undergoing screening mammography

OBJECTIVE

We sought to evaluate the effects of hormone therapy (HT) on false-positive (FP) recall for additional breast evaluation and costs.

DESIGN

We undertook an observational cohort study of women ages 40-80 years with 2 mammography screenings in an integrated delivery system.

MEASURES

FP recall, defined as mammograms resulting in a radiologist's recommendation for additional imaging, ultrasound, or invasive procedures among disease-free women, was compared for nonusers, initiators, discontinuers, and continuers of HT. Differences in health care costs by HT were assessed for total, primary care, specialty, laboratory, radiology, inpatient, mental health, and pharmacy.

RESULTS

There was no association between HT and FP recall among women ages 40-49 years. Among women 50 years or older, current HT users, ie, initiators and continuers, had increased odds of FP recall (odds ratio; 95% confidence interval) compared with nonusers (1.2; 1.0-1.4 for women 50-59 years; 1.8; 1.5-2.2 for women 60-69; and 1.7; 1.4-2.0 for women 70-80 years). Among women 50-59 years, the odds of FP recall were attributed to opposed HT (ie, estrogen+progestin). Increases in FP recall among HT users 60 years and older was maintained for initiators, continuers, opposed, and unopposed (estrogen only). Increases in FP recall among HT users were for imaging and ultrasound but not invasive procedures. Costs for current HT users during the 12 months after screening were not higher than nonusers, except for pharmacy and outpatient mental health.

CONCLUSION

The relationship between HT use and FP recall is greatest among older women and does not result in a differential use of invasive procedures.

Percentage density, Wolfe's and Tabár's mammographic patterns: agreement and association with risk factors for breast cancer

Introduction

The purpose of this report was to classify mammograms according to four methods and to examine their agreement and their relationship to selected risk factors for breast cancer.

Method

Mammograms and epidemiological data were collected from 987 women, aged 55 to 71 years, attending the Norwegian Breast Cancer Screening Program. Two readers each classified the mammograms according to a quantitative method (Cumulus or Madena software) and one reader according to two qualitative methods (Wolfe and Tabár patterns). Mammograms classified in the reader-specific upper quartile of percentage density, Wolfe's P2 and DY patterns, or Tabár's IV and V patterns, were categorized as high-risk density patterns and the remaining mammograms as low-risk density patterns. We calculated intra-reader and inter-reader agreement and estimated prevalence odds ratios of having high-risk mammographic density patterns according to selected risk factors for breast cancer.

Results

The Pearson correlation coefficient was 0.86 for the two quantitative density measurements. There was moderate agreement between the Wolfe and Tabár classifications (Kappa = 0.51; 95% confidence interval 0.46 to 0.56). Age at screening, number of children and body mass index (BMI) showed a statistically significant inverse relationship with high-risk density patterns for all four methods (all P < 0.05). After adjustment for percentage density, the Wolfe classification was not associated with any of the risk factors for breast cancer, whereas the association with number of children and BMI remained statistically significant for the Tabár classification. Adjustment for Wolfe or Tabár patterns did not alter the associations between these risk factors and percentage mammographic density.

Conclusion

The four assessments methods seem to capture the same overall associations with risk factors for breast cancer. Our results indicate that the quantitative methods convey additional information over the qualitative methods.

Episode sensitivity in association with process indicators in the Finnish breast cancer screening program

We assessed the episode sensitivity of the Finnish mammography program for women aged 50-59 (partly 60-64) years and explored associations between the episode sensitivity and the screening process indicators from 1991 to 1999. For the study period, data were available from 10 screening centers. Records of 721,000 screening visits were linked to the files of the nationwide Finnish Cancer Registry from 1991 to 2001 at an individual level. The rates of screen-detected and interval breast cancers were calculated at the first and at the subsequent screens. The episode sensitivity was determined by contrasting the incidence of interval cancers with the expected population incidence rate without screening (incidence method) and as a proportion of interval cancers out of all cancers detected (detection method). At the subsequent screens, the episode sensitivity determined by the incidence method was 54% and by the detection method 65%. The sensitivity 0-11 and 12-23 months after the screening was 70% and 38%, respectively. The episode sensitivity decreased toward the end of the study period and increased with age. The center-specific sensitivity increased 13% per 1% absolute increase in the recall rate. In general, our study provides further information on the effectiveness of screening programs. The sensitivity estimates were comparable with those from other European service screening programs. The variability in the episode sensitivity suggests potential for variations in the future screening outcome.