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Mburu W, Guo C, Tian Y, Koka H, Fu S, Lu N, Li E, Li J, Cora R, Chan A, Guida JL, Sung H, Gierach GL, Abubakar M, Yu K, Yang XR. Associations between quantitative measures of mammographic density and terminal ductal lobular unit involution in Chinese breast cancer patients. Breast Cancer Res 2024; 26:116. [PMID: 39010116 PMCID: PMC11247848 DOI: 10.1186/s13058-024-01856-z] [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: 09/25/2023] [Accepted: 06/06/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Higher mammographic density (MD), a radiological measure of the proportion of fibroglandular tissue in the breast, and lower terminal duct lobular unit (TDLU) involution, a histological measure of the amount of epithelial tissue in the breast, are independent breast cancer risk factors. Previous studies among predominantly white women have associated reduced TDLU involution with higher MD. METHODS In this cohort of 611 invasive breast cancer patients (ages 23-91 years [58.4% ≥ 50 years]) from China, where breast cancer incidence rates are lower and the prevalence of dense breasts is higher compared with Western countries, we examined the associations between TDLU involution assessed in tumor-adjacent normal breast tissue and quantitative MD assessed in the contralateral breast obtained from the VolparaDensity software. Associations were estimated using generalized linear models with MD measures as the outcome variables (log-transformed), TDLU measures as explanatory variables (categorized into quartiles or tertiles), and adjusted for age, body mass index, parity, age at menarche and breast cancer subtype. RESULTS We found that, among all women, percent dense volume (PDV) was positively associated with TDLU count (highest tertile vs. zero: Expbeta = 1.28, 95% confidence interval [CI] 1.08-1.51, ptrend = < .0001), TDLU span (highest vs. lowest tertile: Expbeta = 1.23, 95% CI 1.11-1.37, ptrend = < .0001) and acini count/TDLU (highest vs. lowest tertile: Expbeta = 1.22, 95% CI 1.09-1.37, ptrend = 0.0005), while non-dense volume (NDV) was inversely associated with these measures. Similar trend was observed for absolute dense volume (ADV) after the adjustment of total breast volume, although the associations for ADV were in general weaker than those for PDV. The MD-TDLU associations were generally more pronounced among breast cancer patients ≥ 50 years and those with luminal A tumors compared with patients < 50 years and with luminal B tumors. CONCLUSIONS Our findings based on quantitative MD and TDLU involution measures among Chinese breast cancer patients are largely consistent with those reported in Western populations and may provide additional insights into the complexity of the relationship, which varies by age, and possibly breast cancer subtype.
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Affiliation(s)
- Waruiru Mburu
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Changyuan Guo
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuan Tian
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hela Koka
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Sheng Fu
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Ning Lu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Erni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Renata Cora
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Ariane Chan
- Volpara Health Technologies Ltd, Wellington, New Zealand
- Institute of Environmental Science and Research, Porirua, GA, 5022, New Zealand
| | - Jennifer L Guida
- Division of Cancer Control and Population Sciences, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, 30303, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Kai Yu
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, DHHS, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.
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Yaghjyan L, Heng YJ, Baker GM, Murthy D, Mahoney MB, Rosner B, Tamimi RM. Associations of stem cell markers CD44, CD24 and ALDH1A1 with mammographic breast density in women with benign breast biopsies. Br J Cancer 2024; 131:325-333. [PMID: 38849477 PMCID: PMC11263693 DOI: 10.1038/s41416-024-02743-2] [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: 08/25/2023] [Revised: 04/08/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND We examined associations of CD44, CD24 and ALDH1A1 breast stem cell markers with mammographic breast density (MBD), a well-established breast cancer (BCa) risk factor. METHODS We included 218 cancer-free women with biopsy-confirmed benign breast disease within the Nurses' Health Study (NHS) and NHSII. The data on BCa risk factors were obtained from biennial questionnaires. Immunohistochemistry (IHC) was done on tissue microarrays. For each core, the IHC expression was assessed using a semi-automated platform and expressed as percent of positively stained cells for each marker out of the total cell count. MBD was assessed with computer-assisted techniques. Generalised linear regression was used to examine the associations of each marker with square root-transformed percent density (PD), absolute dense and non-dense areas (NDA), adjusted for BCa risk factors. RESULTS Stromal CD44 and ALDH1A1 expression was positively associated with PD (≥ 10% vs. <10% β = 0.56, 95% confidence interval [CI] [0.06; 1.07] and β = 0.81 [0.27; 1.34], respectively) and inversely associated with NDA (β per 10% increase = -0.17 [-0.34; -0.01] and β for ≥10% vs. <10% = -1.17 [-2.07; -0.28], respectively). Epithelial CD24 expression was inversely associated with PD (β per 10% increase = -0.14 [-0.28; -0.01]. Stromal and epithelial CD24 expression was positively associated with NDA (β per 10% increase = 0.35 [0.2 × 10-2; 0.70] and β per 10% increase = 0.34 [0.11; 0.57], respectively). CONCLUSION Expression of stem cell markers is associated with MBD.
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Affiliation(s)
- Lusine Yaghjyan
- University of Florida, College of Public Health and Health Professions and College of Medicine, Department of Epidemiology, Gainesville, FL, USA.
| | - Yujing J Heng
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gabrielle M Baker
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Divya Murthy
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Matt B Mahoney
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 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
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Yaghjyan L, Wang Z, Warner ET, Rosner B, Heine J, Tamimi RM. Reproductive Factors Related to Childbearing and a Novel Automated Mammographic Measure, V. Cancer Epidemiol Biomarkers Prev 2024; 33:804-811. [PMID: 38497795 PMCID: PMC11147729 DOI: 10.1158/1055-9965.epi-23-1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND We investigated the associations between several reproductive factors related to childbearing and the variation (V) measure (a novel, objective, single summary measure of breast image intensity) by menopausal status. METHODS Our study included 3,814 cancer-free women within the Nurses' Health Study (NHS) and NHSII cohorts. The data on reproductive variables and covariates were obtained from biennial questionnaires closest to the mammogram date. V-measures were obtained from mammographic images using a previously developed algorithm capturing the standard deviation of pixel values. We used multivariate linear regression to examine the associations of parity, age at first birth, time between menarche and first birth, time since last pregnancy, and lifetime breastfeeding duration with V-measure, adjusting for breast cancer risk factors, including the percentage of mammographic density (PMD). We further examined whether these associations were statistically accounted for (mediated) by PMD. RESULTS Among premenopausal women, none of the reproductive factors were associated with V. Among postmenopausal women, inverse associations of parity and positive associations of age at first birth with V were mediated by PMD (percent mediated: nulliparity: 66.7%, P < 0.0001; parity: 50.5%, P < 0.01; age at first birth 76.1%, P < 0.001) and were no longer significant in PMD-adjusted models. Lifetime duration of breastfeeding was positively associated with V [>36 vs. 0 ≤1 months β = 0.29; 95% confidence interval (CI) 0.07; 0.52, Ptrend < 0.01], independent of PMD. CONCLUSIONS Parity, age at first birth, and breastfeeding were associated with postmenopausal V. IMPACT This study highlights associations of reproductive factors with mammographic image intensity.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, University of Florida, College of Public Health and Health Professions and College of Medicine, Gainesville, Florida
| | - Zifan Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica T Warner
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John Heine
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Rajaram N, Yap B, Eriksson M, Mariapun S, Tan LM, Sa’at H, Ho ELM, Taib NAM, Khor GL, Yip CH, Ho WK, Hall P, Teo SH. A Randomized Controlled Trial of Soy Isoflavone Intake on Mammographic Density among Malaysian Women. Nutrients 2023; 15:nu15020299. [PMID: 36678170 PMCID: PMC9862880 DOI: 10.3390/nu15020299] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Soy intake is associated with lower breast cancer risk in observational studies concerning Asian women, however, no randomized controlled trials (RCT) have been conducted among Asian women living in Asia. This three-armed RCT assessed the effects of one-year soy isoflavone (ISF) intervention on mammographic density (MD) change among healthy peri- and postmenopausal Malaysian women. This study was registered at ClinicalTrials.gov (NCT03686098). Participants were randomized into the 100 mg/day ISF Supplement, 50 mg/day ISF Diet, or control arm, and assessed for change in absolute and relative dense area from digital mammograms conducted at enrolment and after 12 months, compared over time across study arms using Kruskal-Wallis tests. Out of 118 women enrolled, 91 women completed the intervention, while 27 women (23%) were lost in follow up. The ISF supplement arm participants observed a larger decline in dense area (−1.3 cm2), compared to the ISF diet (−0.5 cm2) and control arm (−0.8 cm2), though it was not statistically significant (p = 0.48). Notably, among women enrolled within 5 years of menopause; dense area declined by 6 cm2 in the ISF supplement arm, compared to <1.0 cm2 in the control arm (p = 0.13). This RCT demonstrates a possible causal association between soy ISF intake and MD, a biomarker of breast cancer risk, among Asian women around the time of menopause, but these findings require confirmation in a larger trial.
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Affiliation(s)
- Nadia Rajaram
- Cancer Research Malaysia, Subang Jaya 47500, Malaysia
| | - Beverley Yap
- Cancer Research Malaysia, Subang Jaya 47500, Malaysia
| | | | | | - Lee Mei Tan
- Cancer Research Malaysia, Subang Jaya 47500, Malaysia
| | - Hamizah Sa’at
- University of Malaya Cancer Research Institute, Kuala Lumpur 50603, Malaysia
| | - Evelyn Lai Ming Ho
- ParkCity Medical Centre, Ramsay Sime Darby Healthcare, Kuala Lumpur 52200, Malaysia
| | | | - Geok Lin Khor
- Department of Nutrition and Dietetics, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Cheng Har Yip
- Cancer Research Malaysia, Subang Jaya 47500, Malaysia
- Subang Jaya Medical Centre, Ramsay Sime Darby Healthcare, Subang Jaya 47500, Malaysia
| | - Weang Kee Ho
- Cancer Research Malaysia, Subang Jaya 47500, Malaysia
- Department of Applied Mathematics, Faculty of Engineering, University of Nottingham Malaysia, Semenyih 43500, Malaysia
| | - Per Hall
- Karolinska Institutet, 171 77 Stockholm, Sweden
- Södersjukhuset, 118 83 Stockholm, Sweden
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya 47500, Malaysia
- University of Malaya Cancer Research Institute, Kuala Lumpur 50603, Malaysia
- Correspondence: ; Tel.: +60-356-509-797
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Ingthorsson S, Traustadottir GA, Gudjonsson T. Cellular Plasticity and Heterotypic Interactions during Breast Morphogenesis and Cancer Initiation. Cancers (Basel) 2022; 14:cancers14215209. [PMID: 36358627 PMCID: PMC9654604 DOI: 10.3390/cancers14215209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/01/2022] Open
Abstract
Simple Summary This review aims to discuss the structure, function and dynamics of the breast gland and how changes to the function of the breast’s cells can lead to different types of cancer. Abstract The human breast gland is a unique organ as most of its development occurs postnatally between menarche and menopause, a period ranging from 30 to 40 years. During this period, the monthly menstruation cycle drives the mammary gland through phases of cell proliferation, differentiation, and apoptosis, facilitated via a closely choreographed interaction between the epithelial cells and the surrounding stroma preparing the gland for pregnancy. If pregnancy occurs, maximal differentiation is reached to prepare for lactation. After lactation, the mammary gland involutes to a pre-pregnant state. These cycles of proliferation, differentiation, and involution necessitate the presence of epithelial stem cells that give rise to progenitor cells which differentiate further into the luminal and myoepithelial lineages that constitute the epithelial compartment and are responsible for the branching structure of the gland. Maintaining homeostasis and the stem cell niche depends strongly on signaling between the stem and progenitor cells and the surrounding stroma. Breast cancer is a slowly progressing disease whose initiation can take decades to progress into an invasive form. Accumulating evidence indicates that stem cells and/or progenitor cells at different stages, rather than terminally differentiated cells are the main cells of origin for most breast cancer subgroups. Stem cells and cancer cells share several similarities such as increased survival and cellular plasticity which is reflected in their ability to switch fate by receiving intrinsic and extrinsic signals. In this review, we discuss the concept of cellular plasticity in normal breast morphogenesis and cancer, and how the stromal environment plays a vital role in cancer initiation and progression.
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Affiliation(s)
- Saevar Ingthorsson
- Stem Cell Research Unit, Biomedical Center, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland
- Faculty of nursing and midwifery, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland
| | - Gunnhildur Asta Traustadottir
- Stem Cell Research Unit, Biomedical Center, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland
- Department of Pathology, Landspitali University Hospital, 101 Reykjavik, Iceland
| | - Thorarinn Gudjonsson
- Stem Cell Research Unit, Biomedical Center, School of Health Sciences, University of Iceland, 101 Reykjavik, Iceland
- Department of Laboratory Hematology, Landspitali University Hospital, 101 Reykjavik, Iceland
- Correspondence:
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Breast clinical target volume: HU-based glandular CTVs and ESTRO CTVs in modern and historical radiotherapy treatment planning. Strahlenther Onkol 2021; 198:229-235. [PMID: 34477884 PMCID: PMC8863698 DOI: 10.1007/s00066-021-01839-5] [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] [Received: 01/13/2021] [Accepted: 08/09/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE The current study aimed to compare contouring of glandular tissue only (gCTV) with the clinical target volume (CTV) as defined according to European Society for Radiotherapy and Oncology (ESTRO) guidelines (eCTV) and historically treated volumes (marked by wire and determined by palpation and anatomic landmarks) in breast cancer radiotherapy. METHODS A total of 56 consecutive breast cancer patients underwent treatment planning based solely on anatomic landmarks/wire markings ("wire based"). From these treatment plans, the 50% and 95% isodoses were transferred as structures and compared to the following CT-based volumes: eCTV; a Hounsfield unit (HU)-based automatic contouring of the gCTV; and standardized planning target volumes (PTVs) generated with 1‑cm safety margins (resulting in the ePTVs and gPTVs, respectively). RESULTS The 95% isodose volume of the wire-based plan was larger than the eCTV by 352.39 ± 176.06 cm3 but smaller than the ePTV by 157.58 ± 189.32 cm3. The 95% isodose was larger than the gCTV by 921.20 ± 419.78 cm3 and larger than the gPTV by 190.91 ± 233.49 cm3. Patients with larger breasts had significantly less glandular tissue than those with small breasts. There was a trend toward a lower percentage of glandular tissue in older patients. CONCLUSION Historical wire and anatomic landmarks-based treatment planning sufficiently covers the glandular tissue and the theoretical gPTV generated for the glandular tissue. Modern CT-based CTV and PTV definition according to ESTRO results in a larger treated volume than the historical wire-based techniques. HU-standardized glandular tissue contouring results in a significantly smaller CTV and might be an option for reducing the treatment volume and improving reproducibility of contouring between institutions.
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Dabrosin N, Dabrosin C. Postmenopausal Dense Breasts Maintain Premenopausal Levels of GH and Insulin-like Growth Factor Binding Proteins in Vivo. J Clin Endocrinol Metab 2020; 105:5695904. [PMID: 31900484 DOI: 10.1210/clinem/dgz323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/01/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Dense breast tissue is associated with 4 to 6 times higher risk of breast cancer by poorly understood mechanisms. No preventive therapy for this high-risk group is available. After menopause, breast density decreases due to involution of the mammary gland. In dense breast tissue, this process is haltered by undetermined biological actions. Growth hormone (GH) and insulin-like binding proteins (IGFBPs) play major roles in normal mammary gland development, but their roles in maintaining breast density are unknown. OBJECTIVE To reveal in vivo levels of GH, IGFBPs, and other pro-tumorigenic proteins in the extracellular microenvironment in breast cancer, in normal breast tissue with various breast density in postmenopausal women, and premenopausal breasts. We also sought to determine possible correlations between these determinants. SETTING AND DESIGN Microdialysis was used to collect extracellular in vivo proteins intratumorally from breast cancers before surgery and from normal human breast tissue from premenopausal women and postmenopausal women with mammographic dense or nondense breasts. RESULTS Estrogen receptor positive breast cancers exhibited increased extracellular GH (P < .01). Dense breasts of postmenopausal women exhibited similar levels of GH as premenopausal breasts and significantly higher levels than in nondense breasts (P < .001). Similar results were found for IGFBP-1, -2, -3, and -7 (P < .01) and for IGFBP-6 (P <.05). Strong positive correlations were revealed between GH and IGFBPs and pro-tumorigenic matrix metalloproteinases, urokinase-type plasminogen activator, Interleukin 6, Interleukin 8, and vascular endothelial growth factor in normal breast tissue. CONCLUSIONS GH pathways may be targetable for cancer prevention therapeutics in postmenopausal women with dense breast tissue.
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Affiliation(s)
- Nina Dabrosin
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotta Dabrosin
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Maskarinec G, Ju D, Shvetsov YB, Horio D, Chan O, Loo LWM, Hernandez BY. Breast tumor tissue inflammation but not lobular involution is associated with survival among breast cancer patients in the Multiethnic Cohort. Cancer Epidemiol 2020; 65:101685. [PMID: 32058311 DOI: 10.1016/j.canep.2020.101685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study investigated the association of breast lobular involution status and three inflammatory markers as predictors of survival among breast cancer patients in the Multiethnic Cohort. METHODS Lobular involution was evaluated in tissue sections of normal breast tissue and COX-2, TNF-α, and TGF-β proteins were assessed by immunohistochemistry in tumor microarrays. A summary score added the expression levels of the three markers. Cox regression was applied to estimate hazard ratios (HRs) and 95 % confidence intervals (CI) with age as the time metric and adjustment for factors known to affect mortality. RESULTS Among 254 women (mean age = 61.7 ± 8.7 years) with pathologic blocks and follow-up information, 54 all-cause and 10 breast cancer-specific deaths were identified after a mean follow-up time of 16.0 ± 3.1 years. For 214 participants, an inflammatory score was available and 157 women had information on lobular involution. Lobular involution was not significantly associated with survival. Expression of both COX-2 and TNF-α were significant predictors of lower survival (p = 0.02 and 0.04), while the association for TGF-β was weaker (p = 0.09). When combined into one overall inflammation score, both intermediate (HR = 2.72; 95 % CI 0.90-8.28) and high (HR = 4.21; 95 % CI 1.51-11.8) scores were associated with higher mortality but only the latter was statistically significant. No significant association with breast cancer-specific mortality was detected. CONCLUSIONS These results suggest that strong expression of inflammatory markers in breast tissue predicts a poorer prognosis possibly due to a system-wide state of chronic inflammation.
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Affiliation(s)
| | - Dan Ju
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - David Horio
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Owen Chan
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Lenora W M Loo
- University of Hawaii Cancer Center, Honolulu, HI, United States
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Involution of Breast Lobules, Mammographic Breast Density and Prognosis Among Tamoxifen-Treated Estrogen Receptor-Positive Breast Cancer Patients. J Clin Med 2019; 8:jcm8111868. [PMID: 31689948 PMCID: PMC6912285 DOI: 10.3390/jcm8111868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Mammographic breast density (MD) reflects breast fibroglandular content. Its decline following adjuvant tamoxifen treated, estrogen receptor (ER)-positive breast cancer has been associated with improved outcomes. Breast cancers arise from structures termed lobules, and lower MD is associated with increased age-related lobule involution. We assessed whether pre-treatment involution influenced associations between MD decline and risk of breast cancer-specific death. ER-positive tamoxifen treated patients diagnosed at Kaiser Permanente Northwest (1990-2008) were defined as cases who died of breast cancer (n = 54) and matched controls (remained alive over similar follow-up; n = 180). Lobule involution was assessed by examining terminal duct lobular units (TDLUs) in benign tissues surrounding cancers as TDLU count/mm2, median span and acini count/TDLU. MD (%) was measured in the unaffected breast at baseline (median 6-months before) and follow-up (median 12-months after tamoxifen initiation). TDLU measures and baseline MD were positively associated among controls (p < 0.05). In multivariable regression models, MD decline (≥10%) was associated with reduced risk of breast cancer-specific death before (odds ratio (OR): 0.41, 95% CI: 0.18-0.92) and after (OR: 0.41, 95% CI: 0.18-0.94) adjustment for TDLU count/mm2, TDLU span (OR: 0.34, 95% CI: 0.14-0.84), and acini count/TDLU (OR: 0.33, 95% CI: 0.13-0.81). MD decline following adjuvant tamoxifen is associated with reduced risk of breast cancer-specific death, irrespective of pre-treatment lobule involution.
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Sung H, Guo C, Li E, Li J, Pfeiffer RM, Guida JL, Cora R, Hu N, Deng J, Figueroa JD, Sherman ME, Gierach GL, Lu N, Yang XR. The relationship between terminal duct lobular unit features and mammographic density among Chinese breast cancer patients. Int J Cancer 2019; 145:70-77. [PMID: 30561789 DOI: 10.1002/ijc.32077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 12/15/2022]
Abstract
Extensive mammographic density (MD), a well-established breast cancer risk factor, is a radiological representation of stromal and epithelial breast tissue content. In studies conducted predominantly among Caucasian women, histologic measures of reduced terminal duct lobular unit (TDLU) involution have been correlated with extensive MD, but independently associated with breast cancer risk. We therefore examined associations between TDLU measures and MD among Chinese women, a low-risk population but with high prevalence of dense breasts. Diagnostic pre-treatment digital mammograms were obtained from 144 breast cancer cases at a tertiary hospital in Beijing and scored using the Breast Imaging Reporting and Data System (BI-RADS) density classification. TDLU features were assessed using three standardized measures (count/100 mm2 , span [μm], and acini count/TDLU) in benign tissues. Associations between each of TDLU measures and MD were examined using generalized linear models for TDLU count and span and polytomous logistic regression for acini count with adjustment for potential confounders stratified by age. Among women ≥50 years, 63% had dense breasts; cases with dense breasts (BI-RADS, c-d) had greater TDLU count (21.1 [SE = 2.70] vs. 9.0 [SE = 1.83]; p = 0.0004), longer span (480.6 μm [SE = 24.6] vs. 393.8 μm [SE = 31.8]; p = 0.03), and greater acini count (ORtrend = 16.1; 95%CI = 4.08-63.1; ptrend < 0.0001) compared to those with non-dense breasts (BI-RADS, a-b). Among women <50 years, 91% had dense breasts, precluding our ability to detect associations. Our findings are consistent with previously reported associations between extensive MD and reduced TDLU involution, supporting the hypothesis that breast cancer risk associated with extensive MD may be related to the amount of "at-risk" epithelium.
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Affiliation(s)
- Hyuna Sung
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| | - Changyuan Guo
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Erni Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer L Guida
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Renata Cora
- Independent Contractor, CT(ASCP), MB(ASCP), Stamford, Connecticut, USA
| | - Nan Hu
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph Deng
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Usher Institute of Population Health Sciences and Informatics, CRUK Edinburgh Centre, The University of Edinburgh, Edinburgh, United Kingdom
| | - Mark E Sherman
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ning Lu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong R Yang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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11
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Physical activity and mammographic density in an Asian multi-ethnic cohort. Cancer Causes Control 2018; 29:883-894. [DOI: 10.1007/s10552-018-1064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/25/2018] [Indexed: 01/14/2023]
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12
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Vinnicombe SJ. Breast density: why all the fuss? Clin Radiol 2017; 73:334-357. [PMID: 29273225 DOI: 10.1016/j.crad.2017.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/17/2017] [Indexed: 01/06/2023]
Abstract
The term "breast density" or mammographic density (MD) denotes those components of breast parenchyma visualised at mammography that are denser than adipose tissue. MD is composed of a mixture of epithelial and stromal components, notably collagen, in variable proportions. MD is most commonly assessed in clinical practice with the time-honoured method of visual estimation of area-based percent density (PMD) on a mammogram, with categorisation into quartiles. The computerised semi-automated thresholding method, Cumulus, also yielding area-based percent density, is widely used for research purposes; however, the advent of fully automated volumetric methods developed as a consequence of the widespread use of digital mammography (DM) and yielding both absolute and percent dense volumes, has resulted in an explosion of interest in MD recently. Broadly, the importance of MD is twofold: firstly, the presence of marked MD significantly reduces mammographic sensitivity for breast cancer, even with state-of-the-art DM. Recognition of this led to the formation of a powerful lobby group ('Are You Dense') in the US, as a consequence of which 32 states have legislated for mandatory disclosure of MD to women undergoing mammography. Secondly, it is now widely accepted that MD is in itself a risk factor for breast cancer, with a four-to sixfold increased relative risk in women with PMD in the highest quintile compared to those with PMD in the lowest quintile. Consequently, major research efforts are underway to assess whether use of MD could provide a major step forward towards risk-adapted, personalised breast cancer prevention, imaging, and treatment.
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Affiliation(s)
- S J Vinnicombe
- Cancer Research, School of Medicine, Level 7, Mailbox 4, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
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