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Barnard ME, DuPré NC, Heine JJ, Fowler EE, Murthy DJ, Nelleke RL, Chan A, Warner ET, Tamimi RM. Reproductive risk factors for breast cancer and association with novel breast density measurements among Hispanic, Black, and White women. Breast Cancer Res Treat 2024; 204:309-325. [PMID: 38095811 PMCID: PMC10948301 DOI: 10.1007/s10549-023-07174-w] [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: 06/14/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE There are differences in the distributions of breast cancer incidence and risk factors by race and ethnicity. Given the strong association between breast density and breast cancer, it is of interest describe racial and ethnic variation in the determinants of breast density. METHODS We characterized racial and ethnic variation in reproductive history and several measures of breast density for Hispanic (n = 286), non-Hispanic Black (n = 255), and non-Hispanic White (n = 1694) women imaged at a single hospital. We quantified associations between reproductive factors and percent volumetric density (PVD), dense volume (DV), non-dense volume (NDV), and a novel measure of pixel intensity variation (V) using multivariable-adjusted linear regression, and tested for statistical heterogeneity by race and ethnicity. RESULTS Reproductive factors most strongly associated with breast density were age at menarche, parity, and oral contraceptive use. Variation by race and ethnicity was most evident for the associations between reproductive factors and NDV (minimum p-heterogeneity:0.008) and V (minimum p-heterogeneity:0.004) and least evident for PVD (minimum p-heterogeneity:0.042) and DV (minimum p-heterogeneity:0.041). CONCLUSION Reproductive choices, particularly those related to childbearing and oral contraceptive use, may contribute to racial and ethnic variation in breast density.
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Affiliation(s)
- Mollie E Barnard
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA.
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Natalie C DuPré
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - John J Heine
- Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Erin E Fowler
- Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Divya J Murthy
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca L Nelleke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ariane Chan
- Volpara Health Technologies Ltd., Wellington, New Zealand
| | - Erica T Warner
- Clinical Translational Epidemiology Unit, Department of Medicine, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medical, New York, NY, USA
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2
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Dorgan JF, Baer HJ, Bertrand KA, LeBlanc ES, Jung S, Magder LS, Snetselaar LG, Stevens VJ, Zhang Y, Van Horn L. Childhood adiposity, serum metabolites and breast density in young women. Breast Cancer Res 2022; 24:91. [PMID: 36536390 PMCID: PMC9764542 DOI: 10.1186/s13058-022-01588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Childhood adiposity is inversely associated with young adult percent dense breast volume (%DBV) and absolute dense breast volume (ADBV), which could contribute to its protective effect for breast cancer later in life. The objective of this study was to identify metabolites in childhood serum that may mediate the inverse association between childhood adiposity and young adult breast density. METHODS Longitudinal data from 182 female participants in the Dietary Intervention Study in Children (DISC) and the DISC 2006 (DISC06) Follow-Up Study were analyzed. Childhood adiposity was assessed by anthropometry at the DISC visit with serum available that occurred closest to menarche and expressed as a body mass index (BMI) z-score. Serum metabolites were measured by untargeted metabolomics using ultra-high-performance liquid chromatography-tandem mass spectrometry. %DBV and ADBV were measured by magnetic resonance imaging at the DISC06 visit when participants were 25-29 years old. Robust mixed effects linear regression was used to identify serum metabolites associated with childhood BMI z-scores and breast density, and the R package mediation was used to quantify mediation. RESULTS Of the 115 metabolites associated with BMI z-scores (FDR < 0.20), 4 were significantly associated with %DBV and 6 with ADBV before, though not after, adjustment for multiple comparisons. Mediation analysis identified 2 unnamed metabolites, X-16576 and X-24588, as potential mediators of the inverse association between childhood adiposity and dense breast volume. X-16576 mediated 14% (95% confidence interval (CI) = 0.002, 0.46; P = 0.04) of the association of childhood adiposity with %DBV and 11% (95% CI = 0.01, 0.26; P = 0.02) of its association with ADBV. X-24588 also mediated 7% (95% CI = 0.001, 0.18; P = 0.05) of the association of childhood adiposity with ADBV. None of the other metabolites examined contributed to mediation of the childhood adiposity-%DBV association, though there was some support for contributions of lysine, valine and 7-methylguanine to mediation of the inverse association of childhood adiposity with ADBV. CONCLUSIONS Additional large longitudinal studies are needed to identify metabolites and other biomarkers that mediate the inverse association of childhood adiposity with breast density and possibly breast cancer risk.
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Affiliation(s)
- Joanne F Dorgan
- Division of Cancer Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood St., Howard Hall, Room 102E, Baltimore, MD, 21201, USA.
| | - Heather J Baer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Kimberly A Bertrand
- Slone Epidemiology Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, OR, 97227, USA
| | - Seungyoun Jung
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul, South Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Laurence S Magder
- Division of Cancer Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood St., Howard Hall, Room 102E, Baltimore, MD, 21201, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, 52242, USA
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, Portland, OR, 97227, USA
| | - Yuji Zhang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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3
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Duderstadt EL, Samuelson DJ. Rat Mammary carcinoma susceptibility 3 (Mcs3) pleiotropy, socioenvironmental interaction, and comparative genomics with orthologous human 15q25.1-25.2. G3 (BETHESDA, MD.) 2022; 13:6782958. [PMID: 36315068 PMCID: PMC9836357 DOI: 10.1093/g3journal/jkac288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022]
Abstract
Genome-wide association studies of breast cancer susceptibility have revealed risk-associated genetic variants and nominated candidate genes; however, the identification of causal variants and genes is often undetermined by genome-wide association studies. Comparative genomics, utilizing Rattus norvegicus strains differing in susceptibility to mammary tumor development, is a complimentary approach to identify breast cancer susceptibility genes. Mammary carcinoma susceptibility 3 (Mcs3) is a Copenhagen (COP/NHsd) allele that confers resistance to mammary carcinomas when introgressed into a mammary carcinoma susceptible Wistar Furth (WF/NHsd) genome. Here, Mcs3 was positionally mapped to a 7.2-Mb region of RNO1 spanning rs8149408 to rs107402736 (chr1:143700228-150929594, build 6.0/rn6) using WF.COP congenic strains and 7,12-dimethylbenz(a)anthracene-induced mammary carcinogenesis. Male and female WF.COP-Mcs3 rats had significantly lower body mass compared to the Wistar Furth strain. The effect on female body mass was observed only when females were raised in the absence of males indicating a socioenvironmental interaction. Furthermore, female WF.COP-Mcs3 rats, raised in the absence of males, did not develop enhanced lobuloalveolar morphologies compared to those observed in the Wistar Furth strain. Human 15q25.1-25.2 was determined to be orthologous to rat Mcs3 (chr15:80005820-82285404 and chr15:83134545-84130720, build GRCh38/hg38). A public database search of 15q25.1-25.2 revealed genome-wide significant and nominally significant associations for body mass traits and breast cancer risk. These results support the existence of a breast cancer risk-associated allele at human 15q25.1-25.2 and warrant ultrafine mapping of rat Mcs3 and human 15q25.1-25.2 to discover novel causal genes and variants.
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Affiliation(s)
- Emily L Duderstadt
- Present address for Emily L. Duderstadt: Procter and Gamble (P&G), 8700 Mason-Montgomery Road, Mason, OH 45040, USA
| | - David J Samuelson
- Corresponding author: Department of Biochemistry & Molecular Genetics, University of Louisville School of Medicine, 319 Abraham Flexner Way, Louisville, KY 40202, USA.
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Ward SV, Burton A, Tamimi RM, Pereira A, Garmendia ML, Pollan M, Boyd N, Dos-Santos-Silva I, Maskarinec G, Perez-Gomez B, Vachon C, Miao H, Lajous M, López-Ridaura R, Bertrand K, Kwong A, Ursin G, Lee E, Ma H, Vinnicombe S, Moss S, Allen S, Ndumia R, Vinayak S, Teo SH, Mariapun S, Peplonska B, Bukowska-Damska A, Nagata C, Hopper J, Giles G, Ozmen V, Aribal ME, Schüz J, Van Gils CH, Wanders JOP, Sirous R, Sirous M, Hipwell J, Kim J, Lee JW, Dickens C, Hartman M, Chia KS, Scott C, Chiarelli AM, Linton L, Flugelman AA, Salem D, Kamal R, McCormack V, Stone J. The association of age at menarche and adult height with mammographic density in the International Consortium of Mammographic Density. Breast Cancer Res 2022; 24:49. [PMID: 35836268 PMCID: PMC9284807 DOI: 10.1186/s13058-022-01545-9] [Citation(s) in RCA: 3] [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: 02/07/2022] [Accepted: 06/29/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk. METHODS Participants were 10,681 breast-cancer-free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemiologic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi-level linear regression models estimated changes in square-root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult height in pooled analyses and population-specific meta-analyses. Models were adjusted for age at mammogram, body mass index, menopausal status, hormone therapy use, mammography view and type, mammographic density assessor, parity and height/age at menarche. RESULTS In pooled analyses, later age at menarche was associated with higher per cent density (β√PD = 0.023 SE = 0.008, P = 0.003) and larger dense area (β√DA = 0.032 SE = 0.010, P = 0.002). Taller women had larger dense area (β√DA = 0.069 SE = 0.028, P = 0.012) and higher per cent density (β√PD = 0.044, SE = 0.023, P = 0.054), although the observed effect on per cent density depended upon the adjustment used for body size. Similar overall effect estimates were observed in meta-analyses across population groups. CONCLUSIONS In one of the largest international studies to date, later age at menarche was positively associated with mammographic density. This is in contrast to its association with breast cancer risk, providing little evidence of mediation. Increased height was also positively associated with mammographic density, particularly dense area. These results suggest a complex relationship between growth and development, mammographic density and breast cancer risk. Future studies should evaluate the potential mediation of the breast cancer effects of taller stature through absolute breast density.
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Affiliation(s)
- Sarah V Ward
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Anya Burton
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
- Translation Health Sciences, University of Bristol, Bristol, UK
| | - Rulla M Tamimi
- Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, USA
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | | | - Marina Pollan
- Cancer and Environmental Epidemiology Unit, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Norman Boyd
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Beatriz Perez-Gomez
- Cancer and Environmental Epidemiology Unit, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hui Miao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Martín Lajous
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | - Ava Kwong
- Division of Breast Surgery, Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Department of Surgery and Cancer Genetics Center, Hong Kong Sanatorium and Hospital, Pok Fu Lam, Hong Kong, China
- Hong Kong Hereditary Breast Cancer Family Registry, Pok Fu Lam, Hong Kong, China
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eunjung Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Huiyan Ma
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Sarah Vinnicombe
- Division of Cancer Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK
| | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Steve Allen
- Department of Imaging, Royal Marsden NHS Foundation Trust, London, UK
| | - Rose Ndumia
- Aga Khan University Hospital, Nairobi, Kenya
| | | | - Soo-Hwang Teo
- Breast Cancer Research Group, University Malaya Medical Centre, University Malaya, Kuala Lumpur, Malaysia
- Cancer Research Malaysia, Subang Jaya, Malaysia
| | | | - Beata Peplonska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Łódź, Poland
| | - Agnieszka Bukowska-Damska
- Department of Physiology, Pathophysiology and Clinical Immunology,, Medical University of Lodz., Łódź, Poland
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - John Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Graham Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Vahit Ozmen
- Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Erkin Aribal
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Joachim Schüz
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Carla H Van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna O P Wanders
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Reza Sirous
- Radiology Department, George Washington University Hospital, Washington, DC, USA
| | - Mehri Sirous
- Radiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - John Hipwell
- Centre for Medical Image Computing, University College London, London, UK
| | - Jisun Kim
- Asan Medical Center, Seoul, Republic of Korea
| | | | - Caroline Dickens
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Kee-Seng Chia
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Christopher Scott
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Anna M Chiarelli
- Ontario Breast Screening Program, Cancer Care Ontario, Toronto, ON, Canada
| | - Linda Linton
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anath Arzee Flugelman
- National Cancer Control Center, Lady Davis Carmel Medical Center, Faculty of Medicine, Technion-Israel Institute Technology, Haifa, Israel
| | - Dorria Salem
- Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt
| | - Rasha Kamal
- Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | - Jennifer Stone
- School of Population and Global Health, The University of Western Australia, Perth, Australia
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5
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Kamal RM, Mostafa S, Salem D, ElHatw AM, Mokhtar SM, Wessam R, Fakhry S. Body mass index, breast density, and the risk of breast cancer development in relation to the menopausal status; results from a population-based screening program in a native African-Arab country. Acta Radiol Open 2022; 11:20584601221111704. [PMID: 35795247 PMCID: PMC9252007 DOI: 10.1177/20584601221111704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Risk factors are traits or behaviors that have an influence on the development of breast cancer (BC). Awareness of the prevalent risk factors can guide in developing prevention interventions. Purpose To evaluate the correlation between the breast density, body mass index, and the risk of breast cancer development in relation to the menopausal status in a native African-Arab population. Material and methods The study included 30,443 screened females who were classified into cancer and non-cancer groups and each group was further sub-classified into pre- and postmenopausal groups. The breast density (BD) was reported and subjectively classified according to the 2013 ACR BI-RADS breast density classification. The weight and height were measured, and the body mass index (BMI) was calculated and classified according to the WHO BMI classification. Results A statistically significant difference was calculated between the mean BMI in the cancer and non-cancer groups (p: .027) as well as between the pre- and postmenopausal groups (p < .001). A positive statistically insignificant correlation was calculated between the breast density and the risk of breast cancer in the premenopausal group (OR: 1.062, p: .919) and a negative highly significant correlation was calculated in the postmenopausal group (OR: 0.234, p < .001). Conclusion BMI and BD are inversely associated with each other. The current studied population presented unique ethnic characteristics, where a decreased BD and an increased BMI were found to be independent risk factors for developing breast cancer.
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Affiliation(s)
- Rasha M Kamal
- Department of Radiology, Cairo University – Baheya Breast Cancer Foundation, Giza, Egypt
| | - Salma Mostafa
- Department of Radiology, Cairo University, Giza, Egypt
| | - Dorria Salem
- Department of Radiology, Cairo University, Giza, Egypt
| | - Ahmed M ElHatw
- Resident of Radiology, National Cancer Institute, Cairo, Egypt
| | | | - Rasha Wessam
- Department of Radiology, Cairo University – Baheya Breast Cancer Foundation, Giza, Egypt
| | - Sherihan Fakhry
- Department of Radiology, Cairo University – Baheya Breast Cancer Foundation, Giza, Egypt
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Yoon LS, Jacobs JP, Hoehner J, Pereira A, Gana JC, Corvalán C, Michels KB. The Association Between Breast Density and Gut Microbiota Composition at 2 Years Post-Menarche: A Cross-Sectional Study of Adolescents in Santiago, Chile. Front Cell Infect Microbiol 2022; 11:794610. [PMID: 34976871 PMCID: PMC8718921 DOI: 10.3389/fcimb.2021.794610] [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] [Accepted: 11/22/2021] [Indexed: 01/04/2023] Open
Abstract
The gut microbiome has been linked to breast cancer via immune, inflammatory, and hormonal mechanisms. We examined the relation between adolescent breast density and gut microbial composition and function in a cohort of Chilean girls. This cross-sectional study included 218 female participants in the Growth and Obesity Cohort Study who were 2 years post-menarche. We measured absolute breast fibroglandular volume (aFGV) and derived percent FGV (%FGV) using dual energy X-ray absorptiometry. All participants provided a fecal sample. The gut microbiome was characterized using 16S ribosomal RNA sequencing of the V3-V4 hypervariable region. We examined alpha diversity and beta diversity across terciles of %FGV and aFGV. We used MaAsLin2 for multivariable general linear modeling to assess differential taxa and predicted metabolic pathway abundance (MetaCyc) between %FGV and aFGV terciles. All models were adjusted for potential confounding variables and corrected for multiple comparisons. The mean %FGV and aFGV was 49.5% and 217.0 cm3, respectively, among study participants. Similar median alpha diversity levels were found across %FGV and aFGV terciles when measured by the Shannon diversity index (%FGV T1: 4.0, T2: 3.9, T3: 4.1; aFGV T1: 4.0, T2: 4.0, T3: 4.1). %FGV was associated with differences in beta diversity (R2 =0.012, p=0.02). No genera were differentially abundant when comparing %FGV nor aFGV terciles after adjusting for potential confounders (q > 0.56 for all genera). We found no associations between predicted MetaCyc pathway abundance and %FGV and aFGV. Overall, breast density measured at 2 years post-menarche was not associated with composition and predicted function of the gut microbiome among adolescent Chilean girls.
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Affiliation(s)
- Lara S Yoon
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Jonathan P Jacobs
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.,Division of Gastroenterology, Hepatology and Parenteral Nutrition, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | | | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Juan Cristóbal Gana
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States.,Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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7
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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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8
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Vegunta S, Kling JM, Patel BK. Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals. Mayo Clin Proc 2021; 96:2891-2904. [PMID: 34686363 DOI: 10.1016/j.mayocp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient's mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ.
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Bhavika K Patel
- Division of Breast Imaging, Mayo Clinic Hospital, Phoenix, AZ
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9
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Atakpa EC, Brentnall AR, Astley S, Cuzick J, Evans DG, Warren RML, Howell A, Harvie M. The Relationship between Body Mass Index and Mammographic Density during a Premenopausal Weight Loss Intervention Study. Cancers (Basel) 2021; 13:3245. [PMID: 34209579 PMCID: PMC8269424 DOI: 10.3390/cancers13133245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
We evaluated the association between short-term change in body mass index (BMI) and breast density during a 1 year weight-loss intervention (Manchester, UK). We included 65 premenopausal women (35-45 years, ≥7 kg adult weight gain, family history of breast cancer). BMI and breast density (semi-automated area-based, automated volume-based) were measured at baseline, 1 year, and 2 years after study entry (1 year post intervention). Cross-sectional (between-women) and short-term change (within-women) associations between BMI and breast density were measured using repeated-measures correlation coefficients and multivariable linear mixed models. BMI was positively correlated with dense volume between-women (r = 0.41, 95%CI: 0.17, 0.61), but less so within-women (r = 0.08, 95%CI: -0.16, 0.28). There was little association with dense area (between-women r = -0.12, 95%CI: -0.38, 0.16; within-women r = 0.01, 95%CI: -0.24, 0.25). BMI and breast fat were positively correlated (volume: between r = 0.77, 95%CI: 0.69, 0.84, within r = 0.58, 95%CI: 0.36, 0.75; area: between r = 0.74, 95%CI: 0.63, 0.82, within r = 0.45, 95%CI: 0.23, 0.63). Multivariable models reported similar associations. Exploratory analysis suggested associations between BMI gain from 20 years and density measures (standard deviation change per +5 kg/m2 BMI: dense area: +0.61 (95%CI: 0.12, 1.09); fat volume: -0.31 (95%CI: -0.62, 0.00)). Short-term BMI change is likely to be positively associated with breast fat, but we found little association with dense tissue, although power was limited by small sample size.
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Affiliation(s)
- Emma C. Atakpa
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (E.C.A.); (A.R.B.); (J.C.)
| | - Adam R. Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (E.C.A.); (A.R.B.); (J.C.)
| | - Susan Astley
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
- Manchester Breast Centre, The Christie Hospital, Manchester M23 9LT, UK
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (E.C.A.); (A.R.B.); (J.C.)
| | - D. Gareth Evans
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
- Manchester Breast Centre, The Christie Hospital, Manchester M23 9LT, UK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester M23 9LT, UK
- Manchester Centre for Genomic Medicine, NW Genomic Laboratory Hub, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
- Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, Faculty of Biology, School of Biological Sciences, Medicine and Health, University of Manchester, Manchester M23 9LT, UK
| | - Ruth M. L. Warren
- Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK;
- Girton College, University of Cambridge, Cambridge CB3 0JG, UK
| | - Anthony Howell
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
- Manchester Breast Centre, The Christie Hospital, Manchester M23 9LT, UK
- Manchester Academic Health Science Centre, Division of Cancer Sciences, Medicine and Health, University of Manchester, Manchester M23 9LT, UK
| | - Michelle Harvie
- Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (S.A.); (D.G.E.); (A.H.)
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10
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Pubertal mammary gland development is a key determinant of adult mammographic density. Semin Cell Dev Biol 2020; 114:143-158. [PMID: 33309487 DOI: 10.1016/j.semcdb.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 01/04/2023]
Abstract
Mammographic density refers to the radiological appearance of fibroglandular and adipose tissue on a mammogram of the breast. Women with relatively high mammographic density for their age and body mass index are at significantly higher risk for breast cancer. The association between mammographic density and breast cancer risk is well-established, however the molecular and cellular events that lead to the development of high mammographic density are yet to be elucidated. Puberty is a critical time for breast development, where endocrine and paracrine signalling drive development of the mammary gland epithelium, stroma, and adipose tissue. As the relative abundance of these cell types determines the radiological appearance of the adult breast, puberty should be considered as a key developmental stage in the establishment of mammographic density. Epidemiological studies have pointed to the significance of pubertal adipose tissue deposition, as well as timing of menarche and thelarche, on adult mammographic density and breast cancer risk. Activation of hypothalamic-pituitary axes during puberty combined with genetic and epigenetic molecular determinants, together with stromal fibroblasts, extracellular matrix, and immune signalling factors in the mammary gland, act in concert to drive breast development and the relative abundance of different cell types in the adult breast. Here, we discuss the key cellular and molecular mechanisms through which pubertal mammary gland development may affect adult mammographic density and cancer risk.
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11
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Yaghjyan L, Wijayabahu A, Eliassen AH, Colditz G, Rosner B, Tamimi RM. Associations of aspirin and other anti-inflammatory medications with mammographic breast density and breast cancer risk. Cancer Causes Control 2020; 31:827-837. [PMID: 32476101 DOI: 10.1007/s10552-020-01321-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We investigated the associations of aspirin and other non-steroid anti-inflammatory drugs with mammographic breast density (MBD) and their interactions in relation to breast cancer risk. METHODS This study included 3,675 cancer-free women within the Nurses' Health Study (NHS) and Nurses' Health Study II (NHSII) cohorts. Percent breast density (PD), absolute dense area (DA), and non-dense area (NDA) were measured from digitized film mammograms using a computer-assisted thresholding technique; all measures were square root-transformed. Information on medication use was collected in 1980 (NHS) and 1989 (NHSII) and updated biennially. Medication use was defined as none, past or current; average cumulative dose and frequency were calculated for all past or current users from all bi-annual questionnaires preceding the mammogram date. We used generalized linear regression to quantify associations of medications with MBD. Two-way interactions were examined in logistic regression models. RESULTS In multivariate analysis, none of the anti-inflammatory medications were associated with PD, DA, and NDA. We found no interactions of any of the medications with PD with respect to breast cancer risk (all p-interactions > 0.05). However, some of the aspirin variables appeared to have positive associations with breast cancer risk limited only to women with PD 10-24% (past aspirin OR 1.56, 95% CI 1.03-2.35; current aspirin with < 5 years of use OR 1.82, 95% CI 1.01-3.28; current aspirin with ≥ 5 years of use OR 1.89, 95% CI 1.26-2.82). CONCLUSIONS Aspirin and NSAIDs are not associated with breast density measures. We found no interactions of aspirin with MBD in relation to breast cancer risk.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA.
| | - Akemi Wijayabahu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Graham Colditz
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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12
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Park B, Lim SE, Ahn H, Yoon J, Choi YS. Heterogenous Effect of Risk Factors on Breast Cancer across the Breast Density Categories in a Korean Screening Population. Cancers (Basel) 2020; 12:cancers12061391. [PMID: 32481621 PMCID: PMC7352951 DOI: 10.3390/cancers12061391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022] Open
Abstract
We evaluated the heterogeneity of the effect of known risk factors on breast cancer development based on breast density by using the Breast Imaging-Reporting and Data System (BI-RADS). In total, 4,898,880 women, aged 40-74 years, who participated in the national breast cancer screening program in 2009-2010 were followed up to December 2018. Increased age showed a heterogeneous association with breast cancer (1-year hazard ratio (HR) = 0.92, 1.00 (reference), 1.03, and 1.03 in women with BI-RADS density category 1, 2, 3, and 4, respectively; P-heterogeneity < 0.001). More advanced age at menopause increased breast cancer risk in all BI-RADS categories. This was more prominent in women with BI-RADS density category 1 but less prominent in women in other BI-RADS categories (P-heterogeneity = 0.009). In postmenopausal women, a family history of breast cancer, body mass index ≥ 25 kg/m2, and smoking showed a heterogeneous association with breast cancer across all BI-RADS categories. Other risk factors including age at menarche, menopause, hormone replacement therapy after menopause, oral contraceptive use, and alcohol consumption did not show a heterogeneous association with breast cancer across the BI-RADS categories. Several known risk factors of breast cancer had a heterogeneous effect on breast cancer development across breast density categories, especially in postmenopausal women.
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Affiliation(s)
- Boyoung Park
- Department of Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (S.-E.L.); (H.A.)
- Correspondence: ; Tel.: +82-2-2220-0682
| | - Se-Eun Lim
- Department of Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (S.-E.L.); (H.A.)
| | - HyoJin Ahn
- Department of Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (S.-E.L.); (H.A.)
| | - Junghyun Yoon
- Graduate School of Public Health, Hanyang University, Seoul 04763, Korea;
| | - Yun Su Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
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13
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Kanbayti IH, Rae WID, McEntee MF, Al-Foheidi M, Ashour S, Turson SA, Ekpo EU. Is mammographic density a marker of breast cancer phenotypes? Cancer Causes Control 2020; 31:749-765. [PMID: 32410205 DOI: 10.1007/s10552-020-01316-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the association between mammographic density (MD) phenotypes and both clinicopathologic features of breast cancer (BC) and tumor location. METHODS MD was measured for 297 BC-affected females using qualitative (visual method) and quantitative (fully automated area-based method) approaches. Radiologists' description, visible external markers, and surgical scar were used to establish the location of tumors. Binary logistic regression models were used to assess the association between MD phenotypes and BC clinicopathologic features. RESULTS Categorical and numerical MD measures showed no association with clinicopathologic features of BC (p > 0.05). Participants with higher BI-RADS scores [(51-75% glandular) and (> 75% glandular)] (p < 0.001), and percent density (PD) categories [PD (21-49%) and PD ≥ 50%] (p = 0.01) were more likely to have tumors emanating from dense areas. Additionally, tumors were commonly found in dense regions of the breast among patients with higher medians of PD (p = 0.001), dense area (DA) (p = 0.02), and lower medians of non-dense area (NDA) (p < 0.001). Adjusted logistic regression models showed that high BI-RADS density (> 75% glandular) has an almost fivefold increased odds of tumors developing within dense areas (OR 4.99, 95% CI 0.93-25.9; p = 0.05. PD (OR 1.02, 95% CI 1-1.03, p = 0.002) and NDA (OR 0.99, 95% CI 0.991-0.997, p < 0.001) had very small effect on tumor location. Compared to tumors within non-dense areas, tumors in dense areas tended to exhibit human epidermal growth factor receptor 2 positive (p = 0.05) and carcinoma in situ (p = 0.01) characteristics. CONCLUSION MD shows no significant association with clinicopathologic features of BC. However, BC was more likely to originate from dense tissue, with tumors in dense regions having human epidermal growth receptor 2 positive and carcinoma in situ characteristics.
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Affiliation(s)
- Ibrahem H Kanbayti
- Diagnostic Radiography Technology Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia. .,Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Faculty of Health Science, University of Sydney, Cumberland Campus C42
- 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - William I D Rae
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark F McEntee
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Medicine Roinn na Sláinte, UG 12 Áras Watson
- Brookfield Health Sciences, Cork, T12 AK54, Ireland
| | - Meteb Al-Foheidi
- King Saud Bin Abdulaziz University for Health Science-National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Sawsan Ashour
- Radiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Smeera A Turson
- Radiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ernest U Ekpo
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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14
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In utero DDT exposure and breast density before age 50. Reprod Toxicol 2019; 92:85-90. [PMID: 31711904 DOI: 10.1016/j.reprotox.2019.11.002] [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: 03/01/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
Prior studies in the Child Health and Development Studies (CHDS) found in utero exposure to the pesticide, dichlorodiphenyltrichloroethane (DDT), increased breast cancer risk by age 52. Mammographic density is considered a primary risk factor for breast cancer. We conducted a study of 309 daughters from the CHDS to examine in utero DDT exposure and mammographic density in midlife. Among daughters with high (>75th percentile) exposure to p,p'-Dichlorodiphenyldichloroethylene (DDE), p,p'-DDT was significantly correlated with increased dense area and percent density regardless of her body mass in midlife. In the subset of women with lower (<75th percentile) p,p-DDE, p,p'-DDT was associated with increased non-dense breast area. This was explained by adjustment for midlife BMI suggesting that p,p'-DDT may be obesogenic. In aggregate our findings indicate that early life p,p'-DDT exposure impacts breast density in a complex way that depends on the hosts biological ability to sequester and process DDT and levels of exposure.
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15
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McDonald JA, Cirillo PM, Tehranifar P, Krigbaum NY, Engmann NJ, Cohn BA, Terry MB. In utero DDT exposure and breast density in early menopause by maternal history of breast cancer. Reprod Toxicol 2019; 92:78-84. [PMID: 31421228 DOI: 10.1016/j.reprotox.2019.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
We examined the relationship between intrauterine dichlorodiphenyltrichloroethane (DDT) exposure (o,p'-DDT, p,p'-DDT, and p,p'-DDE) and mammographic breast density (MBD) in midlife, one of the strongest risk factors for breast cancer. We focused our analyses on o,p'-DDT exposure given our previous report of a positive association between intrauterine o,p'-DDT exposure and daughter's breast cancer (BC) risk. Here we estimated associations of intrauterine serum DDTs with MBD in 224 daughters of women in the Child Health and Development Studies pregnancy cohort whose mothers did not develop BC (MBCa-) and 156 daughters whose mothers did develop BC (MBCa+). In MBCa+ daughters, highest relative to lowest quartile of o,p'-DDT exposure was associated with a 17-unit higher dense area (95% CI = 2.6-31.2; Ptrend = 0.01). We did not observe an association between o,p'-DDT and density measures in MBCa- daughters. MBD, an intermediate marker of BC risk, may be affected by intrauterine DDT exposures; MBCa status may modify the association.
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Affiliation(s)
- Jasmine A McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, New York, United States; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, 10032, United States.
| | - Piera M Cirillo
- Child Health and Development Studies, Public Health Institute, Berkeley, California, United States.
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, New York, United States; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, 10032, United States.
| | - Nickilou Y Krigbaum
- Child Health and Development Studies, Public Health Institute, Berkeley, California, United States.
| | - Natalie J Engmann
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, New York, United States.
| | - Barbara A Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, California, United States.
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, New York, United States; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, 10032, United States.
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16
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Moran O, Eisen A, Demsky R, Blackmore K, Knight JA, Panchal S, Ginsburg O, Zbuk K, Yaffe M, Metcalfe KA, Narod SA, Kotsopoulos J. Predictors of mammographic density among women with a strong family history of breast cancer. BMC Cancer 2019; 19:631. [PMID: 31242899 PMCID: PMC6595553 DOI: 10.1186/s12885-019-5855-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mammographic density is one of the strongest risk factors for breast cancer. In the general population, mammographic density can be modified by various exposures; whether this is true for women a strong family history is not known. Thus, we evaluated the association between reproductive, hormonal, and lifestyle risk factors and mammographic density among women with a strong family history of breast cancer but no BRCA1 or BRCA2 mutation. METHODS We included 97 premenopausal and 59 postmenopausal women (age range: 27-68 years). Risk factor data was extracted from the research questionnaire closest in time to the mammogram performed nearest to enrollment. The Cumulus software was used to measure percent density, dense area, and non-dense area for each mammogram. Multivariate generalized linear models were used to evaluate the relationships between breast cancer risk factors and measures of mammographic density, adjusting for relevant covariates. RESULTS Among premenopausal women, those who had two live births had a mean percent density of 28.8% vs. 41.6% among women who had one live birth (P=0.04). Women with a high body weight had a lower mean percent density compared to women with a low body weight among premenopausal (17.6% vs. 33.2%; P=0.0006) and postmenopausal women (8.7% vs. 14.7%; P=0.04). Among premenopausal women, those who smoked for 14 years or longer had a lower mean dense area compared to women who smoked for a shorter duration (25.3cm2 vs. 53.1cm2; P=0.002). Among postmenopausal women, former smokers had a higher mean percent density (19.5% vs. 10.8%; P=0.003) and dense area (26.9% vs. 16.4%; P=0.01) compared to never smokers. After applying the Bonferroni correction, the association between body weight and percent density among premenopausal women remained statistically significant. CONCLUSIONS In this cohort of women with a strong family history of breast cancer, body weight was associated with mammographic density. These findings suggest that mammographic density may explain the underlying relationship between some of these risk factors and breast cancer risk, and lend support for the inclusion of mammographic density into risk prediction models.
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Affiliation(s)
- Olivia Moran
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Rochelle Demsky
- Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | | | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Seema Panchal
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ophira Ginsburg
- Perlmutter Cancer Centre, Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Kevin Zbuk
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Martin Yaffe
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Kelly A Metcalfe
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada. .,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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17
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Engmann NJ, Scott CG, Jensen MR, Winham S, Miglioretti DL, Ma L, Brandt K, Mahmoudzadeh A, Whaley DH, Hruska C, Wu F, Norman AD, Hiatt RA, Heine J, Shepherd J, Pankratz VS, Vachon CM, Kerlikowske K. Combined effect of volumetric breast density and body mass index on breast cancer risk. Breast Cancer Res Treat 2019; 177:165-173. [PMID: 31129803 DOI: 10.1007/s10549-019-05283-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/16/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Breast density and body mass index (BMI) are used for breast cancer risk stratification. We evaluate whether the positive association between volumetric breast density and breast cancer risk is strengthened with increasing BMI. METHODS The San Francisco Mammography Registry and Mayo Clinic Rochester identified 781 premenopausal and 1850 postmenopausal women with breast cancer diagnosed between 2007 and 2015 that had a screening digital mammogram at least 6 months prior to diagnosis. Up to three controls (N = 3535) were matched per case on age, race, date, mammography machine, and state. Volumetric percent density (VPD) and dense volume (DV) were measured with Volpara™. Breast cancer risk was assessed with logistic regression stratified by menopause status. Multiplicative interaction tests assessed whether the association of density measures was differential by BMI categories. RESULTS The increased risk of breast cancer associated with VPD was strengthened with higher BMI for both premenopausal (pinteraction = 0.01) and postmenopausal (pinteraction = 0.0003) women. For BMI < 25, 25-30, and ≥ 30 kg/m2, ORs for breast cancer for a 1 SD increase in VPD were 1.24, 1.65, and 1.97 for premenopausal, and 1.20, 1.55, and 2.25 for postmenopausal women, respectively. ORs for breast cancer for a 1 SD increase in DV were 1.39, 1.33, and 1.51 for premenopausal (pinteraction = 0.58), and 1.31, 1.34, and 1.65 (pinteraction = 0.03) for postmenopausal women for BMI < 25, 25-30 and ≥ 30 kg/m2, respectively. CONCLUSIONS The effect of volumetric percent density on breast cancer risk is strongest in overweight and obese women. These associations have clinical relevance for informing prevention strategies.
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Affiliation(s)
| | | | | | | | - Diana L Miglioretti
- University of California, Davis, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Lin Ma
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | | | | | | | | | | | | | - Robert A Hiatt
- Department of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, USA
| | | | | | - V Shane Pankratz
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | | | - Karla Kerlikowske
- Department of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, USA.
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18
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Terry MB, Cohn BA, Goldberg M, Flom JD, Wei Y, Houghton LC, Tehranifar P, McDonald JA, Protacio A, Cirillo P, Michels KB. Do Birth Weight and Weight Gain During Infancy and Early Childhood Explain Variation in Mammographic Density in Women in Midlife? Results From Cohort and Sibling Analyses. Am J Epidemiol 2019; 188:294-304. [PMID: 30383202 DOI: 10.1093/aje/kwy229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023] Open
Abstract
High birth weight is associated with increased breast cancer risk and, less consistently, with higher mammographic density. In contrast, adolescent body size has been consistently, negatively associated with both MD and breast cancer risk. It is unclear when the direction of these associations changes and whether weight gain in infancy is associated with MD. We evaluated the associations of birth weight and postnatal weight (measured at 4 months, 1 year, and 4 years) by absolute and velocity measures (relative within-cohort percentile changes) with adult mammographic density, assessed using a computer-assisted thresholding program (Cumulus), using linear regression models with generalized estimating equations to account for correlation between siblings in the Early Determinants of Mammographic Density study (1959-2008; n = 700 women with 116 sibling sets; mean age = 44.1 years). Birth weight was positively associated with dense area (per 1-kg increase, β = 3.36, 95% confidence interval (CI): 0.06, 6.66). Weight gains from 0 months to 4 months and 1 year to 4 years were negatively associated with dense area (for 10-unit increase in weight percentile, β = -0.65, 95% CI: -1.23, -0.07, and β = -1.07, 95% CI: -1.98, -0.16, respectively). Findings were similar in the sibling subset. These results support the hypothesis that high birth weight is positively associated with increased breast density and suggest that growth spurts starting in early infancy reduce mammographic dense area in adulthood.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
- Imprints Center for Genetic and Environmental Lifecourse Studies, Mailman School of Public Health, Columbia University, New York, New York
| | - Barbara A Cohn
- The Child Health and Development Studies, Public Health Institute, Berkeley, California
| | - Mandy Goldberg
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Julie D Flom
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Lauren C Houghton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | - Jasmine A McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Angeline Protacio
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Piera Cirillo
- The Child Health and Development Studies, Public Health Institute, Berkeley, California
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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19
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Coughlin SS. Epidemiology of Breast Cancer in Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:9-29. [PMID: 31456177 DOI: 10.1007/978-3-030-20301-6_2] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epidemiologic studies have contributed importantly to current knowledge of environmental and genetic risk factors for breast cancer. Worldwide, breast cancer is an important cause of human suffering and premature mortality among women. In the United States, breast cancer accounts for more cancer deaths in women than any site other than lung cancer. A variety of risk factors for breast cancer have been well-established by epidemiologic studies including race, ethnicity, family history of cancer, and genetic traits, as well as modifiable exposures such as increased alcohol consumption, physical inactivity, exogenous hormones, and certain female reproductive factors. Younger age at menarche, parity, and older age at first full-term pregnancy may influence breast cancer risk through long-term effects on sex hormone levels or by other biological mechanisms. Recent studies have suggested that triple negative breast cancers may have a distinct etiology. Genetic variants and mutations in genes that code for proteins having a role in DNA repair pathways and the homologous recombination of DNA double stranded breaks (APEX1, BRCA1, BRCA2, XRCC2, XRCC3, ATM, CHEK2, PALB2, RAD51, XPD), have been implicated in some cases of breast cancer.
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Affiliation(s)
- Steven S Coughlin
- Division of Epidemiology, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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20
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Binder AM, Stiemsma LT, Keller K, van Otterdijk SD, Mericq V, Pereira A, Santos JL, Shepherd J, Michels KB. Inverse association between estrogen receptor-α DNA methylation and breast composition in adolescent Chilean girls. Clin Epigenetics 2018; 10:122. [PMID: 30286806 PMCID: PMC6172836 DOI: 10.1186/s13148-018-0553-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background Estrogen receptor-α (ER-α) is a transcriptional regulator, which mediates estrogen-dependent breast development, as well as breast tumorigenesis. The influence of epigenetic regulation of ER-α on adolescent breast composition has not been previously studied and could serve as a marker of pubertal health and susceptibility to breast cancer. We investigated the association between ER-α DNA methylation in leukocytes and breast composition in adolescent Chilean girls enrolled in the Growth and Obesity Cohort Study (GOCS) in Santiago, Chile. Breast composition (total breast volume (BV; cm3), fibroglandular volume (FGV; cm3), and percent fibroglandular volume (%FGV)) was measured at breast Tanner stage 4 (B4). ER-α promoter DNA methylation was assessed by pyrosequencing in blood samples collected at breast Tanner stages 2 (B2; n = 256) and B4 (n = 338). Results After adjusting for fat percentage at breast density measurement, ER-α methylation at B2, and cellular heterogeneity, we observed an inverse association between B4 average ER-α DNA methylation and BV and FGV. Geometric mean BV was 15% lower (95% CI: − 28%, − 1%) among girls in the highest quartile of B4 ER-α methylation (6.96–23.60%) relative to the lowest (0.78–3.37%). Similarly, FGV was 19% lower (95% CI: − 33%, − 2%) among girls in the highest quartile of B4 ER-α methylation relative to the lowest. The association between ER-α methylation and breast composition was not significantly modified by body fat percentage and was not influenced by pubertal timing. Conclusions These findings suggest that the methylation profile of ER-α may modulate adolescent response to estrogen and breast composition, which may influence breast cancer risk in adulthood. Electronic supplementary material The online version of this article (10.1186/s13148-018-0553-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra M Binder
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 90095, USA
| | - Leah T Stiemsma
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 90095, USA
| | - Kristen Keller
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, 90095, USA
| | - Sanne D van Otterdijk
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Verónica Mericq
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - José L Santos
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - John Shepherd
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 90095, USA.
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21
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Wengert GJ, Helbich TH, Kapetas P, Baltzer PA, Pinker K. Density and tailored breast cancer screening: practice and prediction - an overview. Acta Radiol Open 2018; 7:2058460118791212. [PMID: 30245850 PMCID: PMC6144518 DOI: 10.1177/2058460118791212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/27/2018] [Indexed: 01/13/2023] Open
Abstract
Mammography, as the primary screening modality, has facilitated a substantial
decrease in breast cancer-related mortality in the general population. However,
the sensitivity of mammography for breast cancer detection is decreased in women
with higher breast densities, which is an independent risk factor for breast
cancer. With increasing public awareness of the implications of a high breast
density, there is an increasing demand for supplemental screening in these
patients. Yet, improvements in breast cancer detection with supplemental
screening methods come at the expense of increased false-positives, recall
rates, patient anxiety, and costs. Therefore, breast cancer screening practice
must change from a general one-size-fits-all approach to a more personalized,
risk-based one that is tailored to the individual woman’s risk, personal
beliefs, and preferences, while accounting for cost, potential harm, and
benefits. This overview will provide an overview of the available breast density assessment
modalities, the current breast density screening recommendations for women at
average risk of breast cancer, and supplemental methods for breast cancer
screening. In addition, we will provide a look at the possibilities for a
risk-adapted breast cancer screening.
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Affiliation(s)
- Georg J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Pascal At Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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22
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Binder AM, Corvalan C, Pereira A, Calafat AM, Ye X, Shepherd J, Michels KB. Prepubertal and Pubertal Endocrine-Disrupting Chemical Exposure and Breast Density among Chilean Adolescents. Cancer Epidemiol Biomarkers Prev 2018; 27:1491-1499. [PMID: 30158279 DOI: 10.1158/1055-9965.epi-17-0813] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/09/2017] [Accepted: 08/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During puberty, mammary tissue undergoes rapid development, which provides a window of heightened susceptibility of breast composition to the influence of endogenous and exogenous hormones. Exposure to endocrine-disrupting chemicals (EDC) may affect breast development and composition and the risk of developing breast cancer in adulthood. METHODS We evaluated the associations between breast density and urinary concentrations of phenols and phthalates collected at Tanner 1 (B1) and Tanner 4 (B4) in 200 Chilean girls. Total breast volume (BV), fibroglandular volume (FGV), and percent dense breast (%FGV) were evaluated at B4 using dual X-ray absorptiometry. Generalized estimating equations were used to analyze the association between concentrations of EDC biomarkers across puberty and breast density. RESULTS The geometric mean %FGV was 7% higher among girls in the highest relative to the lowest tertile of monocarboxyisooctyl phthalate [1.07; 95% confidence interval (CI), 1.01-1.14]. Monoethyl phthalate concentrations at B4 were positively associated with FGV (highest vs. lowest tertile: 1.22; 95% CI, 1.06-1.40). Bisphenol A displayed a U-shaped association with FGV; girls in the middle tertile had at least 10% lower FGV than girls in the lowest or highest tertiles. Monocarboxyisononyl phthalate showed a nonlinear association with BV. No other statistically significant associations were observed. CONCLUSIONS Our results suggest that the developing breast tissue is susceptible to select EDCs during childhood and adolescence. IMPACT This study may spur further investigations into environmental influences on breast development during puberty and how shifts in pubertal breast density track through the life course to modify breast cancer risk.
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Affiliation(s)
- Alexandra M Binder
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Shepherd
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California.
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23
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Childhood body size and midlife mammographic breast density in foreign-born and U.S.-born women in New York City. Ann Epidemiol 2018; 28:710-716. [PMID: 30172558 DOI: 10.1016/j.annepidem.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE We investigated whether childhood body size is associated with midlife mammographic density, a strong risk factor for breast cancer. METHODS We collected interview data, including body size at age 10 years using a pictogram, and measured height and weight from 518 women, recruited at the time of screening mammography in New York City (ages 40-64 years, 71% Hispanic, 68% foreign-born). We used linear regression models to examine childhood body size in relation to percent density and areas of dense and nondense tissue, measured using a computer-assisted method from digital mammograms. RESULTS In models that adjusted for race/ethnicity, and age and body mass index at mammogram, the heaviest relative to leanest childhood body size was associated with 5.94% lower percent density (95% confidence interval [CI]: -9.20, -2.29), 7.69 cm2 smaller dense area (95% CI: -13.94, -0.63), and 26.17 cm2 larger nondense area (95% CI: 9.42, 43.58). In stratified analysis by menopausal status and nativity, the observed associations were stronger for postmenopausal and U.S.-born women although these differences did not reach statistical significance. CONCLUSIONS Heavy childhood body size is associated with lower mammographic density, consistent with its associations with breast cancer risk. Suggestive findings by nativity require confirmation in larger samples.
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24
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Johnson MB, Hoffmann JN, You HM, Lastra RR, Fernandez S, Strober JW, Allaw AB, Brady MJ, Conzen SD, McClintock MK. Psychosocial Stress Exposure Disrupts Mammary Gland Development. J Mammary Gland Biol Neoplasia 2018; 23:59-73. [PMID: 29687293 PMCID: PMC6207373 DOI: 10.1007/s10911-018-9392-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Exposure to psychosocial stressors and ensuing stress physiology have been associated with spontaneous invasive mammary tumors in the Sprague-Dawley rat model of human breast cancer. Mammary gland (MG) development is a time when physiologic and environmental exposures influence breast cancer risk. However, the effect of psychosocial stress exposure on MG development remains unknown. Here, in the first comprehensive longitudinal study of MG development in nulliparous female rats (from puberty through young adulthood; 8-25 wks of age), we quantify the spatial gradient of differentiation within the MG of socially stressed (isolated) and control (grouped) rats. We then demonstrate that social isolation increased stress reactivity to everyday stressors, resulting in downregulation of glucocorticoid receptor (GR) expression in the MG epithelium. Surprisingly, given that chemical carcinogens increase MG cancer risk by preventing normal terminal end bud (TEB) differentiation, chronic isolation stress did not alter TEBs. Instead, isolation blunted MG growth and alveolobular differentiation and reduced epithelial cell proliferation in these structures. Social isolation also enhanced corpora luteal progesterone at all ages but reduced estrogenization only in early adulthood, a pattern that precludes modulated ovarian function as a sufficient mechanism for the effects of isolation on MG development. This longitudinal study of natural variation provides an integrated view of MG development and the importance of increased GR activation in nulliparous ductal growth and alveolobular differentiation. Thus, social isolation and its physiological sequelae disrupt MG growth and differentiation and suggest a contribution of stress exposure during puberty and young adulthood to the previously observed increase in invasive MG cancer observed in chronically socially-isolated adult Sprague-Dawley rats.
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Affiliation(s)
- Marianna B Johnson
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Hannah M You
- Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Sully Fernandez
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Jordan W Strober
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Ahmad B Allaw
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Matthew J Brady
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Suzanne D Conzen
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
- Ben May Department of Cancer Research, The University of Chicago, Chicago, IL, USA
| | - Martha K McClintock
- Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA.
- Departments of Psychology and Comparative Human Development, The University of Chicago, 940 East 57th Street, Chicago, IL, 60637, USA.
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25
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Denholm R, De Stavola B, Hipwell JH, Doran SJ, Busana MC, Leach MO, Hawkes DJ, dos-Santos-Silva I. Growth Trajectories, Breast Size, and Breast-Tissue Composition in a British Prebirth Cohort of Young Women. Am J Epidemiol 2018; 187:1259-1268. [PMID: 29140420 PMCID: PMC5982787 DOI: 10.1093/aje/kwx358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 11/14/2022] Open
Abstract
Mammographic percent density, the proportion of fibroglandular tissue in the breast, is a strong risk factor for breast cancer, but its determinants in young women are unknown. We examined associations of magnetic resonance imaging (MRI) breast-tissue composition at age 21 years with prospectively collected measurements of body size and composition from birth to early adulthood and markers of puberty (all standardized) in a sample of 500 nulliparous women from a prebirth cohort of children born in Avon, United Kingdom, in 1991-1992 and followed up to 2011-2014. Linear models were fitted to estimate relative change in MRI percent water, which is equivalent to mammographic percent density, associated with a 1-standard-deviation increase in the exposure of interest. In mutually adjusted analyses, MRI percent water was positively associated with birth weight (relative change (RC) = 1.03, 95% confidence interval (CI): 1.00, 1.06) and pubertal height growth (RC = 1.07, 95% CI: 1.02, 1.13) but inversely associated with pubertal weight growth (RC = 0.86, 95% CI: 0.84, 0.89) and changes in dual-energy x-ray absorptiometry percent body fat mass (e.g., for change between ages 11 years and 13.5 years, RC = 0.96, 95% CI: 0.93, 0.99). Ages at thelarche and menarche were positively associated with MRI percent water, but these associations did not persist upon adjustment for height and weight growth. These findings support the hypothesis that growth trajectories influence breast-tissue composition in young women, whereas puberty plays no independent role.
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Affiliation(s)
- Rachel Denholm
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bianca De Stavola
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John H Hipwell
- Center for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - Simon J Doran
- Cancer Research UK Cancer Imaging Center, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Marta C Busana
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Center, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Hawkes
- Center for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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26
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Borgquist S, Hall P, Lipkus I, Garber JE. Towards Prevention of Breast Cancer: What Are the Clinical Challenges? Cancer Prev Res (Phila) 2018; 11:255-264. [PMID: 29661853 DOI: 10.1158/1940-6207.capr-16-0254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/28/2016] [Accepted: 02/21/2018] [Indexed: 11/16/2022]
Abstract
The dramatic increase in breast cancer incidence compels a paradigm shift in our preventive efforts. There are several barriers to overcome before prevention becomes an established part of breast cancer management. The objective of this review is to identify the clinical challenges for improved breast cancer prevention and discuss current knowledge on breast cancer risk assessment methods, risk communication, ethics, and interventional efforts with the aim of covering the aspects relevant for a breast cancer prevention trial. Herein, the following five areas are discussed: (i) Adequate tools for identification of women at high risk of breast cancer suggestively entitled Prevent! Online. (ii) Consensus on the definition of high risk, which is regarded as mandatory for all risk communication and potential prophylactic interventions. (iii) Risk perception and communication regarding risk information. (iv) Potential ethical concerns relevant for future breast cancer prevention programs. (v) Risk-reducing programs involving multileveled prevention depending on identified risk. Taken together, devoted efforts from both policy makers and health care providers are warranted to improve risk assessment and risk counseling in women at risk for breast cancer to optimize the prevention of breast cancer. Cancer Prev Res; 11(5); 255-64. ©2018 AACR.
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Affiliation(s)
- Signe Borgquist
- Lund University, Department of Oncology and Pathology, Skåne University Hospital, Lund, Sweden. .,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, North Carolina
| | - Judy E Garber
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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27
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Rice MS, Tamimi RM, Bertrand KA, Scott CG, Jensen MR, Norman AD, Visscher DW, Chen YY, Brandt KR, Couch FJ, Shepherd JA, Fan B, Wu FF, Ma L, Collins LC, Cummings SR, Kerlikowske K, Vachon CM. Does mammographic density mediate risk factor associations with breast cancer? An analysis by tumor characteristics. Breast Cancer Res Treat 2018; 170:129-141. [PMID: 29502324 DOI: 10.1007/s10549-018-4735-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Though mammographic density (MD) has been proposed as an intermediate marker of breast cancer risk, few studies have examined whether the associations between breast cancer risk factors and risk are mediated by MD, particularly by tumor characteristics. METHODS Our study population included 3392 cases (1105 premenopausal) and 8882 (3192 premenopausal) controls from four case-control studies. For established risk factors, we estimated the percent of the total risk factor association with breast cancer that was mediated by percent MD (secondarily, by dense area and non-dense area) for invasive breast cancer as well as for subtypes defined by the estrogen receptor (ER+/ER-), progesterone receptor (PR+/PR-), and HER2 (HER2+/HER2-). Analyses were conducted separately in pre- and postmenopausal women. RESULTS Positive associations between prior breast biopsy and risk of invasive breast cancer as well as all subtypes were partially mediated by percent MD in pre- and postmenopausal women (percent mediated = 11-27%, p ≤ 0.02). In postmenopausal women, nulliparity and hormone therapy use were positively associated with invasive, ER+ , PR+ , and HER2- breast cancer; percent MD partially mediated these associations (percent mediated ≥ 31%, p ≤ 0.02). Further, among postmenopausal women, percent MD partially mediated the positive association between later age at first birth and invasive as well as ER+ breast cancer (percent mediated = 16%, p ≤ 0.05). CONCLUSION Percent MD partially mediated the associations between breast biopsy, nulliparity, age at first birth, and hormone therapy with risk of breast cancer, particularly among postmenopausal women, suggesting that these risk factors at least partially influence breast cancer risk through changes in breast tissue composition.
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Affiliation(s)
- Megan S Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Bartlett 9, Boston, MA, 02116, USA.
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Matthew R Jensen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Aaron D Norman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Yunn-Yi Chen
- Department of Pathology, University of California, San Francisco, CA, USA
| | | | - Fergus J Couch
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John A Shepherd
- Department of Radiology, University of California, San Francisco, CA, USA
| | - Bo Fan
- Department of Radiology, University of California, San Francisco, CA, USA
| | - Fang-Fang Wu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Lin Ma
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Laura C Collins
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Karla Kerlikowske
- Departments of Epidemiology and Biostatistics and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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28
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Hidayat K, Yang CM, Shi BM. Body fatness at a young age, body fatness gain and risk of breast cancer: systematic review and meta-analysis of cohort studies. Obes Rev 2018; 19:254-268. [PMID: 29130623 DOI: 10.1111/obr.12627] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 01/22/2023]
Abstract
Higher body fatness in adulthood has been consistently associated with an increased risk of postmenopausal breast cancer, as well as a tendency towards a lower risk of premenopausal breast cancer. However, the association between body fatness at a young age (≤30 years), body fatness gain and the risk of breast cancer is less defined. PubMed and Web of Science databases were searched to identify relevant publications. Risk estimates with 95% confidence intervals from each study were transformed into a continuous variable for each 5 kg m-2 increase in body mass index (BMI) and were pooled under a random-effects model. Each 5 kg m-2 increase in BMI was significantly associated with a 14%, 12% and 17% lower risk of breast cancer later in life among all women, premenopausal women and postmenopausal women, respectively. Significant heterogeneity and publication bias were observed. The results remained unchanged after the trim and fill method was applied to correct the bias. Each 5 kg m-2 increase in BMI from a young age until cohort entry was significantly associated with a 13% and 14% higher risk of breast cancer in all women and postmenopausal women, respectively. In summary, higher body fatness at a young age may have a protective role in the later development of breast cancer in both premenopausal and postmenopausal women. However, this potential benefit should not be overemphasized, as our findings suggest that increased body fatness gain from a young age is positively associated with postmenopausal breast cancer risk. These findings further justify the need to maintain a steady weight throughout life.
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Affiliation(s)
- K Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - C-M Yang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - B-M Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
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Soguel L, Durocher F, Tchernof A, Diorio C. Adiposity, breast density, and breast cancer risk: epidemiological and biological considerations. Eur J Cancer Prev 2017; 26:511-520. [PMID: 27571214 PMCID: PMC5627530 DOI: 10.1097/cej.0000000000000310] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 01/29/2016] [Indexed: 12/16/2022]
Abstract
Excess total body fat and abdominal adipose tissue are recognized risk factors for metabolic diseases but also for some types of cancers, including breast cancer. Several biological mechanisms in connection with local and systemic effects of adiposity are believed to be implicated in breast cancer development, and may involve breast fat. Breast adipose tissue can be studied through mammography by looking at breast density features such as the nondense area mainly composed of fat, or the percent breast density, which is the proportion of fibroglandular tissue in relation to fat. The relation between adiposity, breast density features, and breast cancer is complex. Studies suggest a paradoxical association as adiposity and absolute nondense area correlate positively with each other, but in contrast to adiposity, absolute nondense area seems to be associated negatively with breast cancer risk. As breast density is one of the strongest risk factors for breast cancer, it is therefore critical to understand how these factors interrelate. In this review, we discuss these relations by first presenting how adiposity measurements and breast density features are linked to breast cancer risk. Then, we used a systematic approach to capture the literature to review the relation between adiposity and breast density features. Finally, the role of adipose tissue in carcinogenesis is discussed briefly from a biological perspective.
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Affiliation(s)
- Ludivine Soguel
- Departments of Social and Preventive Medicine
- CHU de Québec Research Center
- Department of Nutrition and Dietetics, University of Applied Sciences Western Switzerland (HES-SO) Geneva, 25 rue des Caroubiers, Carouge, Switzerland
| | - Francine Durocher
- Molecular Medicine, Cancer Research Center, Laval University, 2325 rue de l’Université
- CHU de Québec Research Center, CHUL, 2724 Laurier Boulevard
| | - André Tchernof
- CHU de Québec Research Center, CHUL, 2724 Laurier Boulevard
- Department of Nutrition, Laval University, 2425 rue de l’Agriculture, Quebec City, Quebec, Canada
| | - Caroline Diorio
- Departments of Social and Preventive Medicine
- CHU de Québec Research Center
- Deschênes-Fabia Center for Breast Diseases, Saint-Sacrement Hospital, 1050 Chemin Ste-Foy
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30
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Shawon MSR, Eriksson M, Li J. Body size in early life and risk of breast cancer. Breast Cancer Res 2017; 19:84. [PMID: 28732505 PMCID: PMC5521119 DOI: 10.1186/s13058-017-0875-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/28/2017] [Indexed: 11/26/2022] Open
Abstract
Background Body size in early life is inversely associated with adult breast cancer (BC) risk, but it is unclear whether the associations differ by tumor characteristics. Methods In a pooled analysis of two Swedish population-based studies consisting of 6731 invasive BC cases and 28,705 age-matched cancer-free controls, we examined the associations between body size in early life and BC risk. Self-reported body sizes at ages 7 and 18 years were collected by a validated nine-level pictogram (aggregated into three categories: small, medium and large). Odds ratios (OR) and corresponding 95% confidence intervals (CI) were estimated from multivariable logistic regression models in case-control analyses, adjusting for study, age at diagnosis, age at menarche, number of children, hormone replacement therapy, and family history of BC. Body size change between ages 7 and 18 were also examined in relation to BC risk. Case-only analyses were performed to test whether the associations differed by tumor characteristics. Results Medium or large body size at age 7 and 18 was associated with a statistically significant decreased BC risk compared to small body size (pooled OR (95% CI): comparing large to small, 0.78 (0.70–0.86), Ptrend <0.001 and 0.72 (0.64–0.80), Ptrend <0.001, respectively). The majority of the women (~85%) did not change body size categories between age 7 and 18 . Women who remained medium or large between ages 7 and 18 had significantly decreased BC risk compared to those who remained small. A reduction in body size between ages 7 and 18 was also found to be inversely associated with BC risk (0.90 (0.81–1.00)). No significant association was found between body size at age 7 and tumor characteristics. Body size at age 18 was found to be inversely associated with tumor size (Ptrend = 0.006), but not estrogen receptor status and lymph node involvement. For all analyses, the overall inferences did not change appreciably after further adjustment for adult body mass index. Conclusions Our data provide further support for a strong and independent inverse relationship between early life body size and BC risk. The association between body size at age 18 and tumor size could be mediated by mammographic density. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0875-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Md Shajedur Rahman Shawon
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77, Stockholm, Sweden.,Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77, Stockholm, Sweden
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77, Stockholm, Sweden. .,Genome Institute of Singapore, 60 Biopolis St, Genome, #02-01, Singapore, 138672, Singapore.
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31
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Rice MS, Tworoger SS, Hankinson SE, Tamimi RM, Eliassen AH, Willett WC, Colditz G, Rosner B. Breast cancer risk prediction: an update to the Rosner-Colditz breast cancer incidence model. Breast Cancer Res Treat 2017; 166:227-240. [PMID: 28702896 DOI: 10.1007/s10549-017-4391-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/07/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE To update and expand the Rosner-Colditz breast cancer incidence model by evaluating the contributions of more recently identified risk factors as well as predicted percent mammographic density (MD) to breast cancer risk. METHODS Using data from the Nurses' Health Study (NHS) and NHSII, we added adolescent somatotype (9 unit scale), vegetable intake (servings/day), breastfeeding (months), physical activity (MET-h/week), and predicted percent MD to the Rosner-Colditz model to determine whether these variables improved model discrimination. We evaluated all invasive as well as ER+/PR+, ER+/PR-, and ER-/PR- breast cancer. RESULTS In the NHS/NHSII, we accrued over 5200 cases of invasive breast cancer over more than 20 years of follow-up with complete data on the risk factors. Adolescent somatotype and predicted percent MD significantly improved the original Rosner-Colditz model for all invasive breast cancer (change in age-adjusted AUC = 0.020, p < 0.001). The relative risk (RR) of invasive breast cancer for a 4-unit increase in adolescent somatotype was 0.62 (95% CI 0.56, 0.70), whereas the RR for a 20-unit increase in predicted percent MD was 1.32 (95% CI 1.28, 1.36). Adolescent somatotype and predicted percent MD also significantly improved the ER+/PR+model (change in age-adjusted AUC = 0.020, p < 0.001) as well as the ER+/PR- model (change in age-adjusted AUC = 0.012, p = 0.007). Adolescent somatotype, predicted percent MD, breastfeeding, and vegetable intake improved the ER-/PR- model (change in AUC = 0.031, p < 0.0001). The RR of ER-/PR- disease for 5 vegetable servings/day increase was 0.83 (95% CI 0.70, 0.99), while the RR for every 12 months of breastfeeding was 0.88 (95% CI 0.77, 1.01). Physical activity did not improve risk classification in any model. CONCLUSION Adolescent somatotype and predicted percent MD significantly improved breast cancer risk classification using the Rosner-Colditz model. Further, risk factors specific to ER- disease, such as breastfeeding and vegetable intake, may also help improve risk prediction of this aggressive subtype.
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Affiliation(s)
- Megan S Rice
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bartlett 9, Boston, MA, 02114, USA.
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Susan E Hankinson
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Walter C Willett
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Graham Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Bernard Rosner
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bartlett 9, Boston, MA, 02114, USA
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Alexeeff SE, Odo NU, Lipson JA, Achacoso N, Rothstein JH, Yaffe MJ, Liang RY, Acton L, McGuire V, Whittemore AS, Rubin DL, Sieh W, Habel LA. Age at Menarche and Late Adolescent Adiposity Associated with Mammographic Density on Processed Digital Mammograms in 24,840 Women. Cancer Epidemiol Biomarkers Prev 2017; 26:1450-1458. [PMID: 28698185 DOI: 10.1158/1055-9965.epi-17-0264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/15/2017] [Accepted: 06/28/2017] [Indexed: 12/21/2022] Open
Abstract
Background: High mammographic density is strongly associated with increased breast cancer risk. Some, but not all, risk factors for breast cancer are also associated with higher mammographic density.Methods: The study cohort (N = 24,840) was drawn from the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California and included non-Hispanic white females ages 40 to 74 years with a full-field digital mammogram (FFDM). Percent density (PD) and dense area (DA) were measured by a radiological technologist using Cumulus. The association of age at menarche and late adolescent body mass index (BMI) with PD and DA were modeled using linear regression adjusted for confounders.Results: Age at menarche and late adolescent BMI were negatively correlated. Age at menarche was positively associated with PD (P value for trend <0.0001) and DA (P value for trend <0.0001) in fully adjusted models. Compared with the reference category of ages 12 to 13 years at menarche, menarche at age >16 years was associated with an increase in PD of 1.47% (95% CI, 0.69-2.25) and an increase in DA of 1.59 cm2 (95% CI, 0.48-2.70). Late adolescent BMI was inversely associated with PD (P < 0.0001) and DA (P < 0.0001) in fully adjusted models.Conclusions: Age at menarche and late adolescent BMI are both associated with Cumulus measures of mammographic density on processed FFDM images.Impact: Age at menarche and late adolescent BMI may act through different pathways. The long-term effects of age at menarche on cancer risk may be mediated through factors besides mammographic density. Cancer Epidemiol Biomarkers Prev; 26(9); 1450-8. ©2017 AACR.
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Affiliation(s)
- Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Nnaemeka U Odo
- Data Mining & Analytics, Encounter Information Operations, Kaiser Permanente Northern California, Oakland, California.,Optum360, United Health Group, Las Vegas, Nevada
| | - Jafi A Lipson
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Joseph H Rothstein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Rhea Y Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Daniel L Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Weiva Sieh
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, Stanford, California
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33
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Gynecologic and Obstetric Consequences of Obesity in Adolescent Girls. J Pediatr Adolesc Gynecol 2017; 30:156-168. [PMID: 26915924 DOI: 10.1016/j.jpag.2016.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/06/2016] [Accepted: 02/15/2016] [Indexed: 12/24/2022]
Abstract
In the past few decades, there has been an overwhelming increase in childhood and adolescent obesity worldwide. Besides the well recognized cardiometabolic complications and other physical conditions associated with obesity, during adolescence, it causes psychological and social distress in a period of life that is already sensitive for a girl. This in turn increases their risk of low self-esteem and depression. Furthermore, obesity diminishes health-related quality of life and years of life. Overweight and obese teenagers are more likely to have gynecologic and obstetric complications, during adolescence and also later in life. Consequences of obese and overweight childhood and adolescence include sexual maturation and reproductive dysfunction, alterations in menstruation, dysmenorrhea, risky sexual behavior, and inefficient use of contraception, polycystic ovary syndrome, bone density abnormalities, macromastia, and an increased risk of breast and endometrial cancer. Obese adolescents are at greater risk of pregnancy and perinatal complications, such as preeclampsia, gestational hypertension and preeclampsia, gestational diabetes mellitus, primary cesarean delivery, and induction of labor, to mention a few. Evidence shows that infants born to obese teenagers are also more likely to have complications including preterm or post-term delivery, small-for-gestational age newborns, macrosomia, meconium aspiration, respiratory distress, and even stillbirth, among others. This comprehensive review focuses on the gynecological and obstetric consequences of obesity in adolescent girls.
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Florath I, Sarink D, Saunders C, Heyworth J, Fritschi L. Breast cancer risk and the interaction between adolescent body size and weight gain in later life: A case-control study. Cancer Epidemiol 2016; 45:135-144. [DOI: 10.1016/j.canep.2016.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 01/21/2023]
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35
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Wasim B, Khan K, Samad MA. Association between 25-Hydroxy Vitamin D and volumetric breast density via a fully automated software Volpara™ in the reproductive age group. Pak J Med Sci 2016; 32:1246-1250. [PMID: 27882030 PMCID: PMC5103142 DOI: 10.12669/pjms.325.10731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the association between serum 25 hydroxyvitamin D levels and percent breast density among asymptomatic premenopausal women. Methods: Hundred asymptomatic, pre-menopausal women who visited the General Surgery Breast Clinic, Patel Hospital, Karachi, Pakistan between 3rd March and 10th November, 2015 were included in this study. The serum 25 (OH)D and calcium levels were measured and mammographic density (MD) was assessed using automated volumetric breast density software, Volpara Research (algorithm version 1.5.1, Volpara solutions Ltd, Wellington, NZ) on the same day. The volumetric breast density (VBD) was categorized as; VG1: 0% - 4.5 %; VG2: 4.6% - 7.5%; VG3: 7.6% – 15.5% and VG4 >15.5%. Mean serum 25(OH)D and calcium levels were compared across the four volumetric breast density categories. The percent volumetric density was also correlated with anthropometric measurements and other related variables. Results: No significant difference was found in mean serum 25 (OH)D level across the four groups (15.87 Vs. 12.40 Vs. 8.99 Vs. 9.68; p-value = 0.106). The percent VBD were found significantly negatively correlated with age (r = - 0.365; p-value = 0.001), weight (r = - 0.575; p-value = 0.001), height (r = - 0.197; p-value = 0.049), and BMI (r = - 0.519; p-value = 0.001). The serum Vitamin D, and calcium levels were not found significantly correlated with percent VBD (p-value > 0.05). Conclusion: No significant association exists between serum 25(OH)D level and breast density.
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Affiliation(s)
- Bushra Wasim
- Dr. Bushra Wasim, MBBS, FCPS. Professor of Anatomy, Ziauddin University, Clifton Campus, Karachi, Pakistan
| | - Khalid Khan
- Dr. Khalid M. Khan, PhD. Professor, Department of Anatomy, Faculty of Medicine, Kuwait University, Kuwait
| | - Mohd Abdul Samad
- Dr. Muhammad Abdul Samad, Msc. International Health (Aberdeen) Research Associate, Shaheen Research Group, Karachi, Pakistan
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36
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Rice MS, Bertrand KA, VanderWeele TJ, Rosner BA, Liao X, Adami HO, Tamimi RM. Mammographic density and breast cancer risk: a mediation analysis. Breast Cancer Res 2016; 18:94. [PMID: 27654859 PMCID: PMC5031307 DOI: 10.1186/s13058-016-0750-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High mammographic density (MD) is a strong risk factor for breast cancer. However, it is unclear whether high MD is an intermediate phenotype or whether breast cancer risk factors influence breast cancer risk and MD independently. METHODS Our study population included 1290 invasive breast cancer cases and 3422 controls from the Nurses' Health Studies. We estimated the percent of the total association between the risk factor and breast cancer that was mediated by MD. RESULTS In both pre- and postmenopausal women, the association between history of biopsy-confirmed benign breast disease and risk was partially mediated by percent MD (percent mediated (PM) = 17 %, p < 0.01 and PM = 33 %, p = 0.04, respectively). In premenopausal women, the associations between early life body size (adolescent somatotype and BMI at age 18) and breast cancer risk were substantially mediated by percent MD (PM = 73 %, p = 0.05 and PM = 82 %, p = 0.04, respectively). In postmenopausal women, the proportion of the associations of childhood somatotype and adolescent somatotype that were mediated by percent MD were lower (PM = 26 %, p = 0.01 for both measures). Hormone therapy use at mammogram was significantly mediated by percent MD in postmenopausal women (PM = 22 %, p < 0.01). Associations with other risk factors, such as age at menarche or family history of breast cancer, were not mediated by percent MD. CONCLUSIONS Percent MD partially mediated some of the associations between risk factors and breast cancer, though the magnitude varied by risk factor and menopausal status. These findings suggest that high MD may be an intermediate in some biological pathways for breast cancer development.
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Affiliation(s)
- Megan S Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Bartlett 9, Boston, MA, 02116, USA.
| | | | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Xiaomei Liao
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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37
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Farland LV, Tamimi RM, Eliassen AH, Spiegelman D, Bertrand KA, Missmer SA. Endometriosis and mammographic density measurements in the Nurses' Health Study II. Cancer Causes Control 2016; 27:1229-37. [PMID: 27549771 DOI: 10.1007/s10552-016-0801-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/15/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Endometriosis and mammographic density have been hypothesized to be influenced by sex steroid hormonal exposures in adolescence and early adulthood. We investigated the association between endometriosis and mammographic density, a consistent and independent risk factor for breast cancer. METHODS We conducted a cross-sectional analysis among 1,581 pre- and postmenopausal women not previously diagnosed with breast cancer in the Nurses' Health Study II cohort. We measured average percent mammographic density and absolute dense and non-dense breast area using a validated computer-assisted method. Multivariable linear regression was used to estimate the association between endometriosis and mammographic density among pre- and postmenopausal women separately. RESULTS Among premenopausal women, average percent mammographic density was 43.1 % among women with endometriosis (n = 91) and 40.5 % among women without endometriosis (n = 1,150). Endometriosis was not associated significantly with mammographic density among premenopausal (% difference = 2.00 percentage points 95 % CI -1.33, 5.33) or among postmenopausal women (% difference = -0.89 percentage points 95 % CI -5.10, 3.33). Among premenopausal women, there was heterogeneity by BMI at age 18 (p value = 0.003), with a suggested association among those who were lean at age 18 (BMI < 20.6 kg/m(2)) (% difference = 3.74 percentage points 95 % CI -0.29, 7.78). CONCLUSION Endometriosis was not found to be associated with overall measurements of mammographic density.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. .,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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38
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Gillman J, Chun J, Schwartz S, Schnabel F, Moy L. The relationship of obesity, mammographic breast density, and magnetic resonance imaging in patients with breast cancer. Clin Imaging 2016; 40:1167-1172. [PMID: 27572282 DOI: 10.1016/j.clinimag.2016.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose was to evaluate the relationship between body mass index (BMI), mammographic breast density, magnetic resonance (MR) background parenchymal enhancement (BPE), and MR fibroglandular tissue (FGT) in women with breast cancer. METHODS Our institutional database was queried for patients with preoperative mammography and breast MR imaging. RESULTS There were 573 women eligible for analysis. Elevated BMI was associated with advanced stage of disease (P=.01), lower mammographic density (P<.0001), lower FGT (P<.0001), higher BPE (P=.005), and nonpalpable lesions (P=.04). CONCLUSIONS Higher BMI was associated with decreased breast density and FGT. Higher BMI was also associated with advanced stage disease and nonpalpable tumors on clinical exam.
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Affiliation(s)
- Jennifer Gillman
- Department of Radiology, New York University School of Medicine, Perlmutter Cancer Center, 160 East 34th Street, New York, NY, 10016, USA
| | - Jennifer Chun
- Department of Surgery, New York University School of Medicine, Perlmutter Cancer Center, 160 East 34th Street, New York, NY, 10016, USA
| | - Shira Schwartz
- Department of Surgery, New York University School of Medicine, Perlmutter Cancer Center, 160 East 34th Street, New York, NY, 10016, USA
| | - Freya Schnabel
- Department of Surgery, New York University School of Medicine, Perlmutter Cancer Center, 160 East 34th Street, New York, NY, 10016, USA
| | - Linda Moy
- Department of Radiology, New York University School of Medicine, Perlmutter Cancer Center, 160 East 34th Street, New York, NY, 10016, USA.
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Xue F, Rosner B, Eliassen H, Michels KB. Body fatness throughout the life course and the incidence of premenopausal breast cancer. Int J Epidemiol 2016; 45:1103-1112. [PMID: 27466312 DOI: 10.1093/ije/dyw149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The role of body fatness in the aetiology of breast cancer is complex. We evaluated the independent and synergistic effects of body fatness, at different stages throughout a woman's life course, on premenopausal breast cancer risk. METHODS Premenopausal participants of the Nurses' Health Study II (NHSII) were followed from 1991 up to 2009. Body fatness factors including birthweight, somatotype (a 9-level pictogram with level 1 being the leanest) at ages 5 and 10 years and body mass index (BMI) at age 18 were collected at baseline. Current BMI was updated biennially. Multivariate Cox regression models were used to evaluate the association between each body fatness factor as well as cross-classification of all factors and the incidence of breast cancer. RESULTS Based on 1574 incident premenopausal breast cancer cases and 1 133 893 person-years of follow-up, a lower incidence was associated with lower birthweight: hazard ratio (HR) [95% confidence interval (CI)] = 0.74 (0.58-0.95) for <2.5kg vs 3.9+kg, P for trend < 0.001; higher somatotype at age 5: HR=0.57 (95% CI 0.44-0.73) for 5-9 vs 1, P fortrend < 0.0001]; and at age 10: HR=0.61 (95% CI 0.49-0.75) for 5-9 vs 1, P for trend < 0.0001]; and BMI at age 18: HR=0.67 (95% 0.47-0.95) for ≥ 27.5 kg/m2 vs < 18.5 kg/m2, P for trend = 0.009], after adjusting for age and body fatness measures earlier in life and other risk factors, respectively. No significant interaction between body fatness measures was found. Women with the lowest birthweight, the highest somatotype at ages 5 and 10 and the highest BMI at age 18 and currently had a 72% (95% CI 54%-83%) lower incidence of invasive premenopausal breast cancer than women with the opposite extreme of each body fatness indicator. CONCLUSION The lowest incidence of premenopausal breast cancer was associated with the lowest birthweight and the highest childhood, adolescent and early adult body fatness.
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Affiliation(s)
- Fei Xue
- Obstetrics and Gynecology Epidemiology Center
| | - Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology and.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology and
| | - Karin B Michels
- Obstetrics and Gynecology Epidemiology Center, .,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology and
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McNamara KM, Guestini F, Sakurai M, Kikuchi K, Sasano H. How far have we come in terms of estrogens in breast cancer? [Review]. Endocr J 2016; 63:413-24. [PMID: 27020038 DOI: 10.1507/endocrj.ej16-0022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Major advances in breast cancer treatment have almost always been linked to the actions of estrogen. Therefore, this review focused on estrogen actions in the breast, particularly the developments of the past 20 years, the present understanding of disease biology and possible future developments. Within these areas have focused on what is known about the underlying molecular biology and in particular integration of the bioinformatics revolution of the last 15 years with other facets of research. In addition, there will be an emphasis on the understanding brought about by a greater appreciation for the intracrinology of the breast.
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Affiliation(s)
- Keely May McNamara
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
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Bertrand KA, Baer HJ, Orav EJ, Klifa C, Kumar A, Hylton NM, LeBlanc ES, Snetselaar LG, Van Horn L, Dorgan JF. Early Life Body Fatness, Serum Anti-Müllerian Hormone, and Breast Density in Young Adult Women. Cancer Epidemiol Biomarkers Prev 2016; 25:1151-7. [PMID: 27197299 DOI: 10.1158/1055-9965.epi-16-0185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Emerging evidence suggests positive associations between serum anti-Müllerian hormone (AMH), a marker of ovarian function, and breast cancer risk. Body size at young ages may influence AMH levels, but few studies have examined this. Also, no studies have examined the relation of AMH levels with breast density, a strong predictor of breast cancer risk. METHODS We examined associations of early life body fatness, AMH concentrations, and breast density among 172 women in the Dietary Intervention Study in Children (DISC). Height and weight were measured at baseline (ages 8-10) and throughout adolescence. Serum AMH concentrations and breast density were assessed at ages 25-29 at the DISC 2006 Follow-up visit. We used linear mixed effects models to quantify associations of AMH (dependent variable) with quartiles of age-specific youth body mass index (BMI) Z-scores (independent variable). We assessed cross-sectional associations of breast density (dependent variable) with AMH concentration (independent variable). RESULTS Neither early life BMI nor current adult BMI was associated with AMH concentrations. There were no associations between AMH and percent or absolute dense breast volume. In contrast, women with higher AMH concentrations had significantly lower absolute nondense breast volume (Ptrend < 0.01). CONCLUSIONS We found no evidence that current or early life BMI influences AMH concentrations in later life. Women with higher concentrations of AMH had similar percent and absolute dense breast volume, but lower nondense volume. IMPACT These results suggest that AMH may be associated with lower absolute nondense breast volume; however, future prospective studies are needed to establish temporality. Cancer Epidemiol Biomarkers Prev; 25(7); 1151-7. ©2016 AACR.
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Affiliation(s)
| | - Heather J Baer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Nola M Hylton
- Department of Radiology, University of California, San Francisco, California
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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Benn M, Tybjærg-Hansen A, Smith GD, Nordestgaard BG. High body mass index and cancer risk—a Mendelian randomisation study. Eur J Epidemiol 2016; 31:879-92. [DOI: 10.1007/s10654-016-0147-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/06/2016] [Indexed: 10/22/2022]
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Hopper JL, Nguyen TL, Stone J, Aujard K, Matheson MC, Abramson MJ, Burgess JA, Walters EH, Dite GS, Bui M, Evans C, Makalic E, Schmidt DF, Ward G, Jenkins MA, Giles GG, Dharmage SC, Apicella C. Childhood body mass index and adult mammographic density measures that predict breast cancer risk. Breast Cancer Res Treat 2016; 156:163-70. [DOI: 10.1007/s10549-016-3719-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/11/2016] [Indexed: 01/01/2023]
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Lope V, García-Esquinas E, Pérez-Gómez B, Altzibar JM, Gracia-Lavedan E, Ederra M, Molina de la Torre AJ, LLorca FJ, Tardón A, Moreno V, Bayo J, Salas-Trejo D, Marcos-Gragera R, Pumarega J, Dierssen-Sotos T, Lera JPB, de Miguel Medina MAC, Tusquets I, Amiano P, Boldo E, Kogevinas M, Aragonés N, Castaño-Vinyals G, Pollán M. Perinatal and childhood factors and risk of breast cancer subtypes in adulthood. Cancer Epidemiol 2015; 40:22-30. [PMID: 26613540 DOI: 10.1016/j.canep.2015.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accumulated exposure to hormones and growth factors during early life may influence the future risk of breast cancer (BC). This study examines the influence of childhood-related, socio-demographic and anthropometric variables on BC risk, overall and by specific pathologic subtypes. METHODS This is a case-control study where 1539 histologically-confirmed BC cases (23-85 years) and 1621 population controls, frequency matched by age, were recruited in 10 Spanish provinces. Perinatal and childhood-related characteristics were directly surveyed by trained staff. The association with BC risk, globally and according to menopausal status and pathologic subtypes, was evaluated using logistic and multinomial regression models, adjusting for tumor specific risk factors. RESULTS Birth characteristics were not related with BC risk. However, women with high socioeconomic level at birth presented a decreased BC risk (OR=0.45; 95% CI=0.29-0.70), while those whose mothers were aged over 39 years at their birth showed an almost significant excess risk of hormone receptor positive tumors (HR+) (OR=1.35; 95% CI=0.99-1.84). Women who were taller than their girl mates before puberty showed increased postmenopausal BC risk (OR=1.26; 95% CI=1.03-1.54) and increased HR+ BC risk (OR=1.26; 95% CI=1.04-1.52). Regarding prepubertal weight, while those women who were thinner than average showed higher postmenopausal BC risk (OR=1.46; 95% CI=1.20-1.78), associated with HR+ tumors (OR=1.34; 95% CI=1.12-1.61) and with triple negative tumors (OR=1.56; 95% CI=1.03-2.35), those who were heavier than average presented lower premenopausal BC risk (OR=0.64; 95% CI=0.46-0.90) and lower risk of epidermal growth factor receptor positive tumors (OR=0.61; 95% CI=0.40-0.93). CONCLUSION These data reflect the importance of hormones and growth factors in the early stages of life, when the mammary gland is in development and therefore more vulnerable to proliferative stimuli.
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Affiliation(s)
- Virginia Lope
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222 Madrid, Spain.
| | - Esther García-Esquinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Beatriz Pérez-Gómez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222 Madrid, Spain
| | - Jone M Altzibar
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Public Health Division of Gipuzkoa, Avenida de Navarra 4, 20013 Donostia, San Sebastián, Spain; Biodonostia Research Institute, Doctor Begiristain s/n, 20014 Donostia, San Sebastián, Spain
| | - Esther Gracia-Lavedan
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Centre for Research in Environmental Epidemiology (CREAL). Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - María Ederra
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Early Detection Section, Public Health Institute of Navarra, Leyre 15, 31003 Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
| | | | - Francisco Javier LLorca
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Universidad de Cantabria-IDIVAL. Avenida Cardenal Herrera Oria s/n, 39011, Santander, Spain
| | - Adonina Tardón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Instituto Universitario de Oncología, Universidad de Oviedo, Facultad de Medicina, Planta 7, Campus de El Cristo B, 33006 Oviedo, Asturias, Spain
| | - Víctor Moreno
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; IDIBELL-Catalan Institute of Oncology, Gran Via km 2.7, 08907L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Campus de Bellvitge, Pavelló de Govern, Feixa Llarga s/n 08907, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Juan Bayo
- Servicio de Oncología Médica, Hospital Juan Ramón Jiménez, Avenida de la Orden s/n, 21005 Huelva, Spain; Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva, Campus Universitario de El Carmen, 21071 Huelva, Spain
| | - Dolores Salas-Trejo
- General Directorate Public Health, and FISABIO, Avenida de Catalunya, 21, 46020 Valencia, Spain
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), Carrer del Sol 15, 17004 Girona, Spain
| | - José Pumarega
- Grup de Recerca en Epidemiologia Clínica i Molecular del Càncer (GRECMC), Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Trinidad Dierssen-Sotos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Universidad de Cantabria-IDIVAL. Avenida Cardenal Herrera Oria s/n, 39011, Santander, Spain
| | - Juan Pablo Barrio Lera
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud, Universidad de León, 24071 León, Spain
| | - M A Concepción de Miguel Medina
- Navarra Institute for Health Research (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain; Pathology Department, Navarra Hospital Complex, Irunlarrea 3, 31008 Pamplona, Spain
| | - Ignasi Tusquets
- Servei d'Oncologia Mèdica, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain; Cancer Research Program IMIM (Hospital del Mar Medical Research Institute). Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Autònoma de Barcelona, Plaza Cívica s/n, 08193 Bellaterra, Barcelona, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Public Health Division of Gipuzkoa, Avenida de Navarra 4, 20013 Donostia, San Sebastián, Spain; Biodonostia Research Institute, Doctor Begiristain s/n, 20014 Donostia, San Sebastián, Spain
| | - Elena Boldo
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222 Madrid, Spain
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Centre for Research in Environmental Epidemiology (CREAL). Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Nuria Aragonés
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222 Madrid, Spain
| | - Gemma Castaño-Vinyals
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Centre for Research in Environmental Epidemiology (CREAL). Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222 Madrid, Spain
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Mammographic Breast Density in Chinese Women: Spatial Distribution and Autocorrelation Patterns. PLoS One 2015; 10:e0136881. [PMID: 26332221 PMCID: PMC4558090 DOI: 10.1371/journal.pone.0136881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/10/2015] [Indexed: 01/01/2023] Open
Abstract
Mammographic breast density (MBD) is a strong risk factor for breast cancer. The spatial distribution of MBD in the breast is variable and dependent on physiological, genetic, environmental and pathological factors. This pilot study aims to define the spatial distribution and autocorrelation patterns of MBD in Chinese women aged 40–60. By analyzing their digital mammographic images using a public domain Java image processing program for segmentation and quantification of MBD, we found their left and right breasts were symmetric to each other in regard to their breast size (Total Breast Area), the amount of BMD (overall PD) and Moran's I values. Their MBD was also spatially autocorrelated together in the anterior part of the breast in those with a smaller breast size, while those with a larger breast size tend to have their MBD clustered near the posterior part of the breast. Finally, we observed that the autocorrelation pattern of MBD was dispersed after a 3-year observation period.
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Hart V, Reeves KW, Sturgeon SR, Reich NG, Sievert LL, Kerlikowske K, Ma L, Shepherd J, Tice JA, Mahmoudzadeh AP, Malkov S, Sprague BL. The effect of change in body mass index on volumetric measures of mammographic density. Cancer Epidemiol Biomarkers Prev 2015; 24:1724-30. [PMID: 26315554 DOI: 10.1158/1055-9965.epi-15-0330] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/29/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding how changes in body mass index (BMI) relate to changes in mammographic density is necessary to evaluate adjustment for BMI gain/loss in studies of change in density and breast cancer risk. Increase in BMI has been associated with a decrease in percent density, but the effect on change in absolute dense area or volume is unclear. METHODS We examined the association between change in BMI and change in volumetric breast density among 24,556 women in the San Francisco Mammography Registry from 2007 to 2013. Height and weight were self-reported at the time of mammography. Breast density was assessed using single x-ray absorptiometry measurements. Cross-sectional and longitudinal associations between BMI and dense volume (DV), non-dense volume (NDV), and percent dense volume (PDV) were assessed using multivariable linear regression models, adjusted for demographics, risk factors, and reproductive history. RESULTS In cross-sectional analysis, BMI was positively associated with DV [β, 2.95 cm(3); 95% confidence interval (CI), 2.69-3.21] and inversely associated with PDV (β, -2.03%; 95% CI, -2.09, -1.98). In contrast, increasing BMI was longitudinally associated with a decrease in both DV (β, -1.01 cm(3); 95% CI, -1.59, -0.42) and PDV (β, -1.17%; 95% CI, -1.31, -1.04). These findings were consistent for both pre- and postmenopausal women. CONCLUSION Our findings support an inverse association between change in BMI and change in PDV. The association between increasing BMI and decreasing DV requires confirmation. IMPACT Longitudinal studies of PDV and breast cancer risk, or those using PDV as an indicator of breast cancer risk, should evaluate adjustment for change in BMI.
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Affiliation(s)
- Vicki Hart
- Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, Vermont. Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Katherine W Reeves
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Susan R Sturgeon
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Nicholas G Reich
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Karla Kerlikowske
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Lin Ma
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - John Shepherd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Jeffrey A Tice
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Amir Pasha Mahmoudzadeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Serghei Malkov
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, Vermont
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Oh H, Boeke CE, Tamimi RM, Smith-Warner SA, Wang M, Willett WC, Eliassen AH. The interaction between early-life body size and physical activity on risk of breast cancer. Int J Cancer 2015; 137:571-81. [PMID: 25335465 PMCID: PMC4405425 DOI: 10.1002/ijc.29272] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/07/2014] [Indexed: 01/08/2023]
Abstract
While early-life body leanness is associated with increased breast cancer risk, early-life physical activity may protect against breast cancer. We examined whether the excess risk among lean girls is modified by their levels of prior, concurrent, or future physical activity. We conducted an analysis among 74,723 women in the Nurses' Health Study II (follow-up 1997-2011). Participants recalled their body size at ages 5, 10 and 20 years in 1989 using a 9-level pictogram (Level 1 most lean). In 1997, they reported adolescent levels of physical activity (ages 12-13 and 14-17 years). Cox proportional hazards models estimated the overall association of body size with breast cancer risk and assessed interactions of adolescent physical activity with body size at three different age periods (5-10, 10-20 and 20 years), adjusting for early-life and adult risk factors for breast cancer. Regardless of levels of adolescent physical activity, early-life body leanness (level 1-2 vs. 4.5+) was significantly associated with higher breast cancer risk. The association was slightly attenuated among those who were active (60+ MET-hr/wk) during adolescence compared to those who were inactive (<30 MET-hr/wk) (body size at ages 5-10 years: hazard ratio = 1.37, 95% confidence interval = 1.04-1.81 vs. 1.66, 1.29-2.12), but the interaction was not significant (p = 0.72). The results were similar for body size at three different age periods. Being lean during early life is a risk factor for breast cancer among both inactive and active girls. Adolescent physical activity did not significantly modify the association, although some interaction cannot be excluded.
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Affiliation(s)
- Hannah Oh
- Department of Epidemiology, Harvard School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
- Department of Nutrition, Harvard School of Public Health
| | - Caroline E. Boeke
- Department of Epidemiology, Harvard School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Rulla M. Tamimi
- Department of Epidemiology, Harvard School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Stephanie A. Smith-Warner
- Department of Epidemiology, Harvard School of Public Health
- Department of Nutrition, Harvard School of Public Health
| | - Molin Wang
- Department of Epidemiology, Harvard School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
- Department of Biostatistics, Harvard School of Public Health
| | - Walter C. Willett
- Department of Epidemiology, Harvard School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
- Department of Nutrition, Harvard School of Public Health
| | - A. Heather Eliassen
- Department of Epidemiology, Harvard School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
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Abstract
Introduction Mammographic density (MD) is considered a strong predictor of Breast Cancer (BC). The objective of the present study is to explore the association between MD and the compliance with the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) recommendations for cancer prevention. Methods Data of 3584 women attending screening from a population-based multicenter cross-sectional study (DDM-Spain) collected from October 7, 2007 through July 14, 2008, was used to calculate a score that measures the level of compliance with the WCRF/AICR recommendations: R1)Maintain adequate body weight; R2)Be physically active; 3R)Limit the intake of high density foods; R4)Eat mostly plant foods; R5)Limit the intake of animal foods; R6)Limit alcohol intake; R7)Limit salt and salt preserved food intake; R8)Meet nutritional needs through diet. The association between the score and MD (assessed by a single radiologist using a semi-quantitative scale) was evaluated using ordinal logistic models with random center-specific intercepts adjusted for the main determinants of MD. Stratified analyses by menopausal status and smoking status were also carried out. Results A higher compliance with the WCRF/AICR recommendations was associated with lower MD (OR1-unit increase = 0.93 95%CI:0.86;0.99). The association was stronger in postmenopausal women (OR = 0.91 95%CI:0.84;0.99) and nonsmokers (OR = 0.87;95%CI:0.80;0.96 for nonsmokers, OR = 1.01 95%CI:0.91;1.12 for smokers, P-interaction = 0.042). Among nonsmokers, maintaining adequate body weight (OR = 0.81 95%CI:0.65;1.01), practicing physical activity (OR = 0.68 95%CI:0.48;0.96) and moderating the intake of high-density foods (OR = 0.58 95%CI:0.40;0.86) and alcoholic beverages (OR = 0.76 95%CI:0.55;1.05) were the recommendations showing the strongest associations with MD. Conclusions postmenopausal women and non-smokers with greater compliance with the WCRF/AICR guidelines have lower MD. These results may provide guidance to design specific recommendations for screening attendants with high MD and therefore at higher risk of developing BC.
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Bertrand KA, Baer HJ, Orav EJ, Klifa C, Shepherd JA, Van Horn L, Snetselaar L, Stevens VJ, Hylton NM, Dorgan JF. Body fatness during childhood and adolescence and breast density in young women: a prospective analysis. Breast Cancer Res 2015; 17:95. [PMID: 26174168 PMCID: PMC4502611 DOI: 10.1186/s13058-015-0601-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/18/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Overweight and obesity in childhood and adolescence are associated with reduced breast cancer risk, independent of adult body mass index (BMI). These associations may be mediated through breast density. METHODS We prospectively examined associations of early life body fatness with adult breast density measured by MRI in 182 women in the Dietary Intervention Study in Children (DISC) who were ages 25-29 at follow-up. Height, weight, and other factors were measured at baseline (ages 8-10) and annual clinic visits through adolescence. We used linear mixed-effects models to quantify associations of percent breast density and dense and non-dense breast volume at ages 25-29 with quartiles of age-specific youth body mass index (BMI) Z-scores, adjusting for clinic, treatment group, current adult BMI, and other well-established risk factors for breast cancer and predictors of breast density. RESULTS We observed inverse associations between age-specific BMI Z-scores at all youth clinic visits and percent breast density, adjusting for current adult BMI and other covariates (all p values <0.01). Women whose baseline BMI Z-scores (at ages 8-10 years) were in the top quartile had significantly lower adult breast density, after adjusting for current adult BMI and other covariates [least squares mean (LSM): 23.4 %; 95 % confidence interval (CI): 18.0 %, 28.8 %] compared to those in the bottom quartile (LSM: 31.8 %; 95 % CI: 25.2 %, 38.4 %) (p trend <0.01). Significant inverse associations were also observed for absolute dense breast volume (all p values <0.01), whereas there were no clear associations with non-dense breast volume. CONCLUSIONS These results support the hypothesis that body fatness during childhood and adolescence may play an important role in premenopausal breast density, independent of current BMI, and further suggest direct or indirect influences on absolute dense breast volume. CLINICAL TRIALS REGISTRATION NUMBER NCT00458588 ; April 9, 2007.
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Affiliation(s)
- Kimberly A Bertrand
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Heather J Baer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02120, USA.
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02120, USA. .,Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Catherine Klifa
- Dangeard Group, 740 chemin de la Commanderie St Jean de Malte, 13080, Luynes, France.
| | - John A Shepherd
- Department of Radiology, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, 680 North Lake Shore Drive, Chicago, IL, 60611, USA.
| | - Linda Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, 145 North Riverside Drive, Iowa City, IA, 52242, USA.
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227, USA.
| | - Nola M Hylton
- Department of Radiology, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA.
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Tamaki K, Tamaki N, Terukina S, Kamada Y, Uehara K, Arakaki M, Miyashita M, Ishida T, McNamara KM, Ohuchi N, Sasano H. The correlation between body mass index and breast cancer risk or estrogen receptor status in Okinawan women. TOHOKU J EXP MED 2015; 234:169-74. [PMID: 25283589 DOI: 10.1620/tjem.234.169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dietary changes resulting from the post-World War II occupation of Okinawa by the US military have been largely deleterious, resulting in a marked increase of obesity among Okinawan residents. In this study, we examined the association between BMI and the risk of developing breast cancer according to the menstruation status and age, and the correlation between BMI and expression of estrogen receptor (ER). Breast cancer cases were 3,431 females without any personal or family history of breast cancer. Control subjects were 5,575 women drawn from the clinical files of Nahanishi Clinic. We found that women, who were overweight or obese, regardless of menopausal stage, had a higher risk of breast cancer compared to women with normal weight and this difference was statistically significant (p < 0.001, respectively). This risk was especially apparent in older (> 40 years) overweight or obese women. The women who were overweight or obese during postmenopausal ages were at higher risk of ER-positive breast cancer compared to women with normal weight. Results of our present study clearly indicate that increased BMI was associated with increased risk of developing breast cancer in Okinawan women, regardless of menopausal status. In addition, there was statistically significant correlation between BMI and ER expression in the postmenopausal period. Given the obesity epidemic associated with the extreme sociological and dietary changes brought about by the post-war occupation of Okinawa, the present study provides essential guidelines on the management, treatment and future breast cancer risk in Okinawa.
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