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The Oncologist Jul 2022In screening for breast cancer (BC), mammographic breast density (MBD) is a powerful risk factor that increases breast carcinogenesis and synergistically reduces the... (Review)
Review
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.
Topics: Breast Density; Breast Neoplasms; Female; Humans; Life Style; Mammography; Risk Factors
PubMed: 35536728
DOI: 10.1093/oncolo/oyac084 -
European Journal of Cancer Prevention :... Nov 2017Excess total body fat and abdominal adipose tissue are recognized risk factors for metabolic diseases but also for some types of cancers, including breast cancer.... (Review)
Review
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.
Topics: Adiposity; Body Mass Index; Breast Density; Breast Neoplasms; Female; Humans; Risk Factors
PubMed: 27571214
DOI: 10.1097/CEJ.0000000000000310 -
The Ceylon Medical Journal Nov 2022Breast cancer has a high incidence and is showing a rising trend in Sri Lanka. Mammographic breast density is a radiologically measurable risk factor which has been...
INTRODUCTION
Breast cancer has a high incidence and is showing a rising trend in Sri Lanka. Mammographic breast density is a radiologically measurable risk factor which has been found to be significantly associated with breast cancer risk in women with minor variations between ethnicities. However, the Asian populations studied in previous international studies were of Japanese, Chinese and Filipino ethnicities and not Sri Lankan or other South Asian ethnicities. Also, a previous Sri Lankan study found no significant association between breast density and breast cancer. Therefore it is of interest to study whether there is actually an association between breast density and breast cancer in Sri Lankan women.
OBJECTIVES
This study aimed to assess whether there is a significant association between mammographic breast density and breast cancer in a Sri Lankan women and also to assess factors affecting breast density.
METHODOLOGY
We conducted a retrospective unmatched case control study of 110 women (22 cases of breast cancer and 88 controls) aged between 40 and 75 years who came for mammography to Sri Jayewardenepura General Hospital. Breast density was categorized in to two, as lower density (BIRADS type a and b compositions) and higher density (type c and d compositions) for the analysis.
RESULTS
Contrary to most international research findings and similar to the previous Sri Lankan study, no significant association was found between breast density and breast cancer. Additionally, out of multiple factors, only age, menopausal state and BMI were found to be significantly associated with breast density. Conclusion :These findings may indicate that there is a true difference in the Sri Lankan population form the previously studied international populations suggesting that there is no association between breast density and breast cancer in Sri Lankan women. A further multicenter research is necessary to prove or disprove this theory.
Topics: Adult; Aged; Female; Humans; Middle Aged; Breast Density; Breast Neoplasms; Case-Control Studies; Retrospective Studies; Risk Factors; Sri Lanka
PubMed: 37933880
DOI: 10.4038/cmj.v67i3.9698 -
Breast Cancer Research : BCR Apr 2021Mammographic breast density (MBD) and benign breast disease (BBD) are two of the strongest risk factors for breast cancer. Understanding trends in MBD by age and parity...
BACKGROUND
Mammographic breast density (MBD) and benign breast disease (BBD) are two of the strongest risk factors for breast cancer. Understanding trends in MBD by age and parity in women with BBD is essential to the clinical management and prevention of breast cancer.
METHODS
Using data from the Early Determinants of Mammographic Density (EDMD) study, a prospective follow-up study of women born in 1959-1967, we evaluated MBD in 676 women. We used linear regression with generalized estimating equations to examine associations between self-reported BBD and MBD (percent density, dense area, and non-dense area), assessed through a computer-assisted method.
RESULTS
A prior BBD diagnosis (median age at diagnosis 32 years) was reported by 18% of our cohort. The median time from BBD diagnosis to first available study mammogram was 9.4 years (range 1.1-27.6 years). Women with BBD had a 3.44% higher percent MBD (standard error (SE) = 1.56, p-value = 0.03) on their first available mammogram than women without BBD. Compared with parous women without BBD, nulliparous women with BBD and women with a BBD diagnosis prior to first birth had 7-8% higher percent MBD (β = 7.25, SE = 2.43, p-value< 0.01 and β = 7.84, SE = 2.98, p-value = 0.01, respectively), while there was no difference in MBD in women with a BBD diagnosis after the first birth (β = -0.22, SE = 2.40, p-value = 0.93).
CONCLUSION
Women with self-reported BBD had higher mammographic breast density than women without BBD; the association was limited to women with BBD diagnosed before their first birth.
Topics: Adolescent; Adult; Breast Density; Breast Diseases; Breast Neoplasms; Child; Female; Follow-Up Studies; Humans; Mammography; Parity; Pregnancy; Prospective Studies; Risk Factors; Young Adult
PubMed: 33902651
DOI: 10.1186/s13058-021-01426-7 -
AJR. American Journal of Roentgenology Aug 2021Our previous work showed that variation measures, which represent breast architecture derived from mammograms, were significantly associated with breast cancer. For...
Our previous work showed that variation measures, which represent breast architecture derived from mammograms, were significantly associated with breast cancer. For replication purposes, we examined the association of three variation measures (variation [V], which is measured in the image domain, and P and p [a normalized version of P], which are derived from restricted regions in the Fourier domain) with breast cancer risk in an independent population. We also compared these measures to volumetric density measures (volumetric percent density [VPD] and dense volume [DV]) from a commercial product. We examined 514 patients with breast cancer and 1377 control patients from a screening practice who were matched for age, date of examination, mammography unit, facility, and state of residence. Spearman rank-order correlation was used to evaluate the monotonic association between measures. Breast cancer associations were estimated using conditional logistic regression, after adjustment for age and body mass index. Odds ratios were calculated per SD increment in mammographic measure. These variation measures were strongly correlated with VPD (correlation, 0.68-0.80) but not with DV (correlation, 0.31-0.48). Similar to previous findings, all variation measures were significantly associated with breast cancer (odds ratio per SD: 1.30 [95% CI, 1.16-1.46] for V, 1.55 [95% CI, 1.35-1.77] for P, and 1.51 [95% CI, 1.33-1.72] for p). Associations of volumetric density measures with breast cancer were similar (odds ratio per SD: 1.54 [95% CI, 1.33-1.78] for VPD and 1.34 [95% CI, 1.20-1.50] for DV). When DV was included with each variation measure in the same model, all measures retained significance. Variation measures were significantly associated with breast cancer risk (comparable to the volumetric density measures) but were independent of the DV.
Topics: Adult; Breast; Breast Density; Breast Neoplasms; Case-Control Studies; Female; Humans; Mammography; Reproducibility of Results
PubMed: 34161135
DOI: 10.2214/AJR.20.22794 -
Journal of Primary Care & Community... Jul 2016We reviewed the literature on breast density knowledge and breast density awareness to explore what challenges are faced by this area of research. (Review)
Review
OBJECTIVES
We reviewed the literature on breast density knowledge and breast density awareness to explore what challenges are faced by this area of research.
METHOD
A review of PubMED, PsycINFO, and CINAHL databases was performed. Studies were published in peer-reviewed journals (in all years available) and written in English. The broad search terms used were ["breast density"] AND ["knowledge" OR "awareness"]. Eligible articles were included in the final analysis after meeting the following inclusion criteria: (1) the records had to quantitatively examine and report breast density knowledge and awareness, (2) the number of participants in the sample had to be clearly specified, and (3) studies reporting differences in breast density knowledge and awareness between racial and ethnic groups were included in the review.
RESULTS
Of the 277 articles identified, only 5 met inclusion criteria and addressed breast density knowledge and awareness. Characteristics of studies and results were examined.
CONCLUSIONS
There is insufficient evidence to determine a pattern of breast density knowledge and awareness in women. More quality studies are needed that focus on how well women understand the relationship between breast density, breast cancer risk, and breast cancer screening, especially in diverse populations.
Topics: Awareness; Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Ethnicity; Female; Health Knowledge, Attitudes, Practice; Health Literacy; Humans; Mammography
PubMed: 26906525
DOI: 10.1177/2150131916633138 -
Cancer Causes & Control : CCC Sep 2022We explored the under-debate association between mammographic breast density (MBD) and survival.
PURPOSE
We explored the under-debate association between mammographic breast density (MBD) and survival.
METHODS
From the Piedmont Cancer Registry, we identified 693 invasive breast cancer (BC) cases. We analyzed the overall survival in strata of MBD through the Kaplan-Meier method. Using the Cox proportional hazards model, we estimated the hazard ratios (HRs) of death; using the cause-specific hazards regression model, we estimated the HRs of BC-related and other causes of death. Models included term for Breast Imaging-Reporting and Data System (BI-RADS) MBD (categorized as BI-RADS 1 and BI-RADS 2-4) and were adjusted for selected patient and tumour characteristics.
RESULTS
There were 102 deaths, of which 49 were from BC. After 5 years, the overall survival was 69% in BI-RADS 1 and 88% in BI-RADS 2-4 (p < 0.01). Compared to BI-RADS 2-4, the HRs of death for BI-RADS 1 were 1.65 (95% CI 1.06-2.58) in the crude model and 1.35 (95% CI 0.84-2.16) in the fully adjusted model. Compared to BI-RADS 2-4, the fully adjusted HRs for BI-RADS 1 were 1.52 (95% CI 0.74-3.13) for BC-related death and 1.83 (95% CI 0.84-4.00) for the other causes of death.
CONCLUSION
Higher MBD is one of the strongest independent risk factors for BC, but it seems not to have an unfavorable impact on survival.
Topics: Breast Density; Breast Neoplasms; Female; Humans; Mammography; Risk Factors
PubMed: 35696000
DOI: 10.1007/s10552-022-01590-x -
Academic Radiology Sep 2019Mammographic density is an important risk factor for breast cancer, but translation to the clinic requires assurance that prior work based on mammography is applicable...
RATIONALE AND OBJECTIVES
Mammographic density is an important risk factor for breast cancer, but translation to the clinic requires assurance that prior work based on mammography is applicable to current technologies. The purpose of this work is to evaluate whether a calibration methodology developed previously produces breast density metrics predictive of breast cancer risk when applied to a case-control study.
MATERIALS AND METHODS
A matched case control study (n = 319 pairs) was used to evaluate two calibrated measures of breast density. Two-dimensional mammograms were acquired from six Hologic mammography units: three conventional Selenia two-dimensional full-field digital mammography systems and three Dimensions digital breast tomosynthesis systems. We evaluated the capability of two calibrated breast density measures to quantify breast cancer risk: the mean (PG) and standard deviation (PG) of the calibrated pixels. Matching variables included age, hormone replacement therapy usage/duration, screening history, and mammography unit. Calibrated measures were compared to the percentage of breast density (PD) determined with the operator-assisted Cumulus method. Conditional logistic regression was used to generate odds ratios (ORs) from continuous and quartile (Q) models with 95% confidence intervals. The area under the receiver operating characteristic curve (Az) was also used as a comparison metric. Both univariate models and models adjusted for body mass index and ethnicity were evaluated.
RESULTS
In adjusted models, both PG and PD were statistically significantly associated with breast cancer with similar Az of 0.61-0.62. The corresponding ORs and confidence intervals were also similar. For PG, the OR was 1.34 (1.09, 1.66) for the continuous measure and 1.83 (1.11, 3.02), 2.19 (1.28, 3.73), and 2.20 (1.26, 3.85) for Q2-Q4. For PD, the OR was 1.43 (1.16, 1.76) for the continuous measure and 0.84 (0.52, 1.38), 1.96 (1.19, 3.23), and 2.27 (1.29, 4.00) for Q2-Q4. The results for PG were slightly attenuated and not statistically significant. The OR was 1.22 (0.99, 1.51) with Az = 0.60 for the continuous measure and 1.24 (0.78, 1.97), 0.98 (0.60, 1.61), and 1.26, (0.77, 2.07) for Q2-Q4 with Az = 0.60.
CONCLUSION
The calibrated PG measure provided significant associations with breast cancer comparable to those given by PD. The calibrated PG performed slightly worse. These findings indicate that the calibration approach developed previously replicates under more general conditions.
Topics: Aged; Area Under Curve; Breast Density; Breast Neoplasms; Calibration; Case-Control Studies; Female; Humans; Mammography; Middle Aged; Odds Ratio; ROC Curve; Risk Assessment
PubMed: 30545682
DOI: 10.1016/j.acra.2018.10.009 -
Breast Cancer Research : BCR Dec 2022Breast density and microcalcifications are strongly associated with the risk of breast cancer. However, few studies have evaluated the combined association between these...
BACKGROUND
Breast density and microcalcifications are strongly associated with the risk of breast cancer. However, few studies have evaluated the combined association between these two factors and breast cancer risk. We investigated the association between breast density, microcalcifications, and risk of breast cancer.
METHODS
This cohort study included 3,910,815 women aged 40-74 years who were screened for breast cancer between 2009 and 2010 and followed up until 2020. The National Health Insurance Service database includes national health-screening results from the national breast cancer screening program, which is an organized screening program provided every 2 years for all women aged 40 years or older. Breast density was assessed based on the Breast Imaging Reporting and Data System (BI-RADS) 4 edition, mostly through visual assessment by radiologists. The presence or absence of microcalcifications was obtained from the mammographic results. Cox proportional hazard regression for breast cancer risk was used to estimate hazard ratios (aHRs) adjusted for breast cancer risk factors.
RESULTS
A total of 58,315 women developed breast cancer during a median follow-up of 10.8 years. Women with breast cancer had a higher proportion of microcalcifications than women without breast cancer (0.9% vs. 0.3%). After adjusting for breast density, women with microcalcification had a 3.07-fold (95% confidence interval [CI] 2.82-3.35) increased risk of breast cancer compared to women without microcalcification. The combined association between microcalcification and breast density dramatically increased the risk of breast cancer, corresponding to a higher level of breast density. Among postmenopausal women, the highest risk group was women with BI-RADS 4 and microcalcification. These women had more than a sevenfold higher risk than women with BI-RADS 1 and non-microcalcification (aHR, 7.26; 95% CI 5.01-10.53).
CONCLUSION
Microcalcification is an independent risk factor for breast cancer, and its risk is elevated when combined with breast density.
Topics: Female; Humans; Breast Neoplasms; Breast Density; Cohort Studies; Mammography; Risk Factors
PubMed: 36544167
DOI: 10.1186/s13058-022-01594-0 -
Journal of the American College of... Jan 2022Latinas in low-resource settings face additional barriers to understanding mammographic breast density (MBD) implications. The authors compared MBD awareness and...
PURPOSE
Latinas in low-resource settings face additional barriers to understanding mammographic breast density (MBD) implications. The authors compared MBD awareness and knowledge in Latinas from a safety-net clinic in Arizona with a national sample.
METHODS
Latinas 40 to 74 years of age were recruited within a safety-net clinic during screening mammography appointments from 2016 to 2019 (AZ cohort) and from a nationally representative online panel in 2017 (NS cohort). Surveys completed in either English or Spanish assessed awareness and knowledge of MBD. Chi-square tests and logistic regression were used for comparisons.
RESULTS
The NS cohort (n = 152) was older, more educated, more likely to have undergone prior mammography, and more likely to prefer English compared with the AZ cohort (n = 1,327) (P ≤ .03 for all) The NS cohort was more likely to be aware of MBD (32.6% versus 20.7%). Of those aware, the NS cohort was more likely to understand MBD's effect on masking (67.8% versus 37.0%) and breast cancer risk (72.2% versus 32.6%) compared with the AZ cohort (P ≤ .001 for all). Adjusting for age, education, screening history, and language, MBD awareness was similar between the two cohorts (adjusted odds ratio [ORadj], 0.95; P = .83), but knowledge of MBD as a masking factor (ORadj, 2.8; P = .03) and risk factor (ORadj, 7.2; P < .001) remained higher in the NS cohort compared with the AZ cohort.
CONCLUSIONS
Differences in MBD awareness, but not knowledge, between Latinas in a low-resource setting compared with a national sample could be explained by age, education, screening history, and language preference, underscoring the need for tailored approaches to MBD education among Latinas.
Topics: Breast Density; Breast Neoplasms; Early Detection of Cancer; Female; Hispanic or Latino; Humans; Mammography; Risk Factors
PubMed: 35033304
DOI: 10.1016/j.jacr.2021.08.025