OUP accepted manuscript

Vi-PLUS: Pioneering Plane-Wave Ultrasound to Assess Breast Glandular Tissue in Healthy Women-A Pilot Study

BACKGROUND/OBJECTIVES

This study pioneers the application of the ViPLUS module, utilizing plane-wave ultrasound to measure breast tissue viscosity and elasticity. The primary goal was to establish normal reference values for viscosity in healthy women. Secondary objectives included exploring correlations between breast tissue viscosity and breast density categories, hormonal influences, and menstrual cycle phases.

METHODS

A prospective study was conducted on 245 asymptomatic women. Viscosity and elasticity measurements were obtained using the ViPLUS module, ensuring high reliability with stringent quality control measures. Data were statistically analyzed to evaluate correlations and group differences.

RESULTS

The median viscosity value for normal breast parenchyma was 1.7 Pa.s, with no significant variations based on breast density, menopausal status, or menstrual cycle phase. A strong correlation (rho = 0.866, p < 0.001) was observed between elasticity and viscosity values.

CONCLUSIONS

The findings suggest that breast viscosity is consistent across diverse physiological states, indicating its potential as an independent diagnostic marker. This parameter could be pivotal in future breast cancer screening strategies, especially for younger women and those with dense breasts.

Nomogram Model for Predicting Minimal Breast Cancer Based on Clinical and Ultrasonic Characteristics

Purpose

To construct a nomogram prediction model on minimal breast cancer (≦ 10 mm) based on clinical and ultrasound parameters.

Methods

Clinical and ultrasound data of 433 patients with minimal breast lesions was conducted in this retrospective study. Patients were randomly divided into a training set and a validation set with a ratio of 7:3. Independent risk factors for minimal breast cancer were selected by the least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis to construct a nomogram prediction model. The calibration curve, the clinical decision curve analysis (DCA) and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve were used to evaluate the diagnostic efficacy of the model.

Results

Age, margin, shape, and breast density were independent risk factors for malignant minimal breast lesions (P < 0.05). The AUC of the training set and validation set of the nomogram prediction model were 0.875, the sensitivity were 75.0% and 88.9%, the specificity were 83.8% and 77.7%, respectively. The mean absolute error (MAE) of the training set and validation set of the calibration curve were 0.01 and 0.024, respectively.

Conclusion

The nomogram prediction model has good discrimination, calibration and clinical practical value in the training set and validation set. The minimal breast cancer prediction model based on clinical and ultrasonic features possesses high clinical value, facilitating the early diagnosis of minimal breast cancer.

Associations between breastfeeding and breast cancer risk through mammographic breast density in a cohort of Korean women

BACKGROUND

Mammographic breast density has been suggested to play a role as a mediator between the risk factors for breast cancer (BC) and BC risk. We investigated the extent to which never breastfeeding is a risk factor for BC and how this risk is further mediated by increased mammographic breast density.

METHODS

This retrospective cohort study included 4 136 723 women aged ≥40 years who underwent mammographic screening between 2009 and 2010 and were followed up until 31 December 2020. Breastfeeding information was obtained by using a self-administered questionnaire. Mammographic breast density was extracted from national BC screening results, which were assessed by trained radiologists and categorized into dense and fatty breasts. We estimated the hazard ratios (HRs) and the proportion of the associations between breastfeeding and BC risk mediated by breast density.

RESULTS

The HR of never breastfeeding on BC risk was 1.34 (95% CI, 1.32-1.37) when adjusted for only parity, body mass index and smoking status, which were selected as covariates through a directed acyclic graph and 1.21 (95% CI, 1.19-1.23) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in total, pre- and post-menopausal women was 35.48%, 17.86% and 24.0%, respectively (all P < 0.001). The HR of never breastfeeding on BC risk was 1.10 (95% CI, 1.08-1.12) when adjusted for nine known breast cancer risk factors and 1.09 (95% CI, 1.07-1.12) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in the total, pre- and post-menopausal women was 7.50%, 3.71% and 12.21%, respectively (all P < 0.001).

CONCLUSIONS

Our findings suggest that the association between never breastfeeding and BC risk may be mediated by breast density. However, the HR and proportion of medications varied according to the adjusted covariates, highlighting that variables for adjustment should be selected based on directed acyclic graphs.

Association between breastfeeding, mammographic density, and breast cancer risk: a review

BACKGROUND

Mammographic density has been associated with breast cancer risk, and is modulated by established breast cancer risk factors, such as reproductive and hormonal history, as well as lifestyle. Recent epidemiological and biological findings underscore the recognized benefits of breastfeeding in reducing breast cancer risk, especially for aggressive subtypes. Current research exploring the association among mammographic density, breastfeeding, and breast cancer is sparse.

MAIN FINDINGS

Changes occur in the breasts during pregnancy in preparation for lactation, characterized by the proliferation of mammary gland tissues and the development of mammary alveoli. During lactation, the alveoli fill with milk, and subsequent weaning triggers the involution and remodeling of these tissues. Breastfeeding influences the breast microenvironment, potentially altering mammographic density. When breastfeeding is not initiated after birth, or is abruptly discontinued shortly after, the breast tissue undergoes forced and abrupt involution. Conversely, when breastfeeding is sustained over an extended period and concludes gradually, the breast tissue undergoes slow remodeling process known as gradual involution. Breast tissue undergoing abrupt involution displays denser stroma, altered collagen composition, heightened inflammation and proliferation, along with increased expression of estrogen receptor α (ERα) and progesterone receptor. Furthermore, elevated levels of pregnancy-associated plasma protein-A (PAPP-A) surpass those of its inhibitors during abrupt involution, enhancing insulin-like growth factor (IGF) signaling and collagen deposition. Prolactin and small molecules in breast milk may also modulate DNA methylation levels. Drawing insights from contemporary epidemiological and molecular biology studies, our review sheds light on how breastfeeding impacts mammographic density and explores its role in influencing breast cancer.

CONCLUSION

This review highlights a clear protective link between breastfeeding and reduced breast cancer risk via changes in mammographic density. Future research should investigate the effects of breastfeeding on mammographic density and breast cancer risk among various ethnic groups and elucidate the molecular mechanisms underlying these associations. Such comprehensive research will enhance our understanding and facilitate the development of targeted breast cancer prevention and treatment strategies.

Associations between breast cancer risk factors and mammographic breast density in a large cross-section of Korean women

BACKGROUND

We investigated the association between established risk factors for breast cancer and mammographic breast density in Korean women.

METHODS

This large cross-sectional study included 8 460 928 women aged >40 years, who were screened for breast cancer between 2009 and 2018. Breast density was assessed using the Breast Imaging Reporting and Data System. This study used multiple logistic regression analyses of age, BMI, age at menarche, menopausal status, menopausal age, parity, breastfeeding status, oral contraceptive use, family history of breast cancer, physical activity, smoking, drinking and hormone replacement therapy use to investigate their associations with mammographic breast density. Analyses were performed using SAS software.

RESULTS

Of 8 460 928 women, 4 139 869 (48.9%) had nondense breasts and 4 321 059 (51.1%) had dense breasts. Factors associated with dense breasts were: earlier age at menarche [<15 vs. ≥15; adjusted odds ratio (aOR), 1.18; 95% confidence interval (CI), 1.17-1.18], premenopausal status (aOR, 2.01; 95% CI, 2.00-2.02), later age at menopause (≥52 vs. <52; aOR, 1.23; 95% CI, 1.22-1.23), nulliparity (aOR, 1.64; 95% CI, 1.63-1.65), never breastfed (aOR, 1.23; 95% CI, 1.23-1.24) and use of hormone replacement therapy (aOR, 1.29; 95% CI, 1.28-1.29). Women with a higher BMI and the use of oral contraceptives were more likely to have nondense breasts.

CONCLUSION

Lower BMI, reproductive health and behavioral factors were associated with dense breasts in Korean women. Additional research should investigate the relationship between mammographic breast density, breast cancer risk factors and breast cancer risk.

The global burden, trends and cross-country inequalities of female breast and gynaecologic cancers: A population based study

OBJECTIVE

To analyse the global burden, trends and cross-country inequalities of female breast and gynaecologic cancers (FeBGCs).

DESIGN

Population-Based Study.

SETTING

Data sourced from the Global Burden of Disease Study 2019.

POPULATION

Individuals diagnosed with FeBGCs.

METHODS

Age-standardised mortality rates (ASMRs), age-standardised Disability-Adjusted Life Years (DALYs) rates (ASDRs) and their 95% uncertainty interval (UI) described the burden. Estimated annual percentage changes (EAPCs) and their confidence interval (CI) of age-standardised rates (ASRs) illustrated trends. Social inequalities were quantified using the Slope Index of Inequality (SII) and Concentration Index.

MAIN OUTCOME MEASURES

The main outcome measures were the burden of FeBGCs and the trends in its inequalities over time.

RESULTS

In 2019, the ASDRs per 100 000 females were as follows: breast cancer: 473.83 (95% UI: 437.30-510.51), cervical cancer: 210.64 (95% UI: 177.67-234.85), ovarian cancer: 124.68 (95% UI: 109.13-138.67) and uterine cancer: 210.64 (95% UI: 177.67-234.85). The trends per year from 1990 to 2019 were expressed as EAPCs of ASDRs and these: for Breast cancer: -0.51 (95% CI: -0.57 to -0.45); Cervical cancer: -0.95 (95% CI: -0.99 to -0.89); Ovarian cancer: -0.08 (95% CI: -0.12 to -0.04); and Uterine cancer: -0.84 (95% CI: -0.93 to -0.75). In the Social Inequalities Analysis (1990-2019) the SII changed from 689.26 to 607.08 for Breast, from -226.66 to -239.92 for cervical, from 222.45 to 228.83 for ovarian and from 74.61 to 103.58 for uterine cancer. The concentration index values ranged from 0.2 to 0.4.

CONCLUSIONS

The burden of FeBGCs worldwide showed a downward trend from 1990 to 2019. Countries or regions with higher Socio-demographic Index (SDI) bear a higher DALYs burden of breast, ovarian and uterine cancers, while those with lower SDI bear a heavier burden of cervical cancer. These inequalities increased over time.

Mediterranean diet: Fighting breast cancer naturally: A review

The effects and mechanisms of the Mediterranean diet (MD) on the incidence, recurrence, and prevention of breast cancer (BC) have been extensively investigated since the 1990s. Recent years have witnessed significant advancements in understanding the relationship between the components of the MD and BC, particularly in terms of their role and adherence. This comprehensive review focuses on several key aspects: the influence of the adherence of MD in cohort studies conducted across different regions on BC, the effects and mechanisms of individual component or main components as well as the supplementation of vitamins, drugs, exercise, and other factors of MD on BC; the variations in the impact of the MD on premenopausal and postmenopausal women, as well as different types in BC cases; the possible mechanisms underlying the development, recurrence, and prevention of BC in relation to the MD; and the interaction effects of individual genetic polymorphisms with the MD. Based on current research findings, this review highlights the key issues and identifies future research directions in investigating the relationship between the MD and BC. Furthermore, it suggests that healthy women of various ages and BC patients should adhere to MD in order to prevent BC or improve the prognosis.

Residential exposure to traffic pollution and mammographic density in premenopausal women

BACKGROUND

Mammographic density (MD) is the most important breast cancer biomarker. Ambient pollution is a carcinogen, and its relationship with MD is unclear. This study aims to explore the association between exposure to traffic pollution and MD in premenopausal women.

METHODOLOGY

This Spanish cross-sectional study involved 769 women attending gynecological examinations in Madrid. Annual Average Daily Traffic (AADT), extracted from 1944 measurement road points provided by the City Council of Madrid, was weighted by distances (d) between road points and women's addresses to develop a Weighted Traffic Exposure Index (WTEI). Three methods were employed: method-1 (1dAADT), method-2 (1dAADT), and method-3 (e1dAADT). Multiple linear regression models, considering both log-transformed percentage of MD and untransformed MD, were used to estimate MD differences by WTEI quartiles, through two strategies: "exposed (exposure buffers between 50 and 200 m) vs. not exposed (>200 m)"; and "degree of traffic exposure".

RESULTS

Results showed no association between MD and traffic pollution according to buffers of exposure to the WTEI (first strategy) for the three methods. The highest reductions in MD, although not statistically significant, were detected in the quartile with the highest traffic exposure. For instance, method-3 revealed a suggestive inverse trend (eβQ1 = 1.23, eβQ2 = 0.96, eβQ3 = 0.85, eβQ4 = 0.85, p-trend = 0.099) in the case of 75 m buffer. Similar non-statistically significant trends were observed with Methods-1 and -2. When we examined the effect of traffic exposure considering all the 1944 measurement road points in every participant (second strategy), results showed no association for any of the three methods. A slightly decreased MD, although not significant, was observed only in the quartile with the highest traffic exposure: eβQ4 = 0.98 (method-1), and eβQ4 = 0.95 (methods-2 and -3).

CONCLUSIONS

Our results showed no association between exposure to traffic pollution and MD in premenopausal women. Further research is needed to validate these findings.

Mammographic density changes after neoadjuvant chemotherapy in triple-negative breast cancer: Association with treatment and survival outcome

PURPOSE

To investigate the association of mammographic breast density with treatment and survival outcomes in patients with triple-negative breast cancer (TNBC) undergoing neoadjuvant chemotherapy (NAC).

METHODS

This retrospective study evaluated 306 women with TNBC who underwent NAC followed by surgery between 2010 and 2019. The baseline density and the density changes after NAC were evaluated. Qualitative breast density (a-d) was evaluated using the Breast Imaging Reporting and Data System. Quantitative breast density (%) was evaluated using fully automated software (the Laboratory for Individualized Breast Radiodensity Assessment) in the contralateral breast. Multivariable logistic regression analysis was used to evaluate the association between breast density and pathologic complete response (pCR), stratified by menopausal status. Cox proportional hazard regression analysis was used to evaluate the association among breast density, the development of contralateral breast cancer, and the development of locoregional recurrence and/or distant metastasis.

RESULTS

Contralateral density reduction ≥10 % was independently associated with pCR in premenopausal women (odds ratio [OR], 2.5; p = 0.022) but not in postmenopausal women (OR, 0.9; p = 0.823). During a mean follow-up of 65 months, 10 (3 %) women developed contralateral breast cancer, and 68 (22 %) women developed locoregional recurrences and/or distant metastases. Contralateral density reduction ≥10 % showed no association with the occurrence of contralateral breast cancer (hazard ratio [HR], 3.1; p = 0.308) or with locoregional recurrence and/or distant metastasis (HR, 1.1; p = 0.794).

CONCLUSION

In premenopausal women, a contralateral breast density reduction of ≥10 % after NAC was independently associated with pCR, although it did not translate into improved outcomes.

Physical Activity and Mammographic Density in Japanese Women

BACKGROUND

Dense breast is one of the strong risk factors for breast cancer among women. While it has been established that physical activity is associated with decreased risk for breast cancer, results have been inconsistent in terms of mammographic density. Thus, we examined physical activity in relation to mammographic density among Japanese women in Tokyo.

METHODS

We used 123,026 records from 33,698 Japanese women without a history of breast cancer who got mammograms at St. Luke's International Hospital in Tokyo, Japan from 2004 to 2019. Mammographic density was classified according to the Breast Imaging Reporting and Data System (BI-RADS), and women self-reported their physical activity level over the past year. ORs were estimated using logistic generalized estimating equations after adjusting for age, body mass index, menopausal status, parity, family history of breast or ovarian cancer, hormone therapy use, smoking status, alcohol consumption, and year.

RESULTS

We observed inverse associations of physical activity with dense breasts. Adjusted ORs were 0.96 (95% confidence interval: 0.91-1.00) for women with physical exercise for 1-2 days per week, 0.94 (0.88-0.99) for those with physical exercise for 3-5 days per week, and 0.91 (0.84-0.99) for those with daily physical exercise when compared with those reported seldom physical exercise.

CONCLUSIONS

Higher levels of physical activity may be associated with decreased mammographic density levels in Japanese women.

IMPACT

Increasing physical activity may serve as a reasonable intervention to reduce mammographic density, and thereby, to mitigate the risk of breast cancer in Asian women.

Breast cancer: Epidemiology, risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally, epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer. This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography, ultrasound, magnetic resonance imaging (MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.

Epidemiology and Risk Factors for Breast Cancer: 21st Century Advances, Gaps to Address through Interdisciplinary Science

Research methods to study risk factors and prevention of breast cancer have evolved rapidly. We focus on advances from epidemiologic studies reported over the past two decades addressing scientific discoveries, as well as their clinical and public health translation for breast cancer risk reduction. In addition to reviewing methodology advances such as widespread assessment of mammographic density and Mendelian randomization, we summarize the recent evidence with a focus on the timing of exposure and windows of susceptibility. We summarize the implications of the new evidence for application in risk stratification models and clinical translation to focus prevention-maximizing benefits and minimizing harm. We conclude our review identifying research gaps. These include: pathways for the inverse association of vegetable intake and estrogen receptor (ER)-ve tumors, prepubertal and adolescent diet and risk, early life adiposity reducing lifelong risk, and gaps from changes in habits (e.g., vaping, binge drinking), and environmental exposures.

Mammographic density in the environs of multiple industrial sources

BACKGROUND

Mammographic density (MD), defined as the percentage of dense fibroglandular tissue in the breast, is a modifiable marker of the risk of developing breast cancer. Our objective was to evaluate the effect of residential proximity to an increasing number of industrial sources in MD.

METHODS

A cross-sectional study was conducted on 1225 premenopausal women participating in the DDM-Madrid study. We calculated distances between women's houses and industries. The association between MD and proximity to an increasing number of industrial facilities and industrial clusters was explored using multiple linear regression models.

RESULTS

We found a positive linear trend between MD and proximity to an increasing number of industrial sources for all industries, at distances of 1.5 km (p-trend = 0.055) and 2 km (p-trend = 0.083). Moreover, 62 specific industrial clusters were analyzed, highlighting the significant associations found between MD and proximity to the following 6 industrial clusters: cluster 10 and women living at ≤1.5 km (β = 10.78, 95 % confidence interval (95%CI) = 1.59; 19.97) and at ≤2 km (β = 7.96, 95%CI = 0.21; 15.70); cluster 18 and women residing at ≤3 km (β = 8.48, 95%CI = 0.01; 16.96); cluster 19 and women living at ≤3 km (β = 15.72, 95%CI = 1.96; 29.49); cluster 20 and women living at ≤3 km (β = 16.95, 95%CI = 2.90; 31.00); cluster 48 and women residing at ≤3 km (β = 15.86, 95%CI = 3.95; 27.77); and cluster 52 and women living at ≤2.5 km (β = 11.09, 95%CI = 0.12; 22.05). These clusters include the following industrial activities: surface treatment of metals/plastic, surface treatment using organic solvents, production/processing of metals, recycling of animal waste, hazardous waste, urban waste-water treatment plants, inorganic chemical industry, cement and lime, galvanization, and food/beverage sector.

CONCLUSIONS

Our results suggest that women living in the proximity to an increasing number of industrial sources and those near certain types of industrial clusters have higher MD.

A review of the impact of energy balance on triple-negative breast cancer

Cancer cells cannot proliferate without sufficient energy to generate biomass for rapid cell division, as well as to fuel their functions at baseline. For this reason, many recent observational and interventional studies have focused on increasing energy expenditure and/or reducing energy intake during and after cancer treatment. The impact of variance in diet composition and in exercise on cancer outcomes has been detailed extensively elsewhere and is not the primary focus of this review. Instead, in this translational, narrative review we examine studies of how energy balance impacts anticancer immune activation and outcomes in triple-negative breast cancer (TNBC). We discuss preclinical, clinical observational, and the few clinical interventional studies on energy balance in TNBC. We advocate for the implementation of clinical studies to examine how optimizing energy balance-through changes in diet and/or exercise-may optimize the response to immunotherapy in people with TNBC. It is our conviction that by taking a holistic approach that includes energy balance as a key factor to be considered during and after treatment, cancer care may be optimized, and the detrimental effects of cancer treatment and recovery on overall health may be minimized.

Dietary Vitamin A Intake and Circulating Vitamin A Concentrations and the Risk of Three Common Cancers in Women: A Meta-Analysis

BACKGROUND

According to relevant clinical research, dietary and circulating antioxidants vitamin A are connected with the risk of breast, cervical, and ovarian cancer in women. However, there was inconsistency between the findings. We completed this meta-analysis at the right moment to address this contradiction of the problem.

METHODS

Web of Science, Embase, and PubMed databases were searched using the proposed search strategy and filtered using the inclusion and exclusion criteria as well as the NOS quality score. As of May 2022, low intake or low concentration was used as a control, and odds ratio (OR) or relative risk (RR) and ninety-five percent confidence intervals (95% CI) were extracted for high intake. Stata 12.0 was used to process the data.

RESULTS

Our meta-analysis included a total of 49 studies, 29 on breast cancer, 10 on ovarian cancer, and 10 on cervical cancer. There were 38 case-control studies included, with 25,363 cases and 42,281 controls; there were 11 cohort studies included, 1,334,176 individuals were followed up, and finally 9496 obtained cancer. The pooled OR value results were as follows: diet or supplements (OR = 0.83, 95% CI 0.76-0.90, I ² = 56.1%) and serum or plasma (OR = 0.96, 95% CI 0.86-1.09, I ² = 29.5%). Subgroup analyses were performed according to cancer type, diet or supplements, serum or plasma, study type, and geographic regions.

CONCLUSIONS

In North American and Asian populations, high dietary consumption of vitamin A or supplements decreases the incidence of three cancers in women, with breast and ovarian cancers being more significant. However, high circulating vitamin A concentrations were not significantly connected with the risk of the three malignancies.