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Yaghjyan L, Smotherman C, Heine J, Colditz GA, Rosner B, Tamimi RM. Associations of Oral Contraceptives with Mammographic Breast Density in Premenopausal Women. Cancer Epidemiol Biomarkers Prev 2021; 31:436-442. [PMID: 34862209 DOI: 10.1158/1055-9965.epi-21-0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/15/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We investigated the associations of oral contraceptives (OC) with percent breast density (PD), absolute dense area (DA), nondense area (NDA), and a novel image intensity variation (V) measure in premenopausal women. METHODS This study included 1,233 controls from a nested case-control study within Nurses' Health Study II cohort. Information on OCs was collected in 1989 and updated biennially. OC use was defined from the questionnaire closest to the mammogram date. PD, DA, and NDA were measured from digitized film mammograms using a computer-assisted thresholding technique; the V measure was obtained with a previously developed algorithm measuring the SD of pixel values in the eroded breast region. Generalized linear regression was used to assess associations between OCs and density measures (square root-transformed PD, DA, and NDA, and -untransformed V). RESULTS OC use was not associated with PD [current vs. never: β = -0.06; 95% confidence interval (CI), -0.37-0.24; past vs. never: β = 0.10; 95% CI, -0.09-0.29], DA (current vs. never: β = -0.20; 95% CI -0.59-0.18; past vs. never: β = 0.13; 95% CI, -0.12-0.39), and NDA (current vs. never: β = -0.19; 95% CI, -0.56-0.18; past vs. never: β = -0.01; 95% CI, -0.28-0.25). Women with younger age at initiation had significantly greater V-measure (<20 years vs. never: β = 26.88; 95% CI, 3.18-50.58; 20-24 years vs. never: β = 20.23; 95% CI, -4.24-44.71; 25-29 years vs. never: β = 2.61; 95% CI -29.00-34.23; ≥30 years vs. never: β = 0.28; 95% CI, -34.16-34.72, P trend = 0.03). CONCLUSIONS Our findings suggest that an earlier age at first OC use was associated with significantly greater V. IMPACT These findings could guide decisions about the age for OC initiation.
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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.
| | - Carmen Smotherman
- Department of Epidemiology, University of Florida, College of Public Health and Health Professions and College of Medicine, Gainesville, Florida
| | - John Heine
- Cancer Epidemiology Department, Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Graham A Colditz
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.,Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine Research, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Tan PS, Ali MA, Eriksson M, Hall P, Humphreys K, Czene K. Mammography features for early markers of aggressive breast cancer subtypes and tumor characteristics: A population-based cohort study. Int J Cancer 2020; 148:1351-1359. [PMID: 32976625 PMCID: PMC7891615 DOI: 10.1002/ijc.33309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
Current breast cancer risk models identify mostly less aggressive tumors, although only women developing fatal breast cancer will greatly benefit from early identification. Here, we evaluated the use of mammography features (microcalcification clusters, computer-generated Breast Imaging Reporting and Data System [cBIRADS] density and lack of breast density reduction) as early markers of aggressive subtypes and tumor characteristics. Mammograms were retrieved from a population-based cohort of women that were diagnosed with breast cancer from 2001 to 2008 in Stockholm-Gotland County, Sweden. Tumor and patient characteristics were obtained from Stockholm Breast Cancer Quality Register and the Swedish Cancer Registry. Multinomial logistic regression was used to individually model each mammographic feature as a function of molecular subtypes, tumor characteristics and detection mode. A total of 4546 women with invasive breast cancer were included in the study. Women with microcalcification clusters in the affected breast were more likely to have human epidermal growth factor receptor 2 subtype (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.24-2.54) and potentially less likely to have basal subtype (OR 0.54; 0.30-0.96) compared to Luminal A subtype. High mammographic cBIRADS showed association with larger tumor size and interval vs screen-detected cancers. Lack of density reduction was associated with interval vs screen-detected cancers (OR 1.43; 1.11-1.83) and potentially of Luminal B subtype vs Luminal A subtype (OR 1.76; 1.04-2.99). In conclusion, microcalcification clusters, cBIRADS density and lack of breast density reduction could serve as early markers of particular subtypes and tumor characteristics of breast cancer. This information has the potential to be integrated into risk models to identify women at risk for developing aggressive breast cancer in need of supplemental screening.
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Affiliation(s)
- Pui San Tan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Maya Alsheh Ali
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Swedish eScience Research Centre (SeRC), Karolinska Institute, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Swedish eScience Research Centre (SeRC), Karolinska Institute, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
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Brandt KR, Scott CG, Miglioretti DL, Jensen MR, Mahmoudzadeh AP, Hruska C, Ma L, Wu FF, Cummings SR, Norman AD, Engmann NJ, Shepherd JA, Winham SJ, Kerlikowske K, Vachon CM. Automated volumetric breast density measures: differential change between breasts in women with and without breast cancer. Breast Cancer Res 2019; 21:118. [PMID: 31660981 PMCID: PMC6819393 DOI: 10.1186/s13058-019-1198-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Given that breast cancer and normal dense fibroglandular tissue have similar radiographic attenuation, we examine whether automated volumetric density measures identify a differential change between breasts in women with cancer and compare to healthy controls. METHODS Eligible cases (n = 1160) had unilateral invasive breast cancer and bilateral full-field digital mammograms (FFDMs) at two time points: within 2 months and 1-5 years before diagnosis. Controls (n = 2360) were matched to cases on age and date of FFDMs. Dense volume (DV) and volumetric percent density (VPD) for each breast were assessed using Volpara™. Differences in DV and VPD between mammograms (median 3 years apart) were calculated per breast separately for cases and controls and their difference evaluated by using the Wilcoxon signed-rank test. To simulate clinical practice where cancer laterality is unknown, we examined whether the absolute difference between breasts can discriminate cases from controls using area under the ROC curve (AUC) analysis, adjusting for age, BMI, and time. RESULTS Among cases, the VPD and DV between mammograms of the cancerous breast decreased to a lesser degree (- 0.26% and - 2.10 cm3) than the normal breast (- 0.39% and - 2.74 cm3) for a difference of 0.13% (p value < 0.001) and 0.63 cm3 (p = 0.002), respectively. Among controls, the differences between breasts were nearly identical for VPD (- 0.02 [p = 0.92]) and DV (0.05 [p = 0.77]). The AUC for discriminating cases from controls using absolute difference between breasts was 0.54 (95% CI 0.52, 0.56) for VPD and 0.56 (95% CI, 0.54, 0.58) for DV. CONCLUSION There is a small relative increase in volumetric density measures over time in the breast with cancer which is not found in the normal breast. However, the magnitude of this difference is small, and this measure alone does not appear to be a good discriminator between women with and without breast cancer.
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Affiliation(s)
- Kathleen R Brandt
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Christopher G Scott
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Matthew R Jensen
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amir P Mahmoudzadeh
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Carrie Hruska
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lin Ma
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA, 94612, USA
| | - Fang Fang Wu
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, 475 Brannan Street #220, San Francisco, CA, 94107, USA
| | - Aaron D Norman
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Natalie J Engmann
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA
| | - John A Shepherd
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Stacey J Winham
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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A review of the influence of mammographic density on breast cancer clinical and pathological phenotype. Breast Cancer Res Treat 2019; 177:251-276. [PMID: 31177342 DOI: 10.1007/s10549-019-05300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE It is well established that high mammographic density (MD), when adjusted for age and body mass index, is one of the strongest known risk factors for breast cancer (BC), and also associates with higher incidence of interval cancers in screening due to the masking of early mammographic abnormalities. Increasing research is being undertaken to determine the underlying histological and biochemical determinants of MD and their consequences for BC pathogenesis, anticipating that improved mechanistic insights may lead to novel preventative or treatment interventions. At the same time, technological advances in digital and contrast mammography are such that the validity of well-established relationships needs to be re-examined in this context. METHODS With attention to old versus new technologies, we conducted a literature review to summarise the relationships between clinicopathologic features of BC and the density of the surrounding breast tissue on mammography, including the associations with BC biological features inclusive of subtype, and implications for the clinical disease course encompassing relapse, progression, treatment response and survival. RESULTS AND CONCLUSIONS There is reasonable evidence to support positive relationships between high MD (HMD) and tumour size, lymph node positivity and local relapse in the absence of radiotherapy, but not between HMD and LVI, regional relapse or distant metastasis. Conflicting data exist for associations of HMD with tumour location, grade, intrinsic subtype, receptor status, second primary incidence and survival, which need further confirmatory studies. We did not identify any relationships that did not hold up when data involving newer imaging techniques were employed in analysis.
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Hinton B, Ma L, Mahmoudzadeh AP, Malkov S, Fan B, Greenwood H, Joe B, Lee V, Strand F, Kerlikowske K, Shepherd J. Derived mammographic masking measures based on simulated lesions predict the risk of interval cancer after controlling for known risk factors: a case-case analysis. Med Phys 2019; 46:1309-1316. [PMID: 30697755 DOI: 10.1002/mp.13410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Women with radiographically dense or texturally complex breasts are at increased risk for interval cancer, defined as cancers diagnosed after a normal screening examination. The purpose of this study was to create masking measures and apply them to identify interval risk in a population of women who experienced either screen-detected or interval cancers after controlling for breast density. METHODS We examined full-field digital screening mammograms acquired from 2006 to 2015. Examinations associated with 182 interval cancers were matched to 173 screen-detected cancers on age, race, exam date and time since last imaging examination. Local Image Quality Factor (IQF) values were calculated and used to create IQF maps that represented mammographic masking. We used various statistics to define global masking measures of these maps. Association of these masking measures with interval cancer vs screen-detected cancer was estimated using conditional logistic regression in a univariate and adjusted model for Breast Imaging-Reporting and Data System (BI-RADS) density. Receiver operator curves were calculated in each case to compare specificity vs sensitivity, and area under those curves were generated. Proportion of screen-detected cancer was estimated for stratifications of IQF features. RESULTS Several masking features showed significant association with interval compared to screen-detected cancers after adjusting for BI-RADS density (up to P = 2.52E-6), and the 10th percentile of the IQF value (P = 1.72E-3) showed the strongest improvement in the area under the receiver operator curve, increasing from 0.65 using only BI-RADS density to 0.69. The highest masking group had a 32% proportion of screen-detected cancers while the low masking group had a 69% proportion. CONCLUSIONS We conclude that computer vision methods using model observers may improve quantifying the probability of breast cancer detection beyond using breast density alone.
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Affiliation(s)
- Benjamin Hinton
- Department of Bioengineering, UC-San Francisco & UC-Berkeley Joint Program, San Francisco, CA, 94143, USA.,Department of Radiology and Biomedical Imaging, UC-San Francisco, San Francisco, CA, 94143, USA
| | - Lin Ma
- Kaiser Permanente Division of Research, Oakland, CA, 94612, USA
| | - Amir Pasha Mahmoudzadeh
- Department of Radiology and Biomedical Imaging, UC-San Francisco, San Francisco, CA, 94143, USA
| | | | - Bo Fan
- Department of Bioengineering, UC-San Francisco & UC-Berkeley Joint Program, San Francisco, CA, 94143, USA
| | - Heather Greenwood
- Department of Radiology and Biomedical Imaging, UC-San Francisco, San Francisco, CA, 94143, USA
| | - Bonnie Joe
- Department of Radiology and Biomedical Imaging, UC-San Francisco, San Francisco, CA, 94143, USA
| | - Vivian Lee
- Research Advocate, UCSF Breast Science Advocacy Core, San Francisco, CA, 94143, USA
| | - Fredrik Strand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Thoracic Radiology, Karolinska University Hospital, Solna, Sweden
| | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, 94143, USA
| | - John Shepherd
- University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
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