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Yan R, Murakami W, Mortazavi S, Yu T, Chu FI, Lee-Felker S, Sung K. Quantitative assessment of background parenchymal enhancement is associated with lifetime breast cancer risk in screening MRI. Eur Radiol 2024; 34:6358-6368. [PMID: 38683385 PMCID: PMC11399191 DOI: 10.1007/s00330-024-10758-9] [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: 10/02/2023] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To compare the quantitative background parenchymal enhancement (BPE) in women with different lifetime risks and BRCA mutation status of breast cancer using screening MRI. MATERIALS AND METHODS This study included screening MRI of 535 women divided into three groups based on lifetime risk: nonhigh-risk women, high-risk women without BRCA mutation, and BRCA1/2 mutation carriers. Six quantitative BPE measurements, including percent enhancement (PE) and signal enhancement ratio (SER), were calculated on DCE-MRI after segmentation of the whole breast and fibroglandular tissue (FGT). The associations between lifetime risk factors and BPE were analyzed via linear regression analysis. We adjusted for risk factors influencing BPE using propensity score matching (PSM) and compared the BPE between different groups. A two-sided Mann-Whitney U-test was used to compare the BPE with a threshold of 0.1 for multiple testing issue-adjusted p values. RESULTS Age, BMI, menopausal status, and FGT level were significantly correlated with quantitative BPE based on the univariate and multivariable linear regression analyses. After adjusting for age, BMI, menopausal status, hormonal treatment history, and FGT level using PSM, significant differences were observed between high-risk non-BRCA and BRCA groups in PEFGT (11.5 vs. 8.0%, adjusted p = 0.018) and SERFGT (7.2 vs. 9.3%, adjusted p = 0.066). CONCLUSION Quantitative BPE varies in women with different lifetime breast cancer risks and BRCA mutation status. These differences may be due to the influence of multiple lifetime risk factors. Quantitative BPE differences remained between groups with and without BRCA mutations after adjusting for known risk factors associated with BPE. CLINICAL RELEVANCE STATEMENT BRCA germline mutations may be associated with quantitative background parenchymal enhancement, excluding the effects of known confounding factors. This finding can provide potential insights into the cancer pathophysiological mechanisms behind lifetime risk models. KEY POINTS Expanding understanding of breast cancer pathophysiology allows for improved risk stratification and optimized screening protocols. Quantitative BPE is significantly associated with lifetime risk factors and differs between BRCA mutation carriers and noncarriers. This research offers a possible understanding of the physiological mechanisms underlying quantitative BPE and BRCA germline mutations.
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Affiliation(s)
- Ran Yan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Department of Bioengineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA.
| | - Wakana Murakami
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Radiology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Shabnam Mortazavi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tiffany Yu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Fang-I Chu
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Stephanie Lee-Felker
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA
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Taguchi A, Kodama H, Kinoshita M, Goto H. [Breast Decompression Using Automatic Pressure Reduction Control Function: Relationship between Breast Thickness, Density, and Compression Pressure]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1194-1201. [PMID: 36104223 DOI: 10.6009/jjrt.2022-1231] [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] [Indexed: 06/15/2023]
Abstract
PURPOSE This retrospective study was conducted to evaluate whether the breast density and initial compression pressure affected the compressed breast thickness (CBT) and compression pressure after decompression using compression control function (CCF) during mammography. METHODS Consecutive 779 mammograms obtained from 392 patients between February and October 2019 were included. The initial compression was randomly performed at 110 N-140 N. CCF was set to stop decompression when the pressure decreased to 80 N or restoration of CBT reached 3 mm. If the CCF stopped due to 3 mm or more restoration of CBT, it was defined as goal unachieved. Mammograms were classified into non-dense and dense groups. CBT, ∆P (actual compression pressure after decompression-80 N), and the ratio of goal unachieved were compared between breast density subgroups and among initial compression pressure. RESULTS CBT was significantly different between non-dense and dense groups both at initial compression (42.3±12.1 mm vs. 27.6±9.7 mm, p<0.001) and after decompression (44.6±12.3 mm vs. 29.7±9.9 mm, p<0.001), but not different based on initial compression pressure. The higher the initial compression pressure, the higher the ∆P. When the initial compression pressure was 130 N and 140 N, ∆P was significantly higher in the non-dense group, -0.1±3.7 N vs. -1.6±2.7 N (p=0.0018) and 2.9±5.8 N vs. 0.4±3.3 N (p<0.001), respectively. Goal unachieved was significantly frequent in the non-dense group (19.6% vs. 13.1%, p=0.016). CONCLUSION Breast density and initial compression pressure affected the decompression using CCF. Especially with lower initial compression pressure to the dense breast, decompression using CCF was successfully performed.
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Affiliation(s)
| | | | | | - Hiroshi Goto
- Department of Radiology, Ashiya Municipal Hospital
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Brooks JD, Christensen RAG, Sung JS, Pike MC, Orlow I, Bernstein JL, Morris EA. MRI background parenchymal enhancement, breast density and breast cancer risk factors: A cross-sectional study in pre- and post-menopausal women. NPJ Breast Cancer 2022; 8:97. [PMID: 36008488 PMCID: PMC9411561 DOI: 10.1038/s41523-022-00458-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022] Open
Abstract
Breast tissue enhances on contrast MRI and is called background parenchymal enhancement (BPE). Having high BPE has been associated with an increased risk of breast cancer. We examined the relationship between BPE and the amount of fibroglandular tissue on MRI (MRI-FGT) and breast cancer risk factors. This was a cross-sectional study of 415 women without breast cancer undergoing contrast-enhanced breast MRI at Memorial Sloan Kettering Cancer Center. All women completed a questionnaire assessing exposures at the time of MRI. Prevalence ratios (PR) and 95% confidence intervals (CI) describing the relationship between breast cancer risk factors and BPE and MRI-FGT were generated using modified Poisson regression. In multivariable-adjusted models a positive association between body mass index (BMI) and BPE was observed, with a 5-unit increase in BMI associated with a 14% and 44% increase in prevalence of high BPE in pre- and post-menopausal women, respectively. Conversely, a strong inverse relationship between BMI and MRI-FGT was observed in both pre- (PR = 0.66, 95% CI 0.57, 0.76) and post-menopausal (PR = 0.66, 95% CI 0.56, 0.78) women. Use of preventive medication (e.g., tamoxifen) was associated with having low BPE, while no association was observed for MRI-FGT. BPE is an imaging marker available from standard contrast-enhanced MRI, that is influenced by endogenous and exogenous hormonal exposures in both pre- and post-menopausal women.
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Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, University of California Davis, Sacramento, CA, USA
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Brown A, Buss EJ, Chin C, Liu G, Lee S, Rao R, Taback B, Wiechmann L, Horowitz D, Choi JC, Katz LM, Connolly EP. Targeted Intraoperative Radiotherapy (TARGIT-IORT) for Early-Stage Invasive Breast Cancer: A Single Institution Experience. Front Oncol 2022; 12:788213. [PMID: 35847872 PMCID: PMC9277011 DOI: 10.3389/fonc.2022.788213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose/Objective We present our single-institution experience in the management of invasive breast cancer with targeted intraoperative radiotherapy (TARGIT-IORT), focusing on patient suitability for IORT determined by the American Society for Radiation Oncology (ASTRO) Accelerated Partial Breast Irradiation (APBI) consensus guidelines. Materials/Methods We identified 237 patients treated for biopsy-proven early-stage invasive breast cancer using low energy x-ray TARGIT-IORT at the time of lumpectomy between September 2013 and April 2020 who were prospectively enrolled in an institutional review board (IRB) approved database. We retrospectively reviewed preoperative and postoperative clinicopathologic factors to determine each patient’s ASTRO APBI suitability (suitable, cautionary or unsuitable) according to the 2017 consensus guidelines (CG). Change in suitability group was determined based on final pathology. Kaplan-Meier methods were used to estimate the survival probability and recurrence probability across time. Results 237 patients were included in this analysis, based on preoperative clinicopathologic characteristics, 191 (80.6%) patients were suitable, 46 (19.4%) were cautionary and none were deemed unsuitable. Suitability classification changed in 95 (40%) patients based on final pathology from lumpectomy. Increasing preoperative lesion size or a body mass index (BMI) ≥ 30 kg/m2 were significant predictors for suitability group change. Forty-one (17.3%) patients received additional adjuvant whole breast radiotherapy after TARGIT-IORT. At a median follow up of 38.2 months (range 0.4 – 74.5), five (2.1%) patients had ipsilateral breast tumor recurrences (IBTR), including two (0.8%) true local recurrences defined as a recurrence in the same quadrant as the initial lumpectomy bed with the same histology as the initial tumor. IBTR occurred in 1/103 (0.09%) patient in the post-op suitable group, 4/98 (4.08%) patients in the post-op cautionary group, and no patients in the post-op unsuitable group. At 3-years, the overall survival rate was 98.4% and the local recurrence free survival rate was 97.1%. Conclusion There is a low rate of IBTR after TARGIT-IORT when used in appropriately selected patients. Change in suitability classification pre to postoperatively is common, highlighting a need for further investigation to optimize preoperative patient risk stratification in this setting. Patients who become cautionary or unsuitable based on final pathology should be considered for additional adjuvant therapy.
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Affiliation(s)
- Andrea Brown
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Elizabeth J. Buss
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Christine Chin
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Gaotong Liu
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Shing Lee
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Roshni Rao
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Brett Taback
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Lisa Wiechmann
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - David Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Julie C. Choi
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Leah M. Katz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Eileen P. Connolly
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Eileen P. Connolly,
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Abstract
In screening for breast cancer (BC), mammographic breast density (MBD) is a powerful risk factor that increases breast carcinogenesis and synergistically reduces the sensitivity of mammography. It also reduces specificity of lesion identification, leading to recalls, additional testing, and delayed and later-stage diagnoses, which result in increased health care costs. These findings provide the foundation for dense breast notification laws and lead to the increase in patient and provider interest in MBD. However, unlike other risk factors for BC, MBD is dynamic through a woman’s lifetime and is modifiable. Although MBD is known to change as a result of factors such as reproductive history and hormonal status, few conclusions have been reached for lifestyle factors such as alcohol, diet, physical activity, smoking, body mass index (BMI), and some commonly used medications. Our review examines the emerging evidence for the association of modifiable factors on MBD and the influence of MBD on BC risk. There are clear associations between alcohol use and menopausal hormone therapy and increased MBD. Physical activity and the Mediterranean diet lower the risk of BC without significant effect on MBD. Although high BMI and smoking are known risk factors for BC, they have been found to decrease MBD. The influence of several other factors, including caffeine intake, nonhormonal medications, and vitamins, on MBD is unclear. We recommend counseling patients on these modifiable risk factors and using this knowledge to help with informed decision making for tailored BC prevention strategies.
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Affiliation(s)
- Sara P Lester
- Corresponding author: Sara P. Lester, MD, Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Aparna S Kaur
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suneela Vegunta
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Chalfant JS, Mortazavi S, Lee-Felker SA. Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
To present recent literature regarding the assessment and clinical implications of background parenchymal enhancement on breast MRI.
Recent Findings
The qualitative assessment of BPE remains variable within the literature, as well as in clinical practice. Several different quantitative approaches have been investigated in recent years, most commonly region of interest-based and segmentation-based assessments. However, quantitative assessment has not become standard in clinical practice to date. Numerous studies have demonstrated a clear association between higher BPE and future breast cancer risk. While higher BPE does not appear to significantly impact cancer detection, it may result in a higher abnormal interpretation rate. BPE is also likely a marker of pathologic complete response after neoadjuvant chemotherapy, with decreases in BPE during and after neoadjuvant chemotherapy correlated with pCR. In contrast, pre-treatment BPE does not appear to be predictive of pCR. The association between BPE and prognosis is less clear, with heterogeneous results in the literature.
Summary
Assessment of BPE continues to evolve, with heterogeneity in approaches to both qualitative and quantitative assessment. The level of BPE has important clinical implications, with associations with future breast cancer risk and treatment response. BPE may also be an imaging marker of prognosis, but future research is needed on this topic.
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Lee Y, Kang E, Shin HC, Lee H, Yoon K, Kang B, Kim EK. The Effect of Body Mass Index on Initial Breast Cancer Stage Among Korean Women. Clin Breast Cancer 2021; 21:e631-e637. [PMID: 34024752 DOI: 10.1016/j.clbc.2021.04.007] [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: 09/22/2020] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between obesity and breast cancer stage is not well-known in the Korean population. This study aimed to identify the effect of body mass index (BMI) on initial breast cancer stage. PATIENTS AND METHODS Among patients who underwent surgery for breast cancer (stages 0-III) from June 2003 to December 2018, we analyzed 4510 patients for whom there were BMI data. RESULTS The average BMI of our patients was 23.5 (14.2-44.9). In total, 4.6% and 24.2% of the patients had a BMI of ≥30 and 25-29.9, respectively. In the patients with obesity, the proportion of T2 to T4 was 41.4%, which was higher than that in patients with a BMI of 25 to 29 (28.4%; P = .001) or a BMI of <25 (23.3%; P < .001). There was no difference in positive rates of estrogen receptor and progesterone receptor with BMI, but obese patients were less likely to be human epidermal growth factor receptor 2 positive. Patients with higher stages were more likely to have a higher BMI. The effect of BMI on stage was stronger in patients <50 years (odds ratio, 2.439; 95% CI, 1.783-3.335). Although there was no statistical significance, tumors >2 cm were less likely to be palpable in obese patients than in patients of normal weight (nonpalpable in 33.8% and 27.0%, respectively). CONCLUSION Our study suggests that obesity is associated with a more advanced breast cancer stage, which represents a poor prognosis, and large tumors tend to be less palpable in women with obesity.
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Affiliation(s)
- Yongwoong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Haemin Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyunghwak Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byeongju Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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8
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Tang A, Cohan CM, Hansen KS, Beattie G, Greenwood HI, Mukhtar RA. Relationship between body mass index and malignancy rates of MRI-guided breast biopsies: impact of clinicodemographic factors. Breast Cancer Res Treat 2021; 188:739-747. [PMID: 33772708 DOI: 10.1007/s10549-021-06189-5] [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: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the positive predictive value (PPV) of magnetic resonance imaging (MRI)-guided breast biopsy stratified by body mass index (BMI). Secondary endpoints include evaluation of indications for breast MRI and identification of factors associated with malignant biopsy. METHODS We retrospectively analyzed results of MRI-guided breast biopsies in a consecutive cohort of women at a single institution between 2014 and 2019. The PPV was compared between BMI subgroups and the overall group by the one-sample z-test. Factors associated with malignant biopsy were analyzed using multivariate regression analysis. RESULTS Among 427 MRI-guided breast biopsies, the PPV was significantly higher in patients with a BMI ≥ 35 compared to BMI < 35 (38.6% versus 24.5%, p = 0.043). This remained true in the 180 biopsies from high-risk screening studies, but there was no difference in PPV by BMI in the 205 biopsies performed to evaluate extent of known disease. Among this cohort who underwent MRI-guided breast biopsy, the underlying indication for MRI was less likely to be high-risk screening in those with a higher BMI or Black or Hispanic race (p = 0.015 and p < 0.001, respectively). For high-risk screening studies, only BMI ≥ 35 was associated with malignant biopsies (OR 37.5, p = 0.003). For evaluation of extent of disease studies, only increased lesion size was a significant predictor of malignant result (OR 1.01, p = 0.04). CONCLUSIONS Among women who underwent MRI-guided breast biopsy, elevated BMI was associated with increased PPV and malignant biopsies. Patients with a higher BMI or Black or Hispanic race who had MRI-guided biopsy were less likely to be undergoing high-risk screening and more likely to have breast MRI to evaluate extent of known disease.
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Affiliation(s)
- Annie Tang
- Department of Surgery, University of California, San Francisco, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94158, USA.
| | - Caitlin M Cohan
- Department of Surgery, University of California, San Francisco, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94158, USA
| | - Keith S Hansen
- Department of Surgery, University of California, San Francisco, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94158, USA
| | - Genna Beattie
- Department of Surgery, University of California, San Francisco, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94158, USA
| | - Heather I Greenwood
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Rita A Mukhtar
- Department of Surgery, University of California, San Francisco, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94158, USA
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Miller B, Chalfant H, Thomas A, Wellberg E, Henson C, McNally MW, Grizzle WE, Jain A, McNally LR. Diabetes, Obesity, and Inflammation: Impact on Clinical and Radiographic Features of Breast Cancer. Int J Mol Sci 2021; 22:2757. [PMID: 33803201 PMCID: PMC7963150 DOI: 10.3390/ijms22052757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity, diabetes, and inflammation increase the risk of breast cancer, the most common malignancy in women. One of the mainstays of breast cancer treatment and improving outcomes is early detection through imaging-based screening. There may be a role for individualized imaging strategies for patients with certain co-morbidities. Herein, we review the literature regarding the accuracy of conventional imaging modalities in obese and diabetic women, the potential role of anti-inflammatory agents to improve detection, and the novel molecular imaging techniques that may have a role for breast cancer screening in these patients. We demonstrate that with conventional imaging modalities, increased sensitivity often comes with a loss of specificity, resulting in unnecessary biopsies and overtreatment. Obese women have body size limitations that impair image quality, and diabetes increases the risk for dense breast tis-sue. Increased density is known to obscure the diagnosis of cancer on routine screening mammography. Novel molecu-lar imaging agents with targets such as estrogen receptor, human epidermal growth factor receptor 2 (HER2), pyrimi-dine analogues, and ligand-targeted receptor probes, among others, have potential to reduce false positive results. They can also improve detection rates with increased resolution and inform therapeutic decision making. These emerg-ing imaging techniques promise to improve breast cancer diagnosis in obese patients with diabetes who have dense breasts, but more work is needed to validate their clinical application.
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Affiliation(s)
- Braden Miller
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.M.); (H.C.)
| | - Hunter Chalfant
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.M.); (H.C.)
| | - Alexandra Thomas
- Department of Internal Medicine, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA;
| | - Elizabeth Wellberg
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73105, USA;
| | - Christina Henson
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73105, USA;
| | | | - William E. Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Ajay Jain
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.M.); (H.C.)
- Stephenson Cancer Center, Oklahoma City, OK 73104, USA;
| | - Lacey R. McNally
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.M.); (H.C.)
- Stephenson Cancer Center, Oklahoma City, OK 73104, USA;
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10
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Hellgren R, Saracco A, Strand F, Eriksson M, Sundbom A, Hall P, Dickman PW. The association between breast cancer risk factors and background parenchymal enhancement at dynamic contrast-enhanced breast MRI. Acta Radiol 2020; 61:1600-1607. [PMID: 32216451 PMCID: PMC7720360 DOI: 10.1177/0284185120911583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Background parenchymal enhancement (BPE) of normal tissue at breast magnetic resonance imaging is suggested to be an independent risk factor for breast cancer. Its association with established risk factors for breast cancer is not fully investigated. Purpose To study the association between BPE and risk factors for breast cancer in a healthy, non-high-risk screening population. Material and Methods We measured BPE and mammographic density and used data from self-reported questionnaires in 214 healthy women aged 43–74 years. We estimated odds ratios for the univariable association between BPE and risk factors. We then fitted an adjusted model using logistic regression to evaluate associations between BPE (high vs. low) and risk factors, including mammographic breast density. Results The majority of women had low BPE (84%). In a multivariable model, we found statistically significant associations between BPE and age (P = 0.002) and BMI (P = 0.03). We did find a significant association between systemic progesterone medication and BPE, but due to small numbers, the results should be interpreted with caution. The adjusted odds ratio for high BPE was 3.1 among women with density D (compared to B) and 2.1 for density C (compared to B). However, the association between high BPE and density was not statistically significant. We did not find statistically significant associations with any other risk factors. Conclusion Our study confirmed the known association of BPE with age and BMI. Although our results show a higher likelihood for high BPE with increasing levels of mammographic density, the association was not statistically significant.
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Affiliation(s)
- Roxanna Hellgren
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ariel Saracco
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Fredrik Strand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Thoracic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ann Sundbom
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Walsh SM, Brennan SB, Zabor EC, Rosenberger LH, Stempel M, Lebron-Zapata L, Gemignani ML. Does Breast Density Increase the Risk of Re-excision for Women with Breast Cancer Having Breast-Conservation Therapy? Ann Surg Oncol 2019; 26:4246-4253. [PMID: 31396783 DOI: 10.1245/s10434-019-07647-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women with dense breasts may have less-accurate preoperative evaluation of extent of disease, potentially affecting the achievement of negative margins. The goal of this study is to examine the association between breast density and re-excision rates in women having breast-conserving surgery for invasive breast cancer. PATIENTS AND METHODS Women with stage I/II invasive breast cancer treated with breast-conserving surgery between 1/1/2014 and 10/31/2014 were included. Breast density was assessed by two radiologists. The association between breast density and re-excision was examined using logistic regression. RESULTS Seven hundred and one women were included. Overall, 106 (15.1%) women had at least one re-excision. Younger age at diagnosis was associated with increased breast density (p < 0.001). On univariable analysis, increased breast density was associated with significantly increased odds of re-excision (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.04-1.83), as was multifocal disease, human epidermal growth factor receptor 2 (HER2) positive status, and extensive intraductal component (EIC) (all p < 0.05). On multivariable analysis, breast density remained significantly associated with increased odds of re-excision (OR 1.37, 95% CI 1.00-1.86), as did multifocality and EIC. HER2 positive status was not significantly associated with re-excision on multivariable analysis. CONCLUSIONS Women with dense breasts are more likely to need additional surgery (re-excision after breast-conserving surgery), but increased breast density did not adversely affect disease-free survival in our study. Our findings support the need for further study in developing techniques that can help decrease re-excisions for women with dense breasts who undergo breast-conserving surgery.
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Affiliation(s)
- Siun M Walsh
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sandra B Brennan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura H Rosenberger
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lizza Lebron-Zapata
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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12
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Burkheimer E, Starks L, Khan M, Oostendorp L, Melnik MK, Chung MH, Wright GP. The impact of obesity on treatment choices and outcomes in operable breast cancer. Am J Surg 2018; 217:474-477. [PMID: 30573156 DOI: 10.1016/j.amjsurg.2018.10.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Obesity has been associated with negative oncologic outcomes in breast cancer. METHODS Retrospective review of patients with operable breast cancer at a single institution from 2009 to 2012. Patients with carcinoma in situ or metastatic disease were excluded. Variables included utilization of MRI, surgical treatment, perioperative, and long-term oncologic outcomes. Primary outcome was rate of breast conserving surgery. Secondary outcomes included MRI utilization, contralateral prophylactic mastectomy, and perioperative outcomes. RESULTS There were 1566 patients included for the study, 596 (38%) of whom were obese. MRI was utilized less in obese patients (62.4% vs 51.2%, p < 0.001). Breast conserving surgery was more common in obese patients (53.1% vs 59.7%, p 0.010). There was no difference in performance of contralateral prophylactic mastectomy or post-mastectomy reconstruction. Perioperative outcomes were inferior in obese patients including increased surgical site infections (5.7% vs 11.7%, p < 0.001), return to the emergency department (2.5% vs 5.2%, p 0.004), and hospital readmissions (1.8% vs 3.7%, p 0.017). No difference in survival was observed. CONCLUSION Obese patients with operable breast cancer receive different treatment than non-obese patients, however survival and recurrence outcomes were similar among the two groups.
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Affiliation(s)
- Erica Burkheimer
- Spectrum Health General Surgery Residency Program, Grand Rapids, MI, USA; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Leah Starks
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Mariam Khan
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Leon Oostendorp
- Spectrum Health General Surgery Residency Program, Grand Rapids, MI, USA; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Marianne K Melnik
- Spectrum Health General Surgery Residency Program, Grand Rapids, MI, USA; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Mathew H Chung
- Spectrum Health General Surgery Residency Program, Grand Rapids, MI, USA; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - G Paul Wright
- Spectrum Health General Surgery Residency Program, Grand Rapids, MI, USA; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, USA
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13
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He D, Mustafi D, Fan X, Fernandez S, Markiewicz E, Zamora M, Mueller J, Sachleben JR, Brady MJ, Conzen SD, Karczmar GS. Magnetic resonance spectroscopy detects differential lipid composition in mammary glands on low fat, high animal fat versus high fructose diets. PLoS One 2018; 13:e0190929. [PMID: 29324859 PMCID: PMC5764316 DOI: 10.1371/journal.pone.0190929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/24/2017] [Indexed: 11/18/2022] Open
Abstract
The effects of consumption of different diets on the fatty acid composition in the mammary glands of SV40 T-antigen (Tag) transgenic mice, a well-established model of human triple-negative breast cancer, were investigated with magnetic resonance spectroscopy and spectroscopic imaging. Female C3(1) SV40 Tag transgenic mice (n = 12) were divided into three groups at 4 weeks of age: low fat diet (LFD), high animal fat diet (HAFD), and high fructose diet (HFruD). MRI scans of mammary glands were acquired with a 9.4 T scanner after 8 weeks on the diet. 1H spectra were acquired using point resolved spectroscopy (PRESS) from two 1 mm3 boxes on each side of inguinal mammary gland with no cancers, lymph nodes, or lymph ducts. High spectral and spatial resolution (HiSS) images were also acquired from nine 1-mm slices. A combination of Gaussian and Lorentzian functions was used to fit the spectra. The percentages of poly-unsaturated fatty acids (PUFA), mono-unsaturated fatty acids (MUFA), and saturated fatty acids (SFA) were calculated from each fitted spectrum. Water and fat peak height images (maps) were generated from HiSS data. The results showed that HAFD mice had significantly lower PUFA than both LFD (p < 0.001) and HFruD (p < 0.01) mice. The mammary lipid quantity calculated from 1H spectra was much larger in HAFD mice than in LFD (p = 0.03) but similar to HFruD mice (p = 0.10). The average fat signal intensity over the mammary glands calculated from HiSS fat maps was ~60% higher in HAFD mice than in LFD (p = 0.04) mice. The mean or median of calculated parameters for the HFruD mice were between those for LFD and HAFD mice. Therefore, PRESS spectroscopy and HiSS MRI demonstrated water and fat composition changes in mammary glands due to a Western diet, which was low in potassium, high in sodium, animal fat, and simple carbohydrates. Measurements of PUFA with MRI could be used to evaluate cancer risk, improve cancer detection and diagnosis, and guide preventative therapy.
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Affiliation(s)
- Dianning He
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China
| | - Devkumar Mustafi
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Xiaobing Fan
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Sully Fernandez
- Department of Medicine, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, Illinois, United States of America
| | - Erica Markiewicz
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Marta Zamora
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago, Chicago, Illinois, United States of America
| | - Joseph R. Sachleben
- Biomolecular NMR Core Facility, The University of Chicago, Chicago, Illinois, United States of America
| | - Matthew J. Brady
- Department of Medicine, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, Illinois, United States of America
| | - Suzanne D. Conzen
- Department of Medicine, Hematology/Oncology, Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
| | - Gregory S. Karczmar
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Ellies LG. Collagen and fibronectin: threads linking obesity and breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:S50. [PMID: 27868018 PMCID: PMC5104618 DOI: 10.21037/atm.2016.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lesley G Ellies
- Department of Pathology, UC San Diego, La Jolla, CA 92093, USA; Moores Cancer Center, UC San Diego, La Jolla, CA 92093, USA
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