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Journal of the American College of... May 2022Women are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear....
OBJECTIVE
Women are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear. We compared self-reported with clinically assessed breast density and assessed knowledge of density implications and feelings about future screening.
METHODS
From December 2017 to January 2020, we surveyed women aged 40 to 74 years without prior breast cancer, with a normal screening mammogram in the prior year, and ≥1 recorded breast density measures in four Breast Cancer Surveillance Consortium registries with density reporting laws. We measured agreement between self-reported and BI-RADS breast density categorized as "ever-dense" if heterogeneously or extremely dense within the past 5 years or "never-dense" otherwise, knowledge of dense breast implications, and feelings about future screening.
RESULTS
Survey participation was 28% (1,528 of 5,408), and 59% (896 of 1,528) of participants had ever-dense breasts. Concordance between self-report versus clinical density was 76% (677 of 896) among women with ever-dense breasts and 14% (89 of 632) among women with never-dense breasts, and 34% (217 of 632) with never-dense breasts reported being told they had dense breasts. Desire for supplemental screening was more frequent among those who reported having dense breasts 29% (256 of 893) or asked to imagine having dense breasts 30% (152 of 513) versus those reporting nondense breasts 15% (15 of 102) (P = .003, P = .002, respectively). Women with never-dense breasts had 6.3-fold higher odds (95% confidence interval:3.39-11.80) of accurate knowledge in states reporting density to all compared to states reporting only to women with dense breasts.
DISCUSSION
Standardized communications of breast density results to all women may increase density knowledge and are needed to support informed screening decisions.
Topics: Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Male; Mammography; Mass Screening
PubMed: 35341697
DOI: 10.1016/j.jacr.2022.02.025 -
Breast Cancer Research and Treatment Feb 2020Tumor microenvironment, including inflammatory cells, adipocytes and extracellular matrix constituents such as hyaluronan (HA), impacts on cancer progression. Systemic...
PURPOSE
Tumor microenvironment, including inflammatory cells, adipocytes and extracellular matrix constituents such as hyaluronan (HA), impacts on cancer progression. Systemic metabolism also influences tumor growth e.g. obesity and type 2 diabetes (T2D) are risk factors for breast cancer. Here, in 262 breast cancer cases, we explored the combined impacts on survival of M2-like tumor associated macrophages (TAMs), the abundance of breast fat visualized as low density in mammograms, and tumor HA, and their associations with T2D.
METHODS
Mammographic densities were assessed visually from the diagnostic images and dichotomized into very low density (VLD, density ≤ 10%, "fatty breast") and mixed density (MID, density > 10%). The amounts of TAMs (CD163+ and CD68+) and tumor HA were determined by immunohistochemistry. The data of T2D was collected from the patient records. Statistical differences between the parameters were calculated with Chi square or Mann-Whitney test and survival analyses with Cox's model.
RESULTS
A combination of fatty breasts (VLD), abundance of M2-like TAMs (CD163+) and tumor HA associated with poor survival, as survival was 88-89% in the absence of these factors but only 40-47% when all three factors were present (p < 0.001). Also, an association between T2D and fatty breasts was found (p < 0.01). Furthermore, tumors in fatty breasts contained more frequently high levels of M2-like TAMs than tumors in MID breasts (p = 0.01).
CONCLUSIONS
Our results demonstrate a dramatic effect of the tumor microenvironment on breast cancer progression. We hypothesize that T2D as well as obesity increase the fat content of the breasts, subsequently enhancing local pro-tumoral inflammation.
Topics: Adipocytes; Adipose Tissue; Adult; Aged; Aged, 80 and over; Breast; Breast Density; Breast Neoplasms; Diabetes Mellitus, Type 2; Disease-Free Survival; Female; Humans; Hyaluronic Acid; Macrophages; Middle Aged; Obesity; Retrospective Studies; Survival Analysis; Tumor Microenvironment
PubMed: 31720917
DOI: 10.1007/s10549-019-05491-7 -
Cancer Epidemiology, Biomarkers &... Apr 2021Early-life body size has been consistently associated with breast cancer risk. The direction of the association changes over time, with high birth weight, smaller...
Early-life body size has been consistently associated with breast cancer risk. The direction of the association changes over time, with high birth weight, smaller adolescent body size, and adult weight gain all increasing breast cancer risk. There is also a clear positive association between larger body size and increased breast adipose tissue measured by mammograms, but less is known about how body size changes across life stages affect stromal and epithelial breast tissue. Using breast tissue slides from women with benign breast disease, Oh and colleagues applied machine learning methods to evaluate body size across the life course and adipose, epithelial, and stromal tissue concentrations in adulthood. They found consistent patterns for higher adipose and lower stromal tissue concentrations with larger childhood and adult body size at age 18 years. They reported lower levels of epithelial tissue with larger body size at 18 years, but not at other time periods. Additional studies examining how body size at different life stages may affect breast tissue composition will be important. Noninvasive methods that can provide measures of breast tissue composition may offer potential ways forward to ensure generalizability, and repeated measurements by life stage..
Topics: Adolescent; Adult; Birth Weight; Breast; Breast Density; Breast Neoplasms; Child; Female; Humans; Mammography
PubMed: 33811170
DOI: 10.1158/1055-9965.EPI-20-1807 -
Preoperative Breast Pain Predicts Persistent Breast Pain and Disability After Breast Cancer Surgery.Journal of Pain and Symptom Management Jun 2015Approximately 30% of the women report pain in the affected breast before breast cancer surgery.
CONTEXT
Approximately 30% of the women report pain in the affected breast before breast cancer surgery.
OBJECTIVES
The purpose of this secondary analysis of our prospective study was to determine how women who experienced both preoperative and persistent postsurgical breast pain (n=107) differed from women who did not report preoperative breast pain and did (n=158) or did not (n=122) experience persistent postsurgical breast pain.
METHODS
Differences in demographic and clinical characteristics were evaluated. Linear mixed effects (LME) modeling was used to evaluate for group differences in symptom severity, function, sensation, and quality of life (QOL) over time.
RESULTS
Between-group differences in demographic and clinical characteristics as well as trajectories of shoulder function and QOL were identified. Women with both preoperative and persistent postsurgical breast pain were younger; were more likely to report swelling, strange sensations, hardness, and numbness in the affected breast before surgery; and were more likely to have reconstruction at the time of surgery. Women with both preoperative and persistent postsurgical breast pain had more biopsies in the prior year, more lymph nodes removed, and reported more severe acute postsurgical pain than women without preoperative breast pain. The LME modeling revealed significant group effects for most outcomes evaluated. Over the six months of the study, women with both preoperative and persistent postsurgical pain had persistently poorer shoulder flexion and physical well-being than women without preoperative breast pain.
CONCLUSION
Investigations of the etiology and molecular mechanisms of preoperative breast pain, as well as interventions for this high-risk group, are needed.
Topics: Breast; Breast Neoplasms; Disability Evaluation; Female; Humans; Linear Models; Longitudinal Studies; Middle Aged; Pain Measurement; Pain, Postoperative; Preoperative Period; Prognosis; Prospective Studies; Quality of Life; Severity of Illness Index
PubMed: 25527442
DOI: 10.1016/j.jpainsymman.2014.11.292 -
Scientific Reports Aug 2021Mammographic density (MD) of the breast and body mass index (BMI) are inversely associated with each other, but have inconsistent associations with respect to the risk...
Mammographic density (MD) of the breast and body mass index (BMI) are inversely associated with each other, but have inconsistent associations with respect to the risk of breast cancer. Skeletal muscle mass index (SMI) has been considered to reflect a relatively accurate fat and muscle percentage in the body. So, we evaluated the relation between SMI and MD. A cross-sectional study was performed in 143,456 women who underwent comprehensive examinations from 2012 to 2016. BMI was adjusted to analyze whether SMI is an independent factor predicting dense breast. After adjustment for confounding factors including BMI, the odds ratios for MD for the dense breasts was between the highest and lowest quartiles of SMI at 2.65 for premenopausal women and at 2.39 for postmenopausal women. SMI was a significant predictor for MD, which could be due to the similar growth mechanism of the skeletal muscle and breast parenchymal tissue. Further studies are needed to understand the causal link between muscularity, MD and breast cancer risk.
Topics: Adult; Body Mass Index; Breast; Breast Density; Breast Neoplasms; Female; Humans; Mammary Glands, Human; Mammography; Middle Aged; Muscle, Skeletal; Postmenopause; Premenopause
PubMed: 34408263
DOI: 10.1038/s41598-021-96390-9 -
BMJ Case Reports Aug 2020A 35-year-old woman presented to the surgery outpatient department with a lump in her right breast for 2 months and pain for 1 month. After clinical examination and...
A 35-year-old woman presented to the surgery outpatient department with a lump in her right breast for 2 months and pain for 1 month. After clinical examination and relevant investigations, we kept a working diagnosis of antibioma. The lump was excised under local anaesthesia and biopsy was sent. However, histopathological examination reported multiple non-caseating granulomas without acid-fast bacilli. Two months later, she developed a sinus with serous discharge at the scar site. At the same time, she developed pain in the left upper breast, which subsequently progressed to an abscess. Incision and drainage of the abscess was done, but the wound did not heal, and a discharging sinus appeared at the site. Finally, a diagnosis of idiopathic granulomatous mastitis was made, after excluding all other causes, and the patient was prescribed oral steroids. She recovered fully after 8 months and there is no recurrence till date.
Topics: Adult; Anti-Inflammatory Agents; Breast; Diagnosis, Differential; Drainage; Female; Granulomatous Mastitis; Humans; Methylprednisolone; Treatment Outcome
PubMed: 32868320
DOI: 10.1136/bcr-2020-234979 -
Archives of Pathology & Laboratory... Oct 2016Apocrine change in the breast is an extremely common finding. In most cases, the benign or malignant nature of the lesion is easily recognized. Apocrine adenosis is used... (Review)
Review
Apocrine change in the breast is an extremely common finding. In most cases, the benign or malignant nature of the lesion is easily recognized. Apocrine adenosis is used to describe sclerosing adenosis with apocrine change. The term apocrine atypia is used when there is significant cytologic atypia in apocrine cells, characterized by a 3-fold nuclear enlargement, prominent/multiple nucleoli, and hyperchromasia. Atypical apocrine adenosis is diagnosed when apocrine adenosis and apocrine atypia are superimposed. However, there are no definite criteria to distinguish atypical apocrine adenosis from apocrine ductal carcinoma in situ. Immunohistochemical markers can be confounding and may lead to erroneous diagnoses. Atypical apocrine features in sclerosing lesions may be misinterpreted as invasive carcinoma if the underlying lesion is not recognized. In the absence of definite features of malignancy, the diagnosis of apocrine ductal carcinoma in situ may be extremely difficult. In the present article, we review atypical apocrine adenosis focusing on diagnostic challenges and their implications on clinical management.
Topics: Apocrine Glands; Breast; Carrier Proteins; Diagnosis, Differential; Female; Fibrocystic Breast Disease; Glycoproteins; Humans; Immunohistochemistry; Membrane Transport Proteins; Metaplasia; Precancerous Conditions
PubMed: 27684975
DOI: 10.5858/arpa.2016-0238-RA -
European Radiology Nov 2023To assess whether mammographic breast density in women diagnosed with breast cancer correlates with the total number of incidental magnetic resonance imaging...
OBJECTIVES
To assess whether mammographic breast density in women diagnosed with breast cancer correlates with the total number of incidental magnetic resonance imaging (MRI)-detected lesions and the likelihood of the lesions being malignant.
METHODS
Patients diagnosed with breast cancer meeting the EUSOBI and EUSOMA criteria for preoperative breast MRI routinely undergo mammography and ultrasound before MRI at our institution. Incidental suspicious breast lesions detected in MRI are biopsied. We included patients diagnosed with invasive breast cancers between 2014 and 2019 who underwent preoperative breast MRI. One reader retrospectively determined breast density categories according to the 5 edition of the BI-RADS lexicon.
RESULTS
Of 946 patients with 973 malignant primary breast tumors, 166 (17.5%) had a total of 175 (18.0%) incidental MRI-detected lesions (82 (46.9%) malignant and 93 (53.1%) benign). High breast density according to BI-RADS was associated with higher incidence of all incidental enhancing lesions in preoperative breast MRIs: 2.66 (95% confidence interval: 1.03-6.86) higher for BI-RADS density category B, 2.68 (1.04-6.92) for category C, and 3.67 (1.36-9.93) for category D compared to category A (p < 0.05). However, high breast density did not predict higher incidence of malignant incidental lesions (p = 0.741). Incidental MRI-detected lesions in the contralateral breast were more likely benign (p < 0.001): 18 (27.3%)/48 (72.7%) vs. 64 (58.7%)/45 (41.3%) malignant/benign incidental lesions in contralateral vs. ipsilateral breasts.
CONCLUSION
Women diagnosed with breast cancer who have dense breasts have more incidental MRI-detected lesions, but higher breast density does not translate to increased likelihood of malignant incidental lesions.
CLINICAL RELEVANCE STATEMENT
Dense breasts should not be considered as an indication for preoperative breast MRI in women diagnosed with breast cancer.
KEY POINTS
• The role of preoperative MRI of patients with dense breasts diagnosed with breast cancer is under debate. • Women with denser breasts have a higher incidence of all MRI-detected incidental breast lesions, but the incidence of malignant MRI-detected incidental lesions is not higher than in women with fatty breasts. • High breast density alone should not indicate preoperative breast MRI.
Topics: Female; Humans; Breast Neoplasms; Breast Density; Retrospective Studies; Breast; Mammography; Magnetic Resonance Imaging
PubMed: 37646814
DOI: 10.1007/s00330-023-10072-w -
Medical Physics Jul 2017To evaluate a method for measuring breast density using photon-counting spectral mammography. Breast density is an indicator of breast cancer risk and diagnostic...
PURPOSE
To evaluate a method for measuring breast density using photon-counting spectral mammography. Breast density is an indicator of breast cancer risk and diagnostic accuracy in mammography, and can be used as input to personalized screening, treatment monitoring and dose estimation.
METHODS
The measurement method employs the spectral difference in x-ray attenuation between adipose and fibro-glandular tissue, and does not rely on any a priori information. The method was evaluated using phantom measurements on tissue-equivalent material (slabs and breast-shaped phantoms) and using clinical data from a screening population (n=1329). A state-of-the-art nonspectral method for breast-density assessment was used for benchmarking.
RESULTS
The precision of the spectral method was estimated to be 1.5-1.8 percentage points (pp) breast density. Expected correlations were observed in the screening population for thickness versus breast density, dense volume, breast volume, and compression height. Densities ranged between 4.5% and 99.6%, and exhibited a skewed distribution with a mode of 12.5%, a median of 18.3%, and a mean of 23.7%. The precision of the nonspectral method was estimated to be 2.7-2.8 pp. The major uncertainty of the nonspectral method originated from the thickness estimate, and in particular thin/dense breasts posed problems compared to the spectral method.
CONCLUSIONS
The spectral method yielded reasonable results in a screening population with a precision approximately two times that of the nonspectral method, which may improve or enable applications of breast-density measurement on an individual basis such as treatment monitoring and personalized screening.
Topics: Breast; Breast Neoplasms; Humans; Male; Mammography; Phantoms, Imaging; Photons; X-Rays
PubMed: 28421611
DOI: 10.1002/mp.12279 -
Annual Review of Biomedical Data Science Aug 2023Breast cancer risk is highly variable within the population and current research is leading the shift toward personalized medicine. By accurately assessing an individual... (Review)
Review
Breast cancer risk is highly variable within the population and current research is leading the shift toward personalized medicine. By accurately assessing an individual woman's risk, we can reduce the risk of over/undertreatment by preventing unnecessary procedures or by elevating screening procedures. Breast density measured from conventional mammography has been established as one of the most dominant risk factors for breast cancer; however, it is currently limited by its ability to characterize more complex breast parenchymal patterns that have been shown to provide additional information to strengthen cancer risk models. Molecular factors ranging from high penetrance, or high likelihood that a mutation will show signs and symptoms of the disease, to combinations of gene mutations with low penetrance have shown promise for augmenting risk assessment. Although imaging biomarkers and molecular biomarkers have both individually demonstrated improved performance in risk assessment, few studies have evaluated them together. This review aims to highlight the current state of the art in breast cancer risk assessment using imaging and genetic biomarkers.
Topics: Female; Humans; Breast Neoplasms; Mammography; Breast Density; Breast; Risk Assessment
PubMed: 37159874
DOI: 10.1146/annurev-biodatasci-020722-092748