1
|
Bhimani F, Zhang J, Shah L, McEvoy M, Gupta A, Pastoriza J, Shihabi A, Feldman S. Can the Clinical Utility of iBreastExam, a Novel Device, Aid in Optimizing Breast Cancer Diagnosis? A Systematic Review. JCO Glob Oncol 2023; 9:e2300149. [PMID: 38085036 PMCID: PMC10846782 DOI: 10.1200/go.23.00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/05/2023] [Accepted: 09/02/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE A portable, cost-effective, easy-to-use, hand-held Intelligent Breast Exam (iBE), which is a wireless, radiation-free device, may be a valuable screening tool in resource-limited settings. While multiple studies evaluating the use of iBE have been conducted worldwide, there are no cumulative studies evaluating the iBE's performance. Therefore this review aims to determine the clinical utility and applicability of iBE compared with clinical breast examinations, ultrasound, and mammography and discuss its strengths and weaknesses when performing breast-cancer screening. METHODS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four electronic databases were searched: PubMed, Cochrane Library, Web of Science, and Google Scholar. RESULTS The review included 11 studies with a total sample size of 16,052 breasts. The mean age ranged from 42 to 58 years. The sensitivity and specificity of the iBE ranged from 34.3% to 86% and 59% to 94%, respectively. For malignant lesions, iBE demonstrated a moderate to higher diagnostic capacity ranging from 57% to 93% and could identify tumor sizes spanning from 0.5 cm to 9 cm. CONCLUSION Our findings underscore the potential clinical utility and applicability of iBE as a prescreening and triaging tool, which may aid in reducing the burden of patients undergoing diagnostic imaging in lower- and middle-income countries. Furthermore, iBE has shown to diagnose cancers as small as 0.5 cm, which can be a boon in early detection and reduce mortality rates. However, the encouraging results of this systematic review should be interpreted with caution because of the device's low sensitivity and high false-positive rates.
Collapse
Affiliation(s)
- Fardeen Bhimani
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, New York, NY
| | - Janice Zhang
- Albert Einstein College of Medicine, New York, NY
| | - Lamisha Shah
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, New York, NY
| | - Maureen McEvoy
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, New York, NY
| | - Anjuli Gupta
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, New York, NY
| | - Jessica Pastoriza
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, New York, NY
| | - Areej Shihabi
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, New York, NY
| | - Sheldon Feldman
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, New York, NY
| |
Collapse
|
2
|
Bai S, Song D, Chen M, Lai X, Xu J, Dong F. The association between mammographic density and breast cancer molecular subtypes: a systematic review and meta-analysis. Clin Radiol 2023; 78:622-632. [PMID: 37230842 DOI: 10.1016/j.crad.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023]
Abstract
AIM To conduct a systematic review and meta-analysis to evaluate the whether high mammographic density (MD) is differentially associated with all subtypes of breast cancer. MATERIALS AND METHODS The PubMed, Cochrane Library, and Embase databases were searched systematically in October 2022 to include all studies that investigated the association between MD and breast cancer subtype. Aggregate data of 17,193 breast cancer cases from 23 studies were selected, including five cohort/case-control and 18 case-only studies. The relative risk (RR) of MD were combined using random/fixed effects models for case-control studies, and for case-only studies, relative risk ratios (RRRs) were a combination of luminal A, luminal B, and HER2-positive versus triple-negative tumours. RESULTS Women in the highest density category in case-control/cohort studies had a 2.24-fold (95% confidence interval [CI] 1.53, 3.28), 1.81-fold (95% CI 1.15, 2.85), 1.44-fold (95% CI 1.14, 1.81), and 1.59-fold (95% CI 0.89, 2.85) higher risk of triple-negative, HER-2 (human epidermal growth factor receptor 2) positive, luminal A, and luminal B breast cancer compared to women in the lowest density category. RRRs for breast tumours being luminal A, luminal B, and HER-2 positive versus triple-negative in case-only studies were 1.62 (95% CI 1.14, 2.31), 1.81 (95% CI 1.22, 2.71) and 2.58 (95% CI 1.63, 4.08), respectively, for BIRADS 4 versus BIRADS 1. CONCLUSION The evidence indicates MD is a potent risk factor for the majority of breast cancer subtypes to different degrees. Increased MD is more strongly linked to HER-2-positive cancers compared to other breast cancer subtypes. The application of MD as a subtype-specific risk marker may facilitate the creation of personalised risk prediction models and screening procedures.
Collapse
Affiliation(s)
- S Bai
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - D Song
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - M Chen
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - X Lai
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - J Xu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
| | - F Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
| |
Collapse
|
3
|
Lin J, Ye S, Ke H, Lin L, Wu X, Guo M, Jiao B, Chen C, Zhao L. Changes in the mammary gland during aging and its links with breast diseases. Acta Biochim Biophys Sin (Shanghai) 2023. [PMID: 37184281 DOI: 10.3724/abbs.2023073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The functional capacity of organisms declines in the process of aging. In the case of breast tissue, abnormal mammary gland development can lead to dysfunction in milk secretion, a primary function, as well as the onset of various diseases, such as breast cancer. In the process of aging, the terminal duct lobular units (TDLUs) within the breast undergo gradual degeneration, while the proportion of adipose tissue in the breast continues to increase and hormonal levels in the breast change accordingly. Here, we review changes in morphology, internal structure, and cellular composition that occur in the mammary gland during aging. We also explore the emerging mechanisms of breast aging and the relationship between changes during aging and breast-related diseases, as well as potential interventions for delaying mammary gland aging and preventing breast disease.
Collapse
Affiliation(s)
- Junqiang Lin
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Shihui Ye
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Hao Ke
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Liang Lin
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Xia Wu
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| | - Mengfei Guo
- Huankui Academy, Nanchang University, Nanchang 330031, China
| | - Baowei Jiao
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650201, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
| | - Ceshi Chen
- Academy of Biomedical Engineering, Kunming Medical University, Kunming 650500, China
- Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
- the Third Affiliated Hospital, Kunming Medical University, Kunming 650118, China
| | - Limin Zhao
- Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang 330031, China
| |
Collapse
|
4
|
Brooks JD, Christensen RAG, Sung JS, Pike MC, Orlow I, Bernstein JL, Morris EA. MRI background parenchymal enhancement, breast density and breast cancer risk factors: A cross-sectional study in pre- and post-menopausal women. NPJ Breast Cancer 2022; 8:97. [PMID: 36008488 PMCID: PMC9411561 DOI: 10.1038/s41523-022-00458-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022] Open
Abstract
Breast tissue enhances on contrast MRI and is called background parenchymal enhancement (BPE). Having high BPE has been associated with an increased risk of breast cancer. We examined the relationship between BPE and the amount of fibroglandular tissue on MRI (MRI-FGT) and breast cancer risk factors. This was a cross-sectional study of 415 women without breast cancer undergoing contrast-enhanced breast MRI at Memorial Sloan Kettering Cancer Center. All women completed a questionnaire assessing exposures at the time of MRI. Prevalence ratios (PR) and 95% confidence intervals (CI) describing the relationship between breast cancer risk factors and BPE and MRI-FGT were generated using modified Poisson regression. In multivariable-adjusted models a positive association between body mass index (BMI) and BPE was observed, with a 5-unit increase in BMI associated with a 14% and 44% increase in prevalence of high BPE in pre- and post-menopausal women, respectively. Conversely, a strong inverse relationship between BMI and MRI-FGT was observed in both pre- (PR = 0.66, 95% CI 0.57, 0.76) and post-menopausal (PR = 0.66, 95% CI 0.56, 0.78) women. Use of preventive medication (e.g., tamoxifen) was associated with having low BPE, while no association was observed for MRI-FGT. BPE is an imaging marker available from standard contrast-enhanced MRI, that is influenced by endogenous and exogenous hormonal exposures in both pre- and post-menopausal women.
Collapse
Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
5
|
Byun D, Hong S, Ryu S, Nam Y, Jang H, Cho Y, Keum N, Oh H. Early-life body mass index and risks of breast, endometrial, and ovarian cancers: a dose-response meta-analysis of prospective studies. Br J Cancer 2022; 126:664-672. [PMID: 34773099 PMCID: PMC8854408 DOI: 10.1038/s41416-021-01625-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/16/2021] [Accepted: 10/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The evidence for the associations between early-life adiposity and female cancer risks is mixed. Little is known about the exact shape of the relationships and whether the associations are independent of adult adiposity. METHODS We conducted dose-response meta-analyses of prospective studies to summarise the relationships of early-life body mass index (BMI) with breast, endometrial, and ovarian cancer risks. Pubmed and Embase were searched through June 2020 to identify relevant studies. Using random-effects models, the summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated per 5-kg/m2 increase in BMI at ages ≤ 25 years. A nonlinear dose-response meta-analysis was conducted using restricted cubic spline analysis. RESULTS After screening 33,948 publications, 37 prospective studies were included in this analysis. The summary RRs associated with every 5-kg/m2 increase in early-life BMI were 0.84 (95% CI = 0.81-0.87) for breast, 1.40 (95% CI = 1.25-1.57) for endometrial, and 1.15 (95% CI = 1.07-1.23) for ovarian cancers. For breast cancer, the association remained statistically significant after adjustment for adult BMI (RR = 0.80, 95% CI = 0.73-0.87). For premenopausal breast, endometrial, and ovarian cancers, the dose-response curves suggested evidence of nonlinearity. CONCLUSIONS With early-life adiposity, our data support an inverse association with breast cancer and positive associations with ovarian and endometrial cancer risks.
Collapse
Affiliation(s)
- Dohyun Byun
- grid.222754.40000 0001 0840 2678Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - SungEun Hong
- grid.255168.d0000 0001 0671 5021Department of Food Science and Biotechnology, Dongguk University, Goyang, Republic of Korea
| | - Seaun Ryu
- grid.222754.40000 0001 0840 2678Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yeonju Nam
- grid.222754.40000 0001 0840 2678Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Hajin Jang
- grid.222754.40000 0001 0840 2678Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yoonkyoung Cho
- grid.222754.40000 0001 0840 2678Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - NaNa Keum
- Department of Food Science and Biotechnology, Dongguk University, Goyang, Republic of Korea. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, BostonMA, USA.
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea. .,Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea.
| |
Collapse
|
6
|
Bowles EJA, O'Neill SC, Li T, Knerr S, Mandelblatt JS, Schwartz MD, Jayasekera J, Leppig K, Ehrlich K, Farrell D, Gao H, Graham AL, Luta G, Wernli KJ. Effect of a Randomized Trial of a Web-Based Intervention on Patient-Provider Communication About Breast Density. J Womens Health (Larchmt) 2021; 30:1529-1537. [PMID: 34582721 PMCID: PMC8823670 DOI: 10.1089/jwh.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Breast density increases breast cancer risk and decreases mammographic detection. We evaluated a personalized web-based intervention designed to improve breast cancer risk communication between women and their providers. Materials and Methods: This was a secondary outcome analysis of an online randomized trial. Women aged 40-69 years were randomized, February 2017-May 2018, to a control (n = 503) versus intervention website (n = 492). The intervention website included information about breast density, personalized breast cancer risk, chemoprevention, and magnetic resonance imaging. Participants self-reported communication about density with providers (yes/no) at 6 weeks and 12 months. We used logistic regression with generalized estimating equations to evaluate the association of study arm with density communication. In secondary analyses, we tested if the intervention was associated with indicators of patient activation (breast cancer worry, perceived risk, or health care use). Results: Women (mean age 62 years) in the intervention versus control arm were 2.39 times (95% confidence interval [CI] = 1.37-4.18) more likely to report density communication at 6 weeks; this effect persisted at 12 months (odds ratio [OR] = 1.71, 95% CI = 1.25-2.35). At 6 weeks, this effect was only significant among women who reported (OR = 3.23, 95% CI = 1.24-8.40) versus did not report any previous density discussions (OR = 1.64, 95% CI = 0.83-3.26). A quarter of women in each arm never had a density conversation at any time during the study. Conclusions: Despite providing personalized density and risk information, the intervention did not promote density discussions between women and their providers who had not had them previously. This intervention is unlikely to be used clinically to motivate density conversations in women who have not had them before. Clinical trial registration number NCT03029286.
Collapse
Affiliation(s)
- Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.,Address correspondence to: Erin J. Aiello Bowles, MPH, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
| | - Suzanne C. O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA
| | - Sarah Knerr
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Marc D. Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Jinani Jayasekera
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Kathleen Leppig
- Clinical Genetics, Washington Permanente Medical Group, Seattle, Washington, USA
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | | | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Amanda L. Graham
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA.,Truth Initiative, Washington, District of Columbia, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| |
Collapse
|
7
|
Irurhe N, Duru F, Ibeabuchi N, Olowoyeye O, Ihekuna O, Balogun O, Yakubu C. Age-related ultrasonographic mammary gland density patterns: Implication for breast cancer risk. WEST AFRICAN JOURNAL OF RADIOLOGY 2021. [DOI: 10.4103/wajr.wajr_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
8
|
Oh H, Yaghjyan L, Austin-Datta RJ, Heng YJ, Baker GM, Sirinukunwattana K, Vellal AD, Collins LC, Murthy D, Eliassen AH, Rosner BA, Tamimi RM. Early-Life and Adult Adiposity, Adult Height, and Benign Breast Tissue Composition. Cancer Epidemiol Biomarkers Prev 2020; 30:608-615. [PMID: 33288551 DOI: 10.1158/1055-9965.epi-20-1348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early-life and adult anthropometrics are associated with breast density and breast cancer risk. However, little is known about whether these factors also influence breast tissue composition beyond what is captured by breast density among women with benign breast disease (BBD). METHODS This analysis included 788 controls from a nested case-control study of breast cancer within the Nurses' Health Study BBD subcohorts. Body fatness at ages 5 and 10 years was recalled using a 9-level pictogram. Weight at age 18, current weight, and height were reported via questionnaires. A deep-learning image analysis was used to quantify the percentages of epithelial, fibrous stromal, and adipose tissue areas within BBD slides. We performed linear mixed models to estimate beta coefficients (β) and 95% confidence intervals (CI) for the relationships between anthropometrics and the log-transformed percentages of individual tissue type, adjusting for confounders. RESULTS Childhood body fatness (level ≥ 4.5 vs. 1), BMI at age 18 (≥23 vs. <19 kg/m2), and current adult BMI (≥30 vs. <21 kg/m2) were associated with higher proportions of adipose tissue [β (95% CI) = 0.34 (0.03, 0.65), 0.19 (-0.04-0.42), 0.40 (0.12, 0.68), respectively] and lower proportions of fibrous stromal tissue [-0.05 (-0.10, 0.002), -0.03 (-0.07, 0.003), -0.12 (-0.16, -0.07), respectively] during adulthood (all P trend < 0.04). BMI at age 18 was also inversely associated with epithelial tissue (P trend = 0.03). Adult height was not associated with any of the individual tissue types. CONCLUSIONS Our data suggest that body fatness has long-term impacts on breast tissue composition. IMPACT This study contributes to our understanding of the link between body fatness and breast cancer risk.See related commentary by Oskar et al., p. 590.
Collapse
Affiliation(s)
- Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea. .,Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Rebecca J Austin-Datta
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gabrielle M Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Korsuk Sirinukunwattana
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Engineering Science, Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, United Kingdom
| | - Adithya D Vellal
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Divya Murthy
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| |
Collapse
|
9
|
Breast Cancer and Microcalcifications: An Osteoimmunological Disorder? Int J Mol Sci 2020; 21:ijms21228613. [PMID: 33203195 PMCID: PMC7696282 DOI: 10.3390/ijms21228613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
The presence of microcalcifications in the breast microenvironment, combined with the growing evidences of the possible presence of osteoblast-like or osteoclast-like cells in the breast, suggest the existence of active processes of calcification in the breast tissue during a woman’s life. Furthermore, much evidence that osteoimmunological disorders, such as osteoarthritis, rheumatoid arthritis, or periodontitis influence the risk of developing breast cancer in women exists and vice versa. Antiresorptive drugs benefits on breast cancer incidence and progression have been reported in the past decades. More recently, biological agents targeting pro-inflammatory cytokines used against rheumatoid arthritis also demonstrated benefits against breast cancer cell lines proliferation, viability, and migratory abilities, both in vitro and in vivo in xenografted mice. Hence, it is tempting to hypothesize that breast carcinogenesis should be considered as a potential osteoimmunological disorder. In this review, we compare microenvironments and molecular characteristics in the most frequent osteoimmunological disorders with major events occurring in a woman’s breast during her lifetime. We also highlight what the use of bone anabolic drugs, antiresorptive, and biological agents targeting pro-inflammatory cytokines against breast cancer can teach us.
Collapse
|
10
|
Integrin-mediated adhesion and mechanosensing in the mammary gland. Semin Cell Dev Biol 2020; 114:113-125. [PMID: 33187835 DOI: 10.1016/j.semcdb.2020.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Abstract
The mammary gland is dynamically remodelled during its postnatal development and the reproductive cycles. This inherent plasticity has been suggested to increase the susceptibility of the organ to carcinogenesis. Morphological changes in the mammary epithelium involve cell proliferation, differentiation, apoptosis, and migration which, in turn, are affected by cell adhesion to the extracellular matrix (ECM). Integrin adhesion receptors function in the sensing of the biochemical composition, patterning and mechanical properties of the ECM surrounding the cells, and strongly influence cell fate. This review aims to summarize the existing literature on how different aspects of integrin-mediated adhesion and mechanosensing, including ECM composition; stiffness and topography; integrin expression patterns; focal adhesion assembly; dynamic regulation of the actin cytoskeleton; and nuclear mechanotransduction affect mammary gland development, function and homeostasis. As the mechanical properties of a complex tissue environment are challenging to replicate in vitro, emphasis has been placed on studies conducted in vivo or using organoid models. Outright, these studies indicate that mechanosensing also contributes to the regulation of mammary gland morphogenesis in multiple ways.
Collapse
|
11
|
Yaghjyan L, Wijayabahu A, Eliassen AH, Colditz G, Rosner B, Tamimi RM. Associations of aspirin and other anti-inflammatory medications with mammographic breast density and breast cancer risk. Cancer Causes Control 2020; 31:827-837. [PMID: 32476101 DOI: 10.1007/s10552-020-01321-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We investigated the associations of aspirin and other non-steroid anti-inflammatory drugs with mammographic breast density (MBD) and their interactions in relation to breast cancer risk. METHODS This study included 3,675 cancer-free women within the Nurses' Health Study (NHS) and Nurses' Health Study II (NHSII) cohorts. Percent breast density (PD), absolute dense area (DA), and non-dense area (NDA) were measured from digitized film mammograms using a computer-assisted thresholding technique; all measures were square root-transformed. Information on medication use was collected in 1980 (NHS) and 1989 (NHSII) and updated biennially. Medication use was defined as none, past or current; average cumulative dose and frequency were calculated for all past or current users from all bi-annual questionnaires preceding the mammogram date. We used generalized linear regression to quantify associations of medications with MBD. Two-way interactions were examined in logistic regression models. RESULTS In multivariate analysis, none of the anti-inflammatory medications were associated with PD, DA, and NDA. We found no interactions of any of the medications with PD with respect to breast cancer risk (all p-interactions > 0.05). However, some of the aspirin variables appeared to have positive associations with breast cancer risk limited only to women with PD 10-24% (past aspirin OR 1.56, 95% CI 1.03-2.35; current aspirin with < 5 years of use OR 1.82, 95% CI 1.01-3.28; current aspirin with ≥ 5 years of use OR 1.89, 95% CI 1.26-2.82). CONCLUSIONS Aspirin and NSAIDs are not associated with breast density measures. We found no interactions of aspirin with MBD in relation to breast cancer risk.
Collapse
Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA.
| | - Akemi Wijayabahu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Graham Colditz
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Institute for Public Health, Washington University in St. Louis, St. Louis, MO, 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
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
12
|
Wetstein SC, Onken AM, Luffman C, Baker GM, Pyle ME, Kensler KH, Liu Y, Bakker B, Vlutters R, van Leeuwen MB, Collins LC, Schnitt SJ, Pluim JPW, Tamimi RM, Heng YJ, Veta M. Deep learning assessment of breast terminal duct lobular unit involution: Towards automated prediction of breast cancer risk. PLoS One 2020; 15:e0231653. [PMID: 32294107 PMCID: PMC7159218 DOI: 10.1371/journal.pone.0231653] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/27/2020] [Indexed: 02/07/2023] Open
Abstract
Terminal duct lobular unit (TDLU) involution is the regression of milk-producing structures in the breast. Women with less TDLU involution are more likely to develop breast cancer. A major bottleneck in studying TDLU involution in large cohort studies is the need for labor-intensive manual assessment of TDLUs. We developed a computational pathology solution to automatically capture TDLU involution measures. Whole slide images (WSIs) of benign breast biopsies were obtained from the Nurses' Health Study. A set of 92 WSIs was annotated for acini, TDLUs and adipose tissue to train deep convolutional neural network (CNN) models for detection of acini, and segmentation of TDLUs and adipose tissue. These networks were integrated into a single computational method to capture TDLU involution measures including number of TDLUs per tissue area, median TDLU span and median number of acini per TDLU. We validated our method on 40 additional WSIs by comparing with manually acquired measures. Our CNN models detected acini with an F1 score of 0.73±0.07, and segmented TDLUs and adipose tissue with Dice scores of 0.84±0.13 and 0.87±0.04, respectively. The inter-observer ICC scores for manual assessments on 40 WSIs of number of TDLUs per tissue area, median TDLU span, and median acini count per TDLU were 0.71, 0.81 and 0.73, respectively. Intra-observer reliability was evaluated on 10/40 WSIs with ICC scores of >0.8. Inter-observer ICC scores between automated results and the mean of the two observers were: 0.80 for number of TDLUs per tissue area, 0.57 for median TDLU span, and 0.80 for median acini count per TDLU. TDLU involution measures evaluated by manual and automated assessment were inversely associated with age and menopausal status. We developed a computational pathology method to measure TDLU involution. This technology eliminates the labor-intensiveness and subjectivity of manual TDLU assessment, and can be applied to future breast cancer risk studies.
Collapse
Affiliation(s)
- Suzanne C. Wetstein
- Medical Image Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Allison M. Onken
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Christina Luffman
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Gabrielle M. Baker
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Michael E. Pyle
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Kevin H. Kensler
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Alvin J. Siteman Cancer Center, St Louis, Missouri, United States of America
| | - Bart Bakker
- Philips Research Europe, High Tech Campus, Eindhoven, The Netherlands
| | - Ruud Vlutters
- Philips Research Europe, High Tech Campus, Eindhoven, The Netherlands
| | | | - Laura C. Collins
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Stuart J. Schnitt
- Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Dana-Farber Cancer Institute-Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Josien P. W. Pluim
- Medical Image Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rulla M. Tamimi
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Yujing J. Heng
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Mitko Veta
- Medical Image Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
13
|
Khalayleh H, Khalayleh M, Diment J, Allweis TM. Breast density does not affect breast cancer tumor size assessment: A comparison of radiologic versus pathologic measurement by different imaging modalities across breast densities. Eur J Surg Oncol 2020; 46:1435-1440. [PMID: 32115332 DOI: 10.1016/j.ejso.2020.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Tumor size is an important parameter in breast cancer staging. Definitive tumor size is determined by measurement of the pathologic specimen. However, prior to surgery, size must be assessed by imaging with mammography (MMG), ultrasound (US), or magnetic resonance imaging (MRI). Discrepancies between imaging-assessed and pathologic size are not uncommon. Breast density decreases the sensitivity of MMG, and may affect image-based tumor size assessment. AIM To compare tumor size assessed by the different imaging modalities to pathologic size across breast densities. MATERIAL & METHODS This was a retrospective analysis of 183 female patients (197 breast cancers) diagnosed and operated for primary breast cancer at a single center. Tumor size measurements were collated for each available imaging modality and compared with measurements from pathologic specimens. Breast density was assessed on MMG using the Breast Imaging Reporting and Data System. RESULTS Mean pathologic tumor size was 23.0 ± 19.3 mm. Mean tumor size did not differ significantly with MMG (22.3 ± 16.6 mm; P = 0.165) or MRI (23.4 ± 19.2 mm; P = 0.620). However, US significantly underestimated mean tumor size (15.2 ± 8.6 mm; P = 0.0001 vs pathology). Breast density did not affect the accuracy of tumor size assessment by any imaging modality. CONCLUSIONS US may underestimate breast tumor size. Treatment decisions that take into account tumor size can be made equally reliably in patients with high or low breast density.
Collapse
Affiliation(s)
- Harbi Khalayleh
- Department of Surgery, Kaplan Medical Center (affiliated to the School of Medicine, Hebrew University, Jerusalem), Rehovot, Israel.
| | | | - Judith Diment
- Department of Pathology, Kaplan Medical Center, Rehovot, Israel
| | - Tanir M Allweis
- Department of Surgery, Kaplan Medical Center (affiliated to the School of Medicine, Hebrew University, Jerusalem), Rehovot, Israel; Hebrew University Medical School, Jerusalem, Israel
| |
Collapse
|
14
|
Role of Secreted Frizzled-Related Protein 1 in Early Mammary Gland Tumorigenesis and Its Regulation in Breast Microenvironment. Cells 2020; 9:cells9010208. [PMID: 31947616 PMCID: PMC7017175 DOI: 10.3390/cells9010208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 12/11/2022] Open
Abstract
In mice, the lack of secreted frizzled-related protein 1 (SFRP1) is responsible for mammogenesis and hyperplasia, while, in bovines, its overexpression is associated with post-lactational mammary gland involution. Interestingly, there are no reports dealing with the role of SFRP1 in female involution. However, SFRP1 dysregulation is largely associated with human tumorigenesis in the literature. Indeed, the lack of SFRP1 is associated with both tumor development and patient prognosis. Considering the increased risk of breast tumor development associated with incomplete mammary gland involution, it is crucial to demystify the "grey zone" between physiological age-related involution and tumorigenesis. In this review, we explore the functions of SFRP1 involved in the breast involution processes to understand the perturbations driven by the disappearance of SFRP1 in mammary tissue. Moreover, we question the presence of recurrent microcalcifications identified by mammography. In bone metastases from prostate primary tumor, overexpression of SFRP1 results in an osteolytic response of the tumor cells. Hence, we explore the hypothesis of an osteoblastic differentiation of mammary cells induced by the lack of SFRP1 during lobular involution, resulting in a new accumulation of hydroxyapatite crystals in the breast tissue.
Collapse
|
15
|
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.
Collapse
|
16
|
Li E, Guida JL, Tian Y, Sung H, Koka H, Li M, Chan A, Zhang H, Tang E, Guo C, Deng J, Hu N, Lu N, Gierach GL, Li J, Yang XR. Associations between mammographic density and tumor characteristics in Chinese women with breast cancer. Breast Cancer Res Treat 2019; 177:527-536. [PMID: 31254158 DOI: 10.1007/s10549-019-05325-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Mammographic density (MD) is a strong risk factor for breast cancer, yet its relationship with tumor characteristics is not well established, particularly in Asian populations. METHODS MD was assessed from a total of 2001 Chinese breast cancer patients using Breast Imaging Reporting and Data System (BI-RADS) categories. Molecular subtypes were defined using immunohistochemical status on ER, PR, HER2, and Ki-67, as well as tumor grade. Multinomial logistic regression was used to test associations between MD and molecular subtype (luminal A = reference) adjusting for age, body mass index (BMI), menopausal status, parity, and nodal status. RESULTS The mean age at diagnosis was 51.7 years (SD = 10.7) and the average BMI was 24.7 kg/m2 (SD = 3.8). The distribution of BI-RADS categories was 7.4% A = almost entirely fat, 24.2% B = scattered fibroglandular dense, 49.4% C = heterogeneously dense, and 19.0% D = extremely dense. Compared to women with BI-RADS = A/B, women with BI-RADS = D were more likely to have HER2-enriched tumors (OR = 1.81, 95% CI 1.08-3.06, p = 0.03), regardless of menopausal status. The association was only observed in women with normal (< 25 kg/m2) BMI (OR = 2.43, 95% CI 1.24-4.76, p < 0.01), but not among overweight/obese women (OR: 0.98, 95% CI 0.38-2.52, p = 0.96). CONCLUSIONS Among Chinese women with normal BMI, higher breast density was associated with HER2-enriched tumors. The results may partially explain the higher proportion of HER2+ tumors previously reported in Asian women.
Collapse
Affiliation(s)
- 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
| | - Jennifer L Guida
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.,Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - 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
| | - Hyuna Sung
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.,Cancer Surveillance and Health Services Program, American Cancer Society, Atlanta, GA, 30303, USA
| | - Hela Koka
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Mengjie Li
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.,Vanderbilt University, Nashville, TN, USA
| | - Ariane Chan
- Volpara Health Technologies Ltd, Wellington, New Zealand
| | - Han Zhang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Eric Tang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 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
| | - Joseph Deng
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Nan Hu
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 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
| | - Gretchen L Gierach
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - 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.
| | - Xiaohong R Yang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.
| |
Collapse
|
17
|
Chollet-Hinton L, Puvanesarajah S, Sandhu R, Kirk EL, Midkiff BR, Ghosh K, Brandt KR, Scott CG, Gierach GL, Sherman ME, Vachon CM, Troester MA. Stroma modifies relationships between risk factor exposure and age-related epithelial involution in benign breast. Mod Pathol 2018; 31:1085-1096. [PMID: 29463881 PMCID: PMC6076344 DOI: 10.1038/s41379-018-0033-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 12/01/2022]
Abstract
Delayed age-related lobular involution has been previously associated with elevated breast cancer risk. However, intraindividual variability in epithelial involution status within a woman is undefined. We developed a novel measure of age-related epithelial involution, density of epithelial nuclei in epithelial areas using digital image analysis in combination with stromal characteristics (percentage of section area comprising stroma). Approximately 1800 hematoxylin and eosin stained sections of benign breast tissue were evaluated from 416 participants having breast surgery for cancer or benign conditions. Two to sixteen slides per woman from different regions of the breast were studied. Epithelial involution status varied within a woman and as a function of stromal area. Percentage stromal area varied between samples from the same woman (median difference between highest and lowest stromal area within a woman was 7.5%, but ranged from 0.01 to 86.7%). Restricting to women with at least 10% stromal area (N = 317), epithelial nuclear density decreased with age (-637.1 cells/mm2 per decade of life after age 40, p < 0.0001), increased with mammographic density (457.8 cells/mm2 per increasing BI-RADs density category p = 0.002), and increased non-significantly with recent parity, later age at first pregnancy, and longer and more recent oral contraceptive use. These associations were attenuated in women with mostly fat samples (<10% stroma (N = 99)). Thirty-one percent of women evaluated had both adequate stroma (≥10%) and mostly fat (<10% stroma) regions of breast tissue, with the probability of having both types increasing with the number breast tissue samplings. Several breast cancer risk factors are associated with elevated age-related epithelial content, but associations depend upon stromal context. Stromal characteristics appear to modify relationships between risk factor exposures and breast epithelial involution.
Collapse
Affiliation(s)
| | | | - Rupninder Sandhu
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Erin L. Kirk
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
| | - Bentley R. Midkiff
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Karthik Ghosh
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Christopher G. Scott
- Division of Biostatistics, Department of Health Sciences, Mayo Clinic College of Medicine, Rochester, MN
| | - Gretchen L. Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Mark E. Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Celine M. Vachon
- Division of Epidemiology, Department of Health Sciences, Mayo Clinic College of Medicine, Rochester, MN
| | - Melissa A. Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC,Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
18
|
Yaghjyan L, Colditz G, Eliassen H, Rosner B, Gasparova A, Tamimi RM. Interactions of alcohol and postmenopausal hormone use in regards to mammographic breast density. Cancer Causes Control 2018; 29:751-758. [PMID: 29938357 DOI: 10.1007/s10552-018-1053-9] [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: 02/14/2018] [Accepted: 06/20/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE We investigated the association of alcohol intake with mammographic breast density in postmenopausal women by their hormone therapy (HT) status. METHODS This study included 2,100 cancer-free postmenopausal women within the Nurses' Health Study and Nurses' Health Study II cohorts. Percent breast density (PD), absolute dense (DA), and non-dense areas (NDA) were measured from digitized film mammograms using a computer-assisted thresholding technique; all measures were square root transformed. Alcohol consumption was assessed with a food frequency questionnaire (0, < 5, and ≥ 5 g/day). Information regarding breast cancer risk factors was obtained from baseline or biennial questionnaires closest to the mammogram date. We used generalized linear regression to examine associations between alcohol and breast density measures in women with no HT history, current, and past HT users. RESULTS In multivariable analyses, we found no associations of alcohol consumption with PD (p trend = 0.32) and DA (p trend = 0.53) and an inverse association with NDA (β = - 0.41, 95% CI - 0.73, - 0.09 for ≥ 5 g/day, p trend < 0.01). In the stratified analysis by HT status, alcohol was not associated with PD in any of the strata. We found a significant inverse association of alcohol with NDA among past HT users (β = - 0.79, 95% CI - 1.51, - 0.07 for ≥ 5 g/day, p trend = 0.02). There were no significant interactions between alcohol and HT in relation to PD, DA, and NDA (p interaction = 0.19, 0.42, and 0.43, respectively). CONCLUSIONS Our findings suggest that associations of alcohol with breast density do not vary by HT status.
Collapse
Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd., Gainesville, FL, 32610, USA.
| | - Graham Colditz
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aleksandra Gasparova
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd., Gainesville, FL, 32610, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
Automatic Estimation of Volumetric Breast Density Using Artificial Neural Network-Based Calibration of Full-Field Digital Mammography: Feasibility on Japanese Women With and Without Breast Cancer. J Digit Imaging 2018; 30:215-227. [PMID: 27832519 DOI: 10.1007/s10278-016-9922-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Breast cancer is the most common invasive cancer among women and its incidence is increasing. Risk assessment is valuable and recent methods are incorporating novel biomarkers such as mammographic density. Artificial neural networks (ANN) are adaptive algorithms capable of performing pattern-to-pattern learning and are well suited for medical applications. They are potentially useful for calibrating full-field digital mammography (FFDM) for quantitative analysis. This study uses ANN modeling to estimate volumetric breast density (VBD) from FFDM on Japanese women with and without breast cancer. ANN calibration of VBD was performed using phantom data for one FFDM system. Mammograms of 46 Japanese women diagnosed with invasive carcinoma and 53 with negative findings were analyzed using ANN models learned. ANN-estimated VBD was validated against phantom data, compared intra-patient, with qualitative composition scoring, with MRI VBD, and inter-patient with classical risk factors of breast cancer as well as cancer status. Phantom validations reached an R 2 of 0.993. Intra-patient validations ranged from R 2 of 0.789 with VBD to 0.908 with breast volume. ANN VBD agreed well with BI-RADS scoring and MRI VBD with R 2 ranging from 0.665 with VBD to 0.852 with breast volume. VBD was significantly higher in women with cancer. Associations with age, BMI, menopause, and cancer status previously reported were also confirmed. ANN modeling appears to produce reasonable measures of mammographic density validated with phantoms, with existing measures of breast density, and with classical biomarkers of breast cancer. FFDM VBD is significantly higher in Japanese women with cancer.
Collapse
|
20
|
Holowatyj AN, Cote ML, Ruterbusch JJ, Ghanem K, Schwartz AG, Vigneau FD, Gorski DH, Purrington KS. Racial Differences in 21-Gene Recurrence Scores Among Patients With Hormone Receptor-Positive, Node-Negative Breast Cancer. J Clin Oncol 2018; 36:652-658. [PMID: 29341832 PMCID: PMC6366808 DOI: 10.1200/jco.2017.74.5448] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The 21-gene recurrence score (RS) breast cancer assay is clinically used to quantify risk of 10-year distant recurrence by category (low, < 18; intermediate, 18 to 30; high, ≥ 31) for treatment management among women diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative, lymph node-negative breast cancer. Although non-Hispanic black (NHB) women have worse prognosis compared with non-Hispanic white (NHW) women, the equivalency of 21-gene RS across racial groups remains unknown. Patients and Methods Using the Metropolitan Detroit Cancer Surveillance System, we identified women who were diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative, lymph node-negative invasive breast cancer between 2010 and 2014. Multinomial logistic regression was used to quantify racial differences in 21-gene RS category. Results We identified 2,216 women (1,824 NHW and 392 NHB) with invasive breast cancer who met clinical guidelines for and underwent 21-gene RS testing. The mean RS was significantly higher in NHBs compared with NHWs (19.3 v 17.0, respectively; P = .0003), where NHBs were more likely to present with high-risk tumors compared with NHWs (14.8% v 8.3%, respectively; P = .0004). These differences were limited to patients younger than 65 years at diagnosis, among whom NHBs had significantly higher RS compared with NHWs (20 to 49 years: 23.6 v 17.3, respectively; P < .001 and 50 to 64 years: 19.6 v 17.4, respectively; P = .023). NHBs remained more likely to have high-risk tumors compared with NHWs after adjusting for age, clinical stage, tumor grade, and histology (odds ratio [OR], 1.75; 95% CI, 1.18 to 2.59). Conclusion NHBs who met clinical criteria for 21-gene RS testing had tumors with higher estimated risks of distant recurrence compared with NHWs. Further study is needed to elucidate whether differences in recurrence are observed for these women, which would have clinical implications for 21-gene RS calibration and treatment recommendations in NHB patients.
Collapse
|
21
|
Abstract
Limitations of screening mammography in patients with dense breasts combined with the significant increased risk for breast cancer have made the issue of dense breasts a matter of great concern in recent years, leading to advocacy for policy change and legislation. Dense breast notification legislation requires direct patient notification of mammographic results indicating the presence of dense breast tissue. The aim of this study was to summarize the state of dense breast notification legislation across the country. The general intent of dense breast notification legislation is to increase awareness of dense breasts and encourage patients to discuss the clinical issues with their physicians. It was first enacted in Connecticut in 2009, and since then, 27 other states have passed, rejected, or considered dense breast notification legislation. At the federal level, a bill was introduced in October 2011, but it was not enacted. There are significant differences in the language of the laws from state to state that complicate implementation. Furthermore, legislated recommendations for possible additional testing are often unaccompanied by legal provisions for insurance coverage, which potentially results in unequal access.
Collapse
Affiliation(s)
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan.
| |
Collapse
|
22
|
Yaghjyan L, Tamimi RM, Bertrand KA, Scott CG, Jensen MR, Pankratz VS, Brandt K, Visscher D, Norman A, Couch F, Shepherd J, Fan B, Chen YY, Ma L, Beck AH, Cummings SR, Kerlikowske K, Vachon CM. Interaction of mammographic breast density with menopausal status and postmenopausal hormone use in relation to the risk of aggressive breast cancer subtypes. Breast Cancer Res Treat 2017; 165:421-431. [PMID: 28624977 PMCID: PMC5773252 DOI: 10.1007/s10549-017-4341-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE We examined the associations of mammographic breast density with breast cancer risk by tumor aggressiveness and by menopausal status and current postmenopausal hormone therapy. METHODS This study included 2596 invasive breast cancer cases and 4059 controls selected from participants of four nested case-control studies within four established cohorts: the Mayo Mammography Health Study, the Nurses' Health Study, Nurses' Health Study II, and San Francisco Mammography Registry. Percent breast density (PD), absolute dense (DA), and non-dense areas (NDA) were assessed from digitized film-screen mammograms using a computer-assisted threshold technique and standardized across studies. We used polytomous logistic regression to quantify the associations of breast density with breast cancer risk by tumor aggressiveness (defined as presence of at least two of the following tumor characteristics: size ≥2 cm, grade 2/3, ER-negative status, or positive nodes), stratified by menopausal status and current hormone therapy. RESULTS Overall, the positive association of PD and borderline inverse association of NDA with breast cancer risk was stronger in aggressive vs. non-aggressive tumors (≥51 vs. 11-25% OR 2.50, 95% CI 1.94-3.22 vs. OR 2.03, 95% CI 1.70-2.43, p-heterogeneity = 0.03; NDA 4th vs. 2nd quartile OR 0.54, 95% CI 0.41-0.70 vs. OR 0.71, 95% CI 0.59-0.85, p-heterogeneity = 0.07). However, there were no differences in the association of DA with breast cancer by aggressive status. In the stratified analysis, there was also evidence of a stronger association of PD and NDA with aggressive tumors among postmenopausal women and, in particular, current estrogen+progesterone users (≥51 vs. 11-25% OR 3.24, 95% CI 1.75-6.00 vs. OR 1.93, 95% CI 1.25-2.98, p-heterogeneity = 0.01; NDA 4th vs. 2nd quartile OR 0.43, 95% CI 0.21-0.85 vs. OR 0.56, 95% CI 0.35-0.89, p-heterogeneity = 0.01), even though the interaction was not significant. CONCLUSION Our findings suggest that associations of mammographic density with breast cancer risk differ by tumor aggressiveness. While there was no strong evidence that these associations differed by menopausal status or hormone therapy, they did appear more prominent among current estrogen+progesterone users.
Collapse
Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Matthew R Jensen
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - V Shane Pankratz
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kathy Brandt
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Daniel Visscher
- Department of Anatomic Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aaron Norman
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Fergus Couch
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - John Shepherd
- Department of Radiology, University of California, 1 Irving Street, AC109, San Francisco, CA, 94143, USA
| | - Bo Fan
- Department of Pathology, University of California, 505 Parnassus AvenueRoom M559, Box 0102, San Francisco, CA, 94143, USA
| | - Yunn-Yi Chen
- Department of Pathology, University of California, 505 Parnassus AvenueRoom M559, Box 0102, San Francisco, CA, 94143, USA
| | - Lin Ma
- Department of Medicine, University of California, 1635 Divisadero St. Suite 600, Box 1793, San Francisco, CA, USA
| | - Andrew H Beck
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, 475 Brannan Street, Suite 220, San Francisco, CA, 94107, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, 4150 Clement Street, Mailing Code 111A1, San Francisco, CA, 94121, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, 4150 Clement Street, Mailing Code 111A1, San Francisco, CA, 94121, USA
| | - Celine M Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
23
|
Hack CC, Emons J, Jud SM, Heusinger K, Adler W, Gass P, Haeberle L, Heindl F, Hein A, Schulz-Wendtland R, Uder M, Hartmann A, Beckmann MW, Fasching PA, Pöhls UG. Association between mammographic density and pregnancies relative to age and BMI: a breast cancer case-only analysis. Breast Cancer Res Treat 2017; 166:701-708. [PMID: 28828694 DOI: 10.1007/s10549-017-4446-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/05/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Percentage mammographic density (PMD) is a major risk factor for breast cancer (BC). It is strongly associated with body mass index (BMI) and age, which are themselves risk factors for breast cancer. This analysis investigated the association between the number of full-term pregnancies and PMD in different subgroups relative to age and BMI. METHODS Patients were identified in the breast cancer database of the University Breast Center for Franconia. A total of 2410 patients were identified, for whom information on parity, age, and BMI, and a mammogram from the time of first diagnosis were available for assessing PMD. Linear regression analyses were conducted to investigate the influence on PMD of the number of full-term pregnancies (FTPs), age, BMI, and interaction terms between them. RESULTS As in previous studies, age, number of FTPs, and BMI were found to be associated with PMD in the expected direction. However, including the respective interaction terms improved the prediction of PMD even further. Specifically, the association between PMD and the number of FTPs differed in young patients under the age of 45 (mean decrease of 0.37 PMD units per pregnancy) from the association in older age groups (mean decrease between 2.29 and 2.39 PMD units). BMI did not alter the association between PMD and the number of FTPs. CONCLUSIONS The effect of pregnancies on mammographic density does not appear to become apparent before the age of menopause. The mechanism that drives the effect of pregnancies on mammographic density appears to be counter-regulated by other influences on mammographic density in younger patients.
Collapse
Affiliation(s)
- Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Michael Uder
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Uwe G Pöhls
- Practice of Dr. Pöhls, Women's Health Center of Würzburg, Würzburg, Germany
| |
Collapse
|
24
|
Erdmann NJ, Harrington LA, Martin LJ. Mammographic density, blood telomere length and lipid peroxidation. Sci Rep 2017; 7:5803. [PMID: 28725051 PMCID: PMC5517610 DOI: 10.1038/s41598-017-06036-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023] Open
Abstract
Extensive mammographic density is a strong risk factor for breast cancer, but may also be an indicator of biological age. In this study we examined whether mammographic density is related to blood telomere length, a potential marker of susceptibility to age-related disease. We measured mammographic density by a computer assisted method and blood telomere length using a validated PCR method. Urinary malondialdehyde (MDA), a marker of lipid peroxidation, was measured in 24 hour urine collections. In the 342 women examined telomere length was negatively correlated with age, was lower in postmenopausal compared to premenopausal women and in smokers compared to non-smokers, and was positively correlated with urinary MDA. Telomere length was not associated with percent mammographic density or dense area, before or after adjustment for risk factors and MDA. However, there was a significant interaction between telomere length and MDA in their association with mammographic density. At lower levels of MDA, mammographic density and telomere length were inversely associated; while at high levels of MDA, there was evidence of a J-shaped association between mammographic density and telomere length. Further work is need to replicate these results and to examine the association of mammographic density with age-related chronic disease and mortality.
Collapse
Affiliation(s)
- Natalie J Erdmann
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Lea A Harrington
- Institute for Research in Immunology & Cancer, Départment de Médécine, Université de Montréal, Montréal, QC, H3T 1J4, Canada.,School of Biological Sciences, College of Science and Engineering, University of Edinburgh, The Kings Buildings, Mayfield Road, Edinburgh, UK
| | - Lisa J Martin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada.
| |
Collapse
|
25
|
Guo C, Sung H, Zheng S, Guida J, Li E, Li J, Hu N, Deng J, Figueroa JD, Sherman ME, Gierach GL, Lu N, Yang XR. Age-related terminal duct lobular unit involution in benign tissues from Chinese breast cancer patients with luminal and triple-negative tumors. Breast Cancer Res 2017; 19:61. [PMID: 28545469 PMCID: PMC5445352 DOI: 10.1186/s13058-017-0850-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/02/2017] [Indexed: 01/20/2023] Open
Abstract
Background Terminal duct lobular unit (TDLU) involution is a physiological process of breast tissue aging characterized by a reduction in the epithelial component. In studies of women with benign breast disease, researchers have found that age-matched women with lower levels of TDLU involution are at increased risk of developing breast cancer. We previously showed that breast cancer cases with core basal phenotype (CBP; estrogen receptor negative [ER−], progesterone receptor-negative [PR−], human epidermal growth factor receptor 2-negative [HER2−], cytokeratins (CK 5 or CK5/6)-positive [CK5/6+] and/or epidermal growth factor receptor-positive [EGFR+]) tumors had significantly reduced TDLU involution compared with cases with luminal A (ER+ and/or PR+, HER2−, CK5/6−, EGFR−) tumors from a population-based case-control study in Poland. We evaluated the association of TDLU involution with tumor subtypes in an independent population of women in China, where the breast cancer incidence rate, prevalence of known risk factors, and mammographic breast density are thought to be markedly different from those of Polish women. Methods We performed morphometric assessment of TDLUs by using three reproducible semiquantitative measures that inversely correlate with TDLU involution (TDLU count/100 mm2, TDLU span in micrometer, and acini count/TDLU) by examining benign tissue blocks from 254 age-matched luminal A and 250 triple-negative (TN; ER−, PR−, HER2−, including 125 CBP) breast cancer cases treated in a tertiary hospital in Beijing, China. Results Overall, we found that TN and particularly CBP cases tended to have greater TDLU measures (less involution) than luminal A cases in logistic regression models accounting for age, body mass index, parity, and tumor grade. The strongest association was observed for tertiles of acini count among younger women (aged <50 years) (CBP vs. luminal A; ORtrend 2.11, 95% CI 1.22–3.67, P = 0.008). Conclusions These data extend previous findings that TN/CBP breast cancers are associated with reduced TDLU involution in surrounding breast parenchyma compared with luminal A cases among Chinese women, providing further support for differences in the pathogenesis of these tumor subtypes. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0850-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Changyuan Guo
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hyuna Sung
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shan Zheng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jennifer Guida
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - 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
| | - Nan Hu
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joseph Deng
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Mark E Sherman
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, 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, MD, USA.
| |
Collapse
|
26
|
Perinatal Exposure to Bisphenol A or Diethylstilbestrol Increases the Susceptibility to Develop Mammary Gland Lesions After Estrogen Replacement Therapy in Middle-Aged Rats. Discov Oncol 2017; 8:78-89. [DOI: 10.1007/s12672-016-0282-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/23/2016] [Indexed: 11/26/2022] Open
|
27
|
Maskarinec G, Ju D, Horio D, Loo LWM, Hernandez BY. Involution of breast tissue and mammographic density. Breast Cancer Res 2016; 18:128. [PMID: 27978856 PMCID: PMC5159985 DOI: 10.1186/s13058-016-0792-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/02/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mammographic density decreases and involution of breast tissue increases with age; both are thought to be risk factors for breast cancer. The current study investigated the relationship between involution or hormone treatment (HT) and breast density among multiethnic patients with breast cancer in Hawaii. METHODS Patients with breast cancer cases were recruited from a nested case-control study within the Multiethnic Cohort. HT use was self-reported at cohort entry and at the time of the density study. Mammographic density and involution in adjacent non-tumor breast tissue were assessed using established methods. Linear regression was applied to evaluate the correlation between involution and four density measures and to compute adjusted means by involution status while adjusting for confounders. RESULTS In the 173 patients with breast cancer, mean percent breast density was 41.2% in mammograms taken approximately 1 year before diagnosis. The respective proportions of women with no, partial, and complete involution were 18.5, 51.4, and 30.1%, respectively and the adjusted density values for these categories were 32.5, 39.2, and 40.2% (p = 0.15). In contrast, the size of the dense area was significantly associated with involution (p = 0.001); the values ranged from 29.7 cm2 for no involution to 48.0 cm2 for complete involution. The size of the total breast area but not of the non-dense areas was also larger with progressive involution. Percent density and dense area were significantly higher in women with combined HT use. CONCLUSIONS Contrary to previous reports, greater lobular involution was not related to lower mammographic density but to higher dense area. Possibly, percent density during the involution process depends on the timing of mammographic density assessment, as epithelial tissue is first replaced with radiographically dense stromal tissue and only later with fat.
Collapse
Affiliation(s)
- Gertraud Maskarinec
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA.
| | - Dan Ju
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - David Horio
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Lenora W M Loo
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brenda Y Hernandez
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| |
Collapse
|
28
|
Xu X, Chung Y, Brooks AD, Shih WH, Shih WY. Development of array piezoelectric fingers towards in vivo breast tumor detection. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2016; 87:124301. [PMID: 28040934 PMCID: PMC5148765 DOI: 10.1063/1.4971325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
We have investigated the development of a handheld 4 × 1 piezoelectric finger (PEF) array breast tumor detector system towards in vivo patient testing, particularly, on how the duration of the DC applied voltage, the depression depth of the handheld unit, and breast density affect the PEF detection sensitivity on 40 patients. The tests were blinded and carried out in four phases: with DC voltage durations 5, 3, 2, to 0.8 s corresponding to scanning a quadrant, a half, a whole breast, and both breasts within 30 min, respectively. The results showed that PEF detection sensitivity was unaffected by shortening the applied voltage duration from 5 to 0.8 s nor was it affected by increasing the depression depth from 2 to 6 mm. Over the 40 patients, PEF detected 46 of the 48 lesions (46/48)-with the smallest lesion detected being 5 mm in size. Of 28 patients (some have more than one lesion) with mammography records, PEF detected 31/33 of all lesions (94%) and 14/15 of malignant lesions (93%), while mammography detected 30/33 of all lesions (91%) and 12/15 of malignant lesions (80%), indicating that PEF could detect malignant lesions not detectable by mammography without significantly increasing false positives. PEF's detection sensitivity is also shown to be independent of breast density, suggesting that PEF could be a potential tool for detecting breast cancer in young women and women with dense breasts.
Collapse
Affiliation(s)
- Xin Xu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Youngsoo Chung
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Ari D Brooks
- Department of Surgery, College of Medicine, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Wei-Heng Shih
- Department of Materials Science and Engineering, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - Wan Y Shih
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
| |
Collapse
|
29
|
Hou XY, Niu HY, Huang XL, Gao Y. Correlation of Breast Ultrasound Classifications with Breast Cancer in Chinese Women. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2616-2621. [PMID: 27554070 DOI: 10.1016/j.ultrasmedbio.2016.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/17/2016] [Accepted: 07/09/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to identify potential links between ultrasonographic breast parenchymal patterns and the risk of breast cancer in Chinese women. The population of Chinese women at high risk for breast cancer was explored using the ultrasonographic classification. Ultrasonographic parenchymal patterns were classified into four types: heterogeneous type, ductal type, mixed type and fibrous type. A total of 5879 Chinese women underwent breast ultrasound examination from May 2010 to April 2014. Of the 5879 women, 256 women had pathology-confirmed breast cancer. Among the remaining 5623 women, 512 randomly selected, age-matched women were recruited into the present study. The correlation between ultrasonographic type and breast cancer revealed that the odds ratio (OR) was highest for the heterogeneous type (odds ratio = 4.11, 95% confidence interval: 2.01-8.41, p < 0.001), followed by the fibrous type (odds ratio = 2.05, 95% confidence interval: 1.51-2.78, p < 0.001). The odds ratios of the ductal and mixed types were both less than 1 (p < 0.05). This study indicates that the heterogeneous and fibrous types in the ultrasonographic classification are associated with an increased risk of breast cancer and, therefore, can be used as a marker of breast cancer risk in the female population of China.
Collapse
Affiliation(s)
- Xin-Yan Hou
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China.
| | - Hai-Yan Niu
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China
| | - Xiao-Ling Huang
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China
| | - Yu Gao
- Department of Ultrasound, PLA Beijing Military General Hospital, Beijing, China
| |
Collapse
|
30
|
Yaghjyan L, Ghita GL, Rosner B, Farvid M, Bertrand KA, Tamimi RM. Adolescent fiber intake and mammographic breast density in premenopausal women. Breast Cancer Res 2016; 18:85. [PMID: 27520794 PMCID: PMC4983022 DOI: 10.1186/s13058-016-0747-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/29/2016] [Indexed: 12/12/2022] Open
Abstract
Background To date, there is limited and inconsistent epidemiologic evidence for associations of adolescent diet with mammographic breast density, a strong and consistent predictor of breast cancer. We investigated the association of adolescent fiber intake with mammographic density in premenopausal women. Methods This study included 743 cancer-free premenopausal women (mean age, 44.9 years) within the Nurses’ Health Study II cohort. Percent breast density, absolute dense and non-dense areas were measured from digitized film mammograms using a computer-assisted thresholding technique. Adolescent and adult diet were assessed with a food frequency questionnaire; energy-adjusted nutrient intakes were estimated for each food item. Information regarding breast cancer risk factors was obtained from baseline or biennial questionnaires closest to the mammogram date. We used generalized linear regression to quantify associations between quartiles of adolescent fiber intake and each of the breast density measures, adjusted for potential confounders. Associations were examined separately for total fiber intake; fiber from fruits, vegetables, legumes, and cereal; and food sources of fiber (fruits, vegetables, and nuts). Results In multivariable analyses, total fiber intake during adolescence was not associated with percent breast density (p for trend = 0.64), absolute dense area (p for trend = 0.80), or non-dense area (p for trend = 0.75). Similarly, neither consumption of fiber from fruits, vegetables, legumes, or cereal nor specific sources of fiber intake (fruits, vegetables, or nuts) during adolescence were associated with any of the mammographic density phenotypes. Conclusions Our findings do not support the hypothesis that adolescent fiber intake is associated with premenopausal mammographic breast density.
Collapse
Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, University of Florida, College of Public Health and Health Professions and College of Medicine, 2004 Mowry Rd., Gainesville, 32610, FL, USA.
| | - Gabriela L Ghita
- Department of Biostatistics, University of Florida, College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Maryam Farvid
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | | | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
31
|
Figueroa JD, Pfeiffer RM, Brinton LA, Palakal MM, Degnim AC, Radisky D, Hartmann LC, Frost MH, Stallings Mann ML, Papathomas D, Gierach GL, Hewitt SM, Duggan MA, Visscher D, Sherman ME. Standardized measures of lobular involution and subsequent breast cancer risk among women with benign breast disease: a nested case-control study. Breast Cancer Res Treat 2016; 159:163-72. [PMID: 27488681 DOI: 10.1007/s10549-016-3908-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/11/2016] [Indexed: 01/21/2023]
Abstract
Lesser degrees of terminal duct-lobular unit (TDLU) involution predict higher breast cancer risk; however, standardized measures to quantitate levels of TDLU involution have only recently been developed. We assessed whether three standardized measures of TDLU involution, with high intra/inter pathologist reproducibility in normal breast tissue, predict subsequent breast cancer risk among women in the Mayo benign breast disease (BBD) cohort. We performed a masked evaluation of biopsies from 99 women with BBD who subsequently developed breast cancer (cases) after a median of 16.9 years and 145 age-matched controls. We assessed three metrics inversely related to TDLU involution: TDLU count/mm(2), median TDLU span (microns, which approximates acini content), and median category of acini counts/TDLU (0-10; 11-20; 21-30; 31-50; >50). Associations with subsequent breast cancer risk for quartiles (or categories of acini counts) of each of these measures were assessed with multivariable conditional logistic regression to estimate odds ratios (ORs) and 95 % confidence intervals (CI). In multivariable models, women in the highest quartile compared to the lowest quartiles of TDLU counts and TDLU span measures were significantly associated with subsequent breast cancer diagnoses; TDLU counts quartile4 versus quartile1, OR = 2.44, 95 %CI 0.96-6.19, p-trend = 0.02; and TDLU spans, quartile4 versus quartile1, OR = 2.83, 95 %CI = 1.13-7.06, p-trend = 0.03. Significant associations with categorical measures of acini counts/TDLU were also observed: compared to women with median category of <10 acini/TDLU, women with >25 acini counts/TDLU were at significantly higher risk, OR = 3.40, 95 %CI 1.03-11.17, p-trend = 0.032. Women with TDLU spans and TDLU count measures above the median were at further increased risk, OR = 3.75 (95 %CI 1.40-10.00, p-trend = 0.008), compared with women below the median for both of these metrics. Similar results were observed for combinatorial metrics of TDLU acini counts/TDLU, and TDLU count. Standardized quantitative measures of TDLU counts and acini counts approximated by TDLU span measures or visually assessed in categories are independently associated with breast cancer risk. Visual assessment of TDLU numbers and acini content, which are highly reproducible between pathologists, could help identify women at high risk for subsequent breast cancer among the million women diagnosed annually with BBD in the US.
Collapse
Affiliation(s)
- Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. .,Medical School, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Maya M Palakal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | - Daphne Papathomas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Stephen M Hewitt
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Maire A Duggan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Mark E Sherman
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
32
|
Zhu W, Harvey S, Macura KJ, Euhus DM, Artemov D. Invasive Breast Cancer Preferably and Predominantly Occurs at the Interface Between Fibroglandular and Adipose Tissue. Clin Breast Cancer 2016; 17:e11-e18. [PMID: 27568102 DOI: 10.1016/j.clbc.2016.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Increasing evidence suggests adipocyte involvement in malignant breast tumor invasive front or margin. The aim of this study was to evaluate the location of invasive breast tumors in relation to fibroglandular and adipose tissue by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). PATIENTS AND METHODS Pretreatment breast DCE-MRI images of 294 patients with biopsy-proven invasive breast cancer from 2008 to 2014 were studied. Invasive breast tumors were visualized as enhanced lesions in the postcontrast subtraction images. Positive identification of biopsy-confirmed invasive breast tumors on DCE-MRI images was achieved by correlation of findings from breast MRI and pathology reports. Tumor location in relation to fibroglandular and adipose tissue was investigated using precontrast T1-weighted MRI images. RESULTS Of 294 patients, 291 had DCE-MRI discernable invasive breast tumors located at the interface between fibroglandular and adipose tissues, regardless of the tumor size, type, receptor status, or breast composition. CONCLUSION Invasive breast cancer preferably and predominantly occurs adjacent to breast adipose tissue.
Collapse
Affiliation(s)
- Wenlian Zhu
- Division of Cancer Imaging Research, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Susan Harvey
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katarzyna J Macura
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David M Euhus
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dmitri Artemov
- Division of Cancer Imaging Research, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
33
|
Lau S, Ng KH, Abdul Aziz YF. Volumetric breast density measurement: sensitivity analysis of a relative physics approach. Br J Radiol 2016; 89:20160258. [PMID: 27452264 DOI: 10.1259/bjr.20160258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To investigate the sensitivity and robustness of a volumetric breast density (VBD) measurement system to errors in the imaging physics parameters including compressed breast thickness (CBT), tube voltage (kVp), filter thickness, tube current-exposure time product (mAs), detector gain, detector offset and image noise. METHODS 3317 raw digital mammograms were processed with Volpara(®) (Matakina Technology Ltd, Wellington, New Zealand) to obtain fibroglandular tissue volume (FGV), breast volume (BV) and VBD. Errors in parameters including CBT, kVp, filter thickness and mAs were simulated by varying them in the Digital Imaging and Communications in Medicine (DICOM) tags of the images up to ±10% of the original values. Errors in detector gain and offset were simulated by varying them in the Volpara configuration file up to ±10% from their default values. For image noise, Gaussian noise was generated and introduced into the original images. RESULTS Errors in filter thickness, mAs, detector gain and offset had limited effects on FGV, BV and VBD. Significant effects in VBD were observed when CBT, kVp, detector offset and image noise were varied (p < 0.0001). Maximum shifts in the mean (1.2%) and median (1.1%) VBD of the study population occurred when CBT was varied. CONCLUSION Volpara was robust to expected clinical variations, with errors in most investigated parameters giving limited changes in results, although extreme variations in CBT and kVp could lead to greater errors. ADVANCES IN KNOWLEDGE Despite Volpara's robustness, rigorous quality control is essential to keep the parameter errors within reasonable bounds. Volpara appears robust within those bounds, albeit for more advanced applications such as tracking density change over time, it remains to be seen how accurate the measures need to be.
Collapse
Affiliation(s)
- Susie Lau
- 1 Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,2 University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kwan Hoong Ng
- 1 Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,2 University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- 1 Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,2 University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
34
|
Reproductive factors related to childbearing and mammographic breast density. Breast Cancer Res Treat 2016; 158:351-9. [PMID: 27351801 DOI: 10.1007/s10549-016-3884-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
We investigated the associations of reproductive factors related to childbearing with percent breast density, absolute dense and nondense areas, by menopausal status. This study included 4110 cancer-free women within the Nurses' Health Study and Nurses' Health Study II cohorts. Percent breast density, absolute dense and nondense areas were measured from digitized mammography film images with computerized techniques. All density measures were square root-transformed in all the analyses to improve normality. The data on reproductive variables and other breast cancer risk factors were obtained from biennial questionnaires, at the time of the mammogram date. As compared to nulliparous women, parous postmenopausal women had lower percent density (β = -0.60, 95 % CI -0.84; -0.37), smaller absolute dense area (β = -0.66, 95 % CI -1.03; -0.29), and greater nondense area (β = 0.72, 95 % CI 0.27; 1.16). Among parous women, number of children was inversely associated with percent density in pre- (β per one child = -0.12, 95 % CI -0.20; -0.05) and postmenopausal women (β per one child = -0.07, 95 % CI -0.12; -0.02). The positive associations of breastfeeding with absolute dense and nondense areas were limited to premenopausal women, while the positive association of the age at first child's birth with percent density and the inverse association with nondense area were limited to postmenopausal women. Women with greater number of children and younger age at first child's birth have more favorable breast density patterns that could explain subsequent breast cancer risk reduction.
Collapse
|
35
|
Oh H, Bodelon C, Palakal M, Chatterjee N, Sherman ME, Linville L, Geller BM, Vacek PM, Weaver DL, Chicoine RE, Papathomas D, Patel DA, Xiang J, Clare SE, Visscher DW, Mies C, Hewitt SM, Brinton LA, Storniolo AMV, He C, Garcia-Closas M, Chanock SJ, Gierach GL, Figueroa JD. Ages at menarche- and menopause-related genetic variants in relation to terminal duct lobular unit involution in normal breast tissue. Breast Cancer Res Treat 2016; 158:341-50. [PMID: 27342457 DOI: 10.1007/s10549-016-3859-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/07/2016] [Indexed: 12/21/2022]
Abstract
Reduced levels of terminal duct lobular unit (TDLU) involution, as reflected by higher numbers of TDLUs and acini per TDLU, have been associated with higher breast cancer risk. Younger age at menarche and older age at menopause have been previously related to lower levels of TDLU involution. To determine a possible genetic link, we examined whether single-nucleotide polymorphisms (SNPs) previously established in genome-wide association studies (GWAS) for ages at menarche and menopause are associated with TDLU involution. We conducted a pooled analysis of 862 women from two studies. H&E tissue sections were assessed for numbers of TDLUs and acini/TDLU. Poisson regression models were used to estimate associations of 36 menarche- and 21 menopause-SNPs with TDLU counts, acini counts/TDLU, and the product of these two measures, adjusting for age and study site. Fourteen percent of evaluated SNPs (eight SNPs) were associated with TDLU counts at p < 0.05, suggesting an enrichment of associations with TDLU counts. However, only menopause-SNPs had >50 % that were either significantly or nonsignificantly associated with TDLU measures in the directions consistent with their relationships shown in GWAS. Among ten SNPs that were statistically significantly associated with at least one TDLU involution measure (p < 0.05), seven SNPs (rs466639: RXRG; rs2243803: SLC14A2; rs2292573: GAB2; rs6438424: 3q13.32; rs7606918: METAP1D; rs11668344: TMEM150B; rs1635501: EXO1) were associated in the consistent directions. Our data suggest that the loci associated with ages at menarche and menopause may influence TDLU involution, suggesting some shared genetic mechanisms. However, larger studies are needed to confirm the results.
Collapse
Affiliation(s)
- Hannah Oh
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Maya Palakal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.,Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Laura Linville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | | | | | | | | | - Daphne Papathomas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Deesha A Patel
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Jackie Xiang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Susan E Clare
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Carolyn Mies
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Genomic Health, Inc., Redwood City, CA, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Anna Maria V Storniolo
- Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Chunyan He
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.,Usher Institute of Population Health Sciences and Informatics, Institute of Genomics and Molecular Medicine, Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
36
|
Horne HN, Sherman ME, Pfeiffer RM, Figueroa JD, Khodr ZG, Falk RT, Pollak M, Patel DA, Palakal MM, Linville L, Papathomas D, Geller B, Vacek PM, Weaver DL, Chicoine R, Shepherd J, Mahmoudzadeh AP, Wang J, Fan B, Malkov S, Herschorn S, Hewitt SM, Brinton LA, Gierach GL. Circulating insulin-like growth factor-I, insulin-like growth factor binding protein-3 and terminal duct lobular unit involution of the breast: a cross-sectional study of women with benign breast disease. Breast Cancer Res 2016; 18:24. [PMID: 26893016 PMCID: PMC4758090 DOI: 10.1186/s13058-016-0678-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/29/2016] [Indexed: 12/19/2022] Open
Abstract
Background Terminal duct lobular units (TDLUs) are the primary structures from which breast cancers and their precursors arise. Decreased age-related TDLU involution and elevated mammographic density are both correlated and independently associated with increased breast cancer risk, suggesting that these characteristics of breast parenchyma might be linked to a common factor. Given data suggesting that increased circulating levels of insulin-like growth factors (IGFs) factors are related to reduced TDLU involution and increased mammographic density, we assessed these relationships using validated quantitative methods in a cross-sectional study of women with benign breast disease. Methods Serum IGF-I, IGFBP-3 and IGF-I:IGFBP-3 molar ratios were measured in 228 women, ages 40-64, who underwent diagnostic breast biopsies yielding benign diagnoses at University of Vermont affiliated centers. Biopsies were assessed for three separate measures inversely related to TDLU involution: numbers of TDLUs per unit of tissue area (“TDLU count”), median TDLU diameter (“TDLU span”), and number of acini per TDLU (“acini count”). Regression models, stratified by menopausal status and adjusted for potential confounders, were used to assess the associations of TDLU count, median TDLU span and median acini count per TDLU with tertiles of circulating IGFs. Given that mammographic density is associated with both IGF levels and breast cancer risk, we also stratified these associations by mammographic density. Results Higher IGF-I levels among postmenopausal women and an elevated IGF-I:IGFBP-3 ratio among all women were associated with higher TDLU counts, a marker of decreased lobular involution (P-trend = 0.009 and <0.0001, respectively); these associations were strongest among women with elevated mammographic density (P-interaction <0.01). Circulating IGF levels were not significantly associated with TDLU span or acini count per TDLU. Conclusions These results suggest that elevated IGF levels may define a sub-group of women with high mammographic density and limited TDLU involution, two markers that have been related to increased breast cancer risk. If confirmed in prospective studies with cancer endpoints, these data may suggest that evaluation of IGF signaling and its downstream effects may have value for risk prediction and suggest strategies for breast cancer chemoprevention through inhibition of the IGF system. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0678-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hisani N Horne
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA. .,Present Affiliation: Food and Drug Administration, Silver Spring, MD, USA.
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Jonine D Figueroa
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland.
| | - Zeina G Khodr
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | - Roni T Falk
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | | | - Deesha A Patel
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA. .,Present Affiliation: Northwestern University Medical School, Chicago, IL, USA.
| | - Maya M Palakal
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | - Laura Linville
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | - Daphne Papathomas
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | | | | | | | | | - John Shepherd
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Amir Pasha Mahmoudzadeh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Jeff Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA. .,Present Affiliation: Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Bo Fan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Serghei Malkov
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Sally Herschorn
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Louise A Brinton
- Office of the Director, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Gretchen L Gierach
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| |
Collapse
|
37
|
Gierach GL, Patel DA, Pfeiffer RM, Figueroa JD, Linville L, Papathomas D, Johnson JM, Chicoine RE, Herschorn SD, Shepherd JA, Wang J, Malkov S, Vacek PM, Weaver DL, Fan B, Mahmoudzadeh AP, Palakal M, Xiang J, Oh H, Horne HN, Sprague BL, Hewitt SM, Brinton LA, Sherman ME. Relationship of Terminal Duct Lobular Unit Involution of the Breast with Area and Volume Mammographic Densities. Cancer Prev Res (Phila) 2015; 9:149-58. [PMID: 26645278 DOI: 10.1158/1940-6207.capr-15-0282] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/17/2015] [Indexed: 01/05/2023]
Abstract
Elevated mammographic density (MD) is an established breast cancer risk factor. Reduced involution of terminal duct lobular units (TDLU), the histologic source of most breast cancers, has been associated with higher MD and breast cancer risk. We investigated relationships of TDLU involution with area and volumetric MD, measured throughout the breast and surrounding biopsy targets (perilesional). Three measures inversely related to TDLU involution (TDLU count/mm(2), median TDLU span, median acini count/TDLU) assessed in benign diagnostic biopsies from 348 women, ages 40-65, were related to MD area (quantified with thresholding software) and volume (assessed with a density phantom) by analysis of covariance, stratified by menopausal status and adjusted for confounders. Among premenopausal women, TDLU count was directly associated with percent perilesional MD (P trend = 0.03), but not with absolute dense area/volume. Greater TDLU span was associated with elevated percent dense area/volume (P trend<0.05) and absolute perilesional MD (P = 0.003). Acini count was directly associated with absolute perilesional MD (P = 0.02). Greater TDLU involution (all metrics) was associated with increased nondense area/volume (P trend ≤ 0.04). Among postmenopausal women, TDLU measures were not significantly associated with MD. Among premenopausal women, reduced TDLU involution was associated with higher area and volumetric MD, particularly in perilesional parenchyma. Data indicating that TDLU involution and MD are correlated markers of breast cancer risk suggest that associations of MD with breast cancer may partly reflect amounts of at-risk epithelium. If confirmed, these results could suggest a prevention paradigm based on enhancing TDLU involution and monitoring efficacy by assessing MD reduction.
Collapse
Affiliation(s)
- Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Deesha A Patel
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonine D Figueroa
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laura Linville
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Papathomas
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason M Johnson
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - John A Shepherd
- University of California, San Francisco, San Francisco, California
| | - Jeff Wang
- University of California, San Francisco, San Francisco, California
| | - Serghei Malkov
- University of California, San Francisco, San Francisco, California
| | | | | | - Bo Fan
- University of California, San Francisco, San Francisco, California
| | | | - Maya Palakal
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jackie Xiang
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hannah Oh
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hisani N Horne
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
38
|
Sandhu R, Chollet-Hinton L, Kirk EL, Midkiff B, Troester MA. Digital histologic analysis reveals morphometric patterns of age-related involution in breast epithelium and stroma. Hum Pathol 2015; 48:60-8. [PMID: 26772400 DOI: 10.1016/j.humpath.2015.09.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/11/2015] [Accepted: 09/23/2015] [Indexed: 12/29/2022]
Abstract
Complete age-related regression of mammary epithelium, often termed postmenopausal involution, is associated with decreased breast cancer risk. However, most studies have qualitatively assessed involution. We quantitatively analyzed epithelium, stroma, and adipose tissue from histologically normal breast tissue of 454 patients in the Normal Breast Study. High-resolution digital images of normal breast hematoxylin and eosin-stained slides were partitioned into epithelium, adipose tissue, and nonfatty stroma. Percentage area and nuclei per unit area (nuclear density) were calculated for each component. Quantitative data were evaluated in association with age using linear regression and cubic spline models. Stromal area decreased (P = 0.0002), and adipose tissue area increased (P < 0.0001), with an approximate 0.7% change in area for each component, until age 55 years when these area measures reached a steady state. Although epithelial area did not show linear changes with age, epithelial nuclear density decreased linearly beginning in the third decade of life. No significant age-related trends were observed for stromal or adipose nuclear density. Digital image analysis offers a high-throughput method for quantitatively measuring tissue morphometry and for objectively assessing age-related changes in adipose tissue, stroma, and epithelium. Epithelial nuclear density is a quantitative measure of age-related breast involution that begins to decline in the early premenopausal period.
Collapse
Affiliation(s)
- Rupninder Sandhu
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, 27599
| | - Lynn Chollet-Hinton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Erin L Kirk
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Bentley Midkiff
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, 27599
| | - Melissa A Troester
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, 27599; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599; Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, 27599.
| |
Collapse
|
39
|
Khodr ZG, Sherman ME, Pfeiffer RM, Gierach GL, Brinton LA, Falk RT, Patel DA, Linville LM, Papathomas D, Clare SE, Visscher DW, Mies C, Hewitt SM, Storniolo AMV, Rosebrock A, Caban JJ, Figueroa JD. Circulating sex hormones and terminal duct lobular unit involution of the normal breast. Cancer Epidemiol Biomarkers Prev 2015; 23:2765-73. [PMID: 25472681 DOI: 10.1158/1055-9965.epi-14-0667] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Terminal duct lobular units (TDLU) are the predominant source of breast cancers. Lesser degrees of age-related TDLU involution have been associated with increased breast cancer risk, but factors that influence involution are largely unknown. We assessed whether circulating hormones, implicated in breast cancer risk, are associated with levels of TDLU involution using data from the Susan G. Komen Tissue Bank (KTB) at the Indiana University Simon Cancer Center (2009-2011). METHODS We evaluated three highly reproducible measures of TDLU involution, using normal breast tissue samples from the KTB (n = 390): TDLU counts, median TDLU span, and median acini counts per TDLU. RRs (for continuous measures), ORs (for categorical measures), 95% confidence intervals (95% CI), and Ptrends were calculated to assess the association between tertiles of estradiol, testosterone, sex hormone-binding globulin (SHBG), progesterone, and prolactin with TDLU measures. All models were stratified by menopausal status and adjusted for confounders. RESULTS Among premenopausal women, higher prolactin levels were associated with higher TDLU counts (RRT3vsT1:1.18; 95% CI: 1.07-1.31; Ptrend = 0.0005), but higher progesterone was associated with lower TDLU counts (RRT3vsT1: 0.80; 95% CI: 0.72-0.89; Ptrend < 0.0001). Among postmenopausal women, higher levels of estradiol (RRT3vsT1:1.61; 95% CI: 1.32-1.97; Ptrend < 0.0001) and testosterone (RRT3vsT1: 1.32; 95% CI: 1.09-1.59; Ptrend = 0.0043) were associated with higher TDLU counts. CONCLUSIONS These data suggest that select hormones may influence breast cancer risk potentially through delaying TDLU involution. IMPACT Increased understanding of the relationship between circulating markers and TDLU involution may offer new insights into breast carcinogenesis. Cancer Epidemiol Biomarkers Prev; 23(12); 2765-73. ©2014 AACR.
Collapse
Affiliation(s)
- Zeina G Khodr
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland. Division of Cancer Prevention, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Deesha A Patel
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Laura M Linville
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Daphne Papathomas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland
| | - Susan E Clare
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Carolyn Mies
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Hewitt
- Applied Molecular Pathology Laboratory, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Anna Maria V Storniolo
- Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Adrian Rosebrock
- Computer Science and Electrical Engineering Department, University of Maryland, Baltimore, Maryland
| | - Jesus J Caban
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland.
| |
Collapse
|
40
|
Breast Tissue Composition and Immunophenotype and Its Relationship with Mammographic Density in Women at High Risk of Breast Cancer. PLoS One 2015; 10:e0128861. [PMID: 26110820 PMCID: PMC4481506 DOI: 10.1371/journal.pone.0128861] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/03/2015] [Indexed: 12/02/2022] Open
Abstract
Aim To investigate the cellular and immunophenotypic basis of mammographic density in women at high risk of breast cancer. Methods Mammograms and targeted breast biopsies were accrued from 24 women at high risk of breast cancer. Mammographic density was classified into Wolfe categories and ranked by increasing density. The histological composition and immunophenotypic profile were quantified from digitized haematoxylin and eosin-stained and immunohistochemically-stained (ERα, ERβ, PgR, HER2, Ki-67, and CD31) slides and correlated to mammographic density. Results Increasing mammographic density was significantly correlated with increased fibrous stroma proportion (rs (22) = 0.5226, p = 0.0088) and significantly inversely associated with adipose tissue proportion (rs (22) = -0.5409, p = 0.0064). Contrary to previous reports, stromal expression of ERα was common (19/20 cases, 95%). There was significantly higher stromal PgR expression in mammographically-dense breasts (p=0.026). Conclusions The proportion of stroma and fat underlies mammographic density in women at high risk of breast cancer. Increased expression of PgR in the stroma of mammographically dense breasts and frequent and unexpected presence of stromal ERα expression raises the possibility that hormone receptor expression in breast stroma may have a role in mediating the effects of exogenous hormonal therapy on mammographic density.
Collapse
|
41
|
Stone J, Thompson DJ, Dos Santos Silva I, Scott C, Tamimi RM, Lindstrom S, Kraft P, Hazra A, Li J, Eriksson L, Czene K, Hall P, Jensen M, Cunningham J, Olson JE, Purrington K, Couch FJ, Brown J, Leyland J, Warren RML, Luben RN, Khaw KT, Smith P, Wareham NJ, Jud SM, Heusinger K, Beckmann MW, Douglas JA, Shah KP, Chan HP, Helvie MA, Le Marchand L, Kolonel LN, Woolcott C, Maskarinec G, Haiman C, Giles GG, Baglietto L, Krishnan K, Southey MC, Apicella C, Andrulis IL, Knight JA, Ursin G, Alnaes GIG, Kristensen VN, Borresen-Dale AL, Gram IT, Bolla MK, Wang Q, Michailidou K, Dennis J, Simard J, Pharoah P, Dunning AM, Easton DF, Fasching PA, Pankratz VS, Hopper JL, Vachon CM. Novel Associations between Common Breast Cancer Susceptibility Variants and Risk-Predicting Mammographic Density Measures. Cancer Res 2015; 75:2457-67. [PMID: 25862352 PMCID: PMC4470785 DOI: 10.1158/0008-5472.can-14-2012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 03/10/2015] [Indexed: 12/30/2022]
Abstract
Mammographic density measures adjusted for age and body mass index (BMI) are heritable predictors of breast cancer risk, but few mammographic density-associated genetic variants have been identified. Using data for 10,727 women from two international consortia, we estimated associations between 77 common breast cancer susceptibility variants and absolute dense area, percent dense area and absolute nondense area adjusted for study, age, and BMI using mixed linear modeling. We found strong support for established associations between rs10995190 (in the region of ZNF365), rs2046210 (ESR1), and rs3817198 (LSP1) and adjusted absolute and percent dense areas (all P < 10(-5)). Of 41 recently discovered breast cancer susceptibility variants, associations were found between rs1432679 (EBF1), rs17817449 (MIR1972-2: FTO), rs12710696 (2p24.1), and rs3757318 (ESR1) and adjusted absolute and percent dense areas, respectively. There were associations between rs6001930 (MKL1) and both adjusted absolute dense and nondense areas, and between rs17356907 (NTN4) and adjusted absolute nondense area. Trends in all but two associations were consistent with those for breast cancer risk. Results suggested that 18% of breast cancer susceptibility variants were associated with at least one mammographic density measure. Genetic variants at multiple loci were associated with both breast cancer risk and the mammographic density measures. Further understanding of the underlying mechanisms at these loci could help identify etiologic pathways implicated in how mammographic density predicts breast cancer risk.
Collapse
Affiliation(s)
- Jennifer Stone
- Centre for Genetic Origins of Health and Disease, University of Western Australia, Crawley, Western Australia, Australia
| | - Deborah J Thompson
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Isabel Dos Santos Silva
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher Scott
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rulla M Tamimi
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara Lindstrom
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aditi Hazra
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Louise Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matt Jensen
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Julie Cunningham
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Janet E Olson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Kristen Purrington
- Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Judith Brown
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jean Leyland
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ruth M L Warren
- Department of Radiology, University of Cambridge, Addenbrooke's NHS Foundation Trust, Cambridge, United Kingdom
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival (CNC), University of Cambridge, Cambridge, United Kingdom
| | - Paula Smith
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sebastian M Jud
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Katharina Heusinger
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Matthias W Beckmann
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Julie A Douglas
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kaanan P Shah
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark A Helvie
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | - Christy Woolcott
- Department of Obstetrics and Genecology, IWK Health Centre, Halifax, Canada
| | | | - Christopher Haiman
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. Centre for Research in Epidemiology and Population Health, Gustave Roussy Institute, Villejuif Cedex, France. Paris-South University, Villejuif, France
| | - Kavitha Krishnan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Melissa C Southey
- Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Irene L Andrulis
- Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Julia A Knight
- Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Giske Ursin
- Institute of Basic Medical Sciences, University of Oslo, Norway. Department of Preventive Medicine, University of Southern California, California
| | - Grethe I Grenaker Alnaes
- Department of Genetics, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, Oslo, Norway
| | - Vessela N Kristensen
- Department of Genetics, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, Oslo, Norway
| | - Anne-Lise Borresen-Dale
- Department of Genetics, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, Oslo, Norway
| | - Inger Torhild Gram
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Qin Wang
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jacques Simard
- Centre Hospitalier Universitaire de Québec Research Center and Laval University, Quebec, Canada
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Peter A Fasching
- University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen-Nuremberg, Germany. Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - V Shane Pankratz
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Celine M Vachon
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
42
|
Background parenchymal uptake during molecular breast imaging and associated clinical factors. AJR Am J Roentgenol 2015; 204:W363-70. [PMID: 25714323 DOI: 10.2214/ajr.14.12979] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purposes of this study were to describe the prevalence of background parenchymal uptake categories observed at screening molecular breast imaging (MBI) and to examine the association of background parenchymal uptake with mammographic density and other clinical factors. MATERIALS AND METHODS. Adjunct MBI screening was performed for women with dense breasts on previous mammograms. Two radiologists reviewed images from the MBI examinations and subjectively categorized background parenchymal uptake into four groups: photopenic, minimal-mild, moderate, or marked. Women with breast implants or a personal history of breast cancer were excluded. The association between background parenchymal uptake categories and patient characteristics was examined with Kruskal-Wallis and chi-square tests as appropriate. RESULTS. In 1149 eligible participants, background parenchymal uptake was photopenic in 252 (22%), minimal-mild in 728 (63%), and moderate or marked in 169 (15%). The distribution of categories differed across BI-RADS density categories (p < 0.0001). In 164 participants with extremely dense breasts, background parenchymal uptake was photopenic in 72 (44%), minimal-mild in 55 (34%), and moderate or marked in 37 (22%). The moderate-marked group was younger on average, more likely to be premenopausal or perimenopausal, and more likely to be using postmenopausal hormone therapy than the photopenic or minimal-mild groups (p < 0.0001). CONCLUSION. Among women with similar-appearing mammographic density, background parenchymal uptake ranged from photopenic to marked. Background parenchymal uptake was associated with menopausal status and postmenopausal hormone therapy but not with premenopausal hormonal contraceptives, phase of menstrual cycle, or Gail model 5-year risk of breast cancer. Additional work is necessary to fully characterize the underlying cause of background parenchymal uptake and determine its utility in predicting subsequent risk of breast cancer.
Collapse
|
43
|
Elmore JG, Longton GM, Carney PA, Geller BM, Onega T, Tosteson ANA, Nelson HD, Pepe MS, Allison KH, Schnitt SJ, O'Malley FP, Weaver DL. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA 2015; 313:1122-32. [PMID: 25781441 PMCID: PMC4516388 DOI: 10.1001/jama.2015.1405] [Citation(s) in RCA: 364] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. OBJECTIVES To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. DESIGN, SETTING, AND PARTICIPANTS Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. EXPOSURES Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. MAIN OUTCOMES AND MEASURES The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. RESULTS Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%-77.0%; 5194 of 6900 interpretations). Among invasive carcinoma cases (663 interpretations), 96% (95% CI, 94%-97%) were concordant, and 4% (95% CI, 3%-6%) were underinterpreted; among DCIS cases (2097 interpretations), 84% (95% CI, 82%-86%) were concordant, 3% (95% CI, 2%-4%) were overinterpreted, and 13% (95% CI, 12%-15%) were underinterpreted; among atypia cases (2070 interpretations), 48% (95% CI, 44%-52%) were concordant, 17% (95% CI, 15%-21%) were overinterpreted, and 35% (95% CI, 31%-39%) were underinterpreted; and among benign cases without atypia (2070 interpretations), 87% (95% CI, 85%-89%) were concordant and 13% (95% CI, 11%-15%) were overinterpreted. Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women with higher (n = 122) vs lower (n = 118) breast density on prior mammograms (overall concordance rate, 73% [95% CI, 71%-75%] for higher vs 77% [95% CI, 75%-80%] for lower, P < .001), and among pathologists who interpreted lower weekly case volumes (P < .001) or worked in smaller practices (P = .034) or nonacademic settings (P = .007). CONCLUSIONS AND RELEVANCE In this study of pathologists, in which diagnostic interpretation was based on a single breast biopsy slide, overall agreement between the individual pathologists' interpretations and the expert consensus-derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia. Further research is needed to understand the relationship of these findings with patient management.
Collapse
Affiliation(s)
- Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Gary M Longton
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Patricia A Carney
- Department of Family Medicine, Oregon Health and Science University, Portland
| | - Berta M Geller
- Department of Family Medicine, University of Vermont, Vineyard Haven, Massachusetts
| | - Tracy Onega
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Anna N A Tosteson
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire6Department of Medicine, Geisel School of Medicine at
| | - Heidi D Nelson
- Providence Cancer Center, Providence Health and Services Oregon, Portland8Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland9Department of Clinical Epidemiology and Medicine, Oregon Health and Scien
| | - Margaret S Pepe
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts12Harvard Medical School, Boston, Massachusetts
| | - Frances P O'Malley
- Department of Laboratory Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada14St Michael's Hospital and the University of Toronto, Ontario, Canada
| | - Donald L Weaver
- Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington
| |
Collapse
|
44
|
Yaghjyan L, Colditz GA, Rosner B, Tamimi RM. Mammographic breast density and breast cancer risk: interactions of percent density, absolute dense, and non-dense areas with breast cancer risk factors. Breast Cancer Res Treat 2015; 150:181-9. [PMID: 25677739 DOI: 10.1007/s10549-015-3286-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 12/20/2022]
Abstract
We investigated if associations of breast density and breast cancer differ according to the level of other known breast cancer risk factors, including body mass index (BMI), age at menarche, parity, age at first child's birth, age at menopause, alcohol consumption, a family history of breast cancer, a history of benign breast disease, and physical activity. This study included 1,044 postmenopausal incident breast cancer cases diagnosed within the Nurses' Health Study cohort and 1,794 matched controls. Percent breast density, absolute dense, and non-dense areas were measured from digitized film images with computerized techniques. Information on breast cancer risk factors was obtained prospectively from biennial questionnaires. Percent breast density was more strongly associated with breast cancer risk in current postmenopausal hormone users (≥50 vs. 10 %: OR 5.34, 95 % CI 3.36-8.49) as compared to women with past (OR 2.69, 95 % CI 1.32-5.49) or no hormone history (OR 2.57, 95 % CI 1.18-5.60, p-interaction = 0.03). Non-dense area was inversely associated with breast cancer risk in parous women, but not in women without children (p-interaction = 0.03). Associations of density with breast cancer risk did not differ by the levels of BMI, age at menarche, parity, age at first child's birth, age at menopause, alcohol consumption, a family history of breast cancer, a history of benign breast disease, and physical activity. Women with dense breasts, who currently use menopausal hormone therapy are at a particularly high risk of breast cancer. Most breast cancer risk factors do not modify the association between mammographic breast density and breast cancer risk.
Collapse
Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | | |
Collapse
|
45
|
Jung S, Stanczyk FZ, Egleston BL, Snetselaar LG, Stevens VJ, Shepherd JA, Van Horn L, LeBlanc ES, Paris K, Klifa C, Dorgan JF. Endogenous sex hormones and breast density in young women. Cancer Epidemiol Biomarkers Prev 2014; 24:369-78. [PMID: 25371447 DOI: 10.1158/1055-9965.epi-14-0939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast density is a strong risk factor for breast cancer and reflects epithelial and stromal content. Breast tissue is particularly sensitive to hormonal stimuli before it fully differentiates following the first full-term pregnancy. Few studies have examined associations between sex hormones and breast density among young women. METHODS We conducted a cross-sectional study among 180 women ages 25 to 29 years old who participated in the Dietary Intervention Study in Children 2006 Follow-up Study. Eighty-five percent of participants attended a clinic visit during their luteal phase of menstrual cycle. Magnetic resonance imaging measured the percentage of dense breast volume (%DBV), absolute dense breast volume (ADBV), and absolute nondense breast volume (ANDBV). Multiple-linear mixed-effect regression models were used to evaluate the association of sex hormones and sex hormone-binding globulin (SHBG) with %DBV, ADBV, and ANDBV. RESULTS Testosterone was significantly positively associated with %DBV and ADBV. The multivariable geometric mean of %DBV and ADBV across testosterone quartiles increased from 16.5% to 20.3% and from 68.6 to 82.3 cm(3), respectively (Ptrend ≤ 0.03). There was no association of %DBV or ADBV with estrogens, progesterone, non-SHBG-bound testosterone, or SHBG (Ptrend ≥ 0.27). Neither sex hormones nor SHBG was associated with ANDBV except progesterone; however, the progesterone result was nonsignificant in analysis restricted to women in the luteal phase. CONCLUSIONS These findings suggest a modest positive association between testosterone and breast density in young women. IMPACT Hormonal influences at critical periods may contribute to morphologic differences in the breast associated with breast cancer risk later in life.
Collapse
Affiliation(s)
- Seungyoun Jung
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Frank Z Stanczyk
- University of Southern California Keck School of Medicine, Los Angeles, California
| | | | | | | | - John A Shepherd
- University of California San Francisco, San Francisco, California
| | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Kenneth Paris
- Louisiana State University School of Medicine, New Orleans, Louisiana
| | | | - Joanne F Dorgan
- University of Maryland School of Medicine, Baltimore, Maryland.
| |
Collapse
|
46
|
Figueroa JD, Pfeiffer RM, Patel DA, Linville L, Brinton LA, Gierach GL, Yang XR, Papathomas D, Visscher D, Mies C, Degnim AC, Anderson WF, Hewitt S, Khodr ZG, Clare SE, Storniolo AM, Sherman ME. Terminal duct lobular unit involution of the normal breast: implications for breast cancer etiology. J Natl Cancer Inst 2014; 106:dju286. [PMID: 25274491 DOI: 10.1093/jnci/dju286] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Greater degrees of terminal duct lobular unit (TDLU) involution have been linked to lower breast cancer risk; however, factors that influence this process are poorly characterized. METHODS To study this question, we developed three reproducible measures that are inversely associated with TDLU involution: TDLU counts, median TDLU span, and median acini counts/TDLU. We determined factors associated with TDLU involution using normal breast tissues from 1938 participants (1369 premenopausal and 569 postmenopausal) ages 18 to 75 years in the Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center. Multivariable zero-inflated Poisson models were used to estimate relative risks (RRs) and 95% confidence intervals (95% CIs) for factors associated with TDLU counts, and multivariable ordinal logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for factors associated with categories of median TDLU span and acini counts/TDLU. RESULTS All TDLU measures started declining in the third age decade (all measures, two-sided P trend ≤ .001); and all metrics were statistically significantly lower among postmenopausal women. Nulliparous women demonstrated lower TDLU counts compared with uniparous women (among premenopausal women, RR = 0.79, 95% CI = 0.73 to 0.85; among postmenopausal, RR = 0.67, 95% CI = 0.56 to 0.79); however, rates of age-related TDLU decline were faster among parous women. Other factors were related to specific measures of TDLU involution. CONCLUSION Morphometric analysis of TDLU involution warrants further evaluation to understand the pathogenesis of breast cancer and assessing its role as a progression marker for women with benign biopsies or as an intermediate endpoint in prevention studies.
Collapse
Affiliation(s)
- Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS).
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Deesha A Patel
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Laura Linville
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Daphne Papathomas
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Daniel Visscher
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Carolyn Mies
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Amy C Degnim
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Stephen Hewitt
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Zeina G Khodr
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Susan E Clare
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Anna Maria Storniolo
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics (JDF, RMP, DAP, LL, LAB, GLG, XRY, DP, WFA, ZGK, MES), Laboratory of Pathology (SH), and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Mayo Clinic Cancer Center, Rochester, MN (DV, ACD); Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA (CM); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (SEC); Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN (AMS)
| |
Collapse
|
47
|
Sun X, Sandhu R, Figueroa JD, Gierach GL, Sherman ME, Troester MA. Benign breast tissue composition in breast cancer patients: association with risk factors, clinical variables, and gene expression. Cancer Epidemiol Biomarkers Prev 2014; 23:2810-8. [PMID: 25249325 DOI: 10.1158/1055-9965.epi-14-0507] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Breast tissue composition (epithelium, non-fatty stroma, and adipose) changes qualitatively and quantitatively throughout the lifespan, and may mediate relationships between risk factors and breast cancer initiation. We sought to identify relationships between tissue composition, risk factors, tumor characteristics, and gene expression. METHODS Participants were 146 patients from the Polish Breast Cancer Study, with data on risk factor and clinicopathological characteristics. Benign breast tissue composition was evaluated using digital image analysis of histologic sections. Whole-genome microarrays were performed on the same tissue blocks. RESULTS Mean epithelial, non-fatty stromal, and adipose proportions were 8.4% (SD = 4.9%), 27.7% (SD = 24.0%), and 64.0% (SD = 24.0%), respectively. Among women <50 years old, stroma proportion decreased and adipose proportion increased with age, with approximately 2% difference per year (P < 0.01). The variation in epithelial proportion with age was modest (0.1% per year). Higher epithelial proportion was associated with obesity (7.6% in nonobese vs. 10.1% in obese; P = 0.02) and with poorly differentiated tumors (7.8% in well/moderate vs. 9.9% in poor; P = 0.05). Gene expression signatures associated with epithelial and stromal proportion were identified and validated. Stroma-associated genes were in metabolism and stem cell maintenance pathways, whereas epithelial genes were enriched for cytokine and immune response pathways. CONCLUSIONS Breast tissue composition was associated with age, body mass index, and tumor grade, with consequences for breast gene expression. IMPACT Breast tissue morphologic factors may influence breast cancer etiology. Composition and gene expression may act as biomarkers of breast cancer risk and progression.
Collapse
Affiliation(s)
| | - Rupninder Sandhu
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonine D Figueroa
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, and
| | - Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, and
| | - Mark E Sherman
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, and Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Melissa A Troester
- Department of Epidemiology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| |
Collapse
|
48
|
Dehkordy SF, Carlos RC. Dense breast legislation in the United States: state of the states. J Am Coll Radiol 2014; 10:899-902. [PMID: 24295937 DOI: 10.1016/j.jacr.2013.09.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/13/2013] [Indexed: 11/29/2022]
Abstract
Limitations of screening mammography in patients with dense breasts combined with the significant increased risk for breast cancer have made the issue of dense breasts a matter of great concern in recent years, leading to advocacy for policy change and legislation. Dense breast notification legislation requires direct patient notification of mammographic results indicating the presence of dense breast tissue. The aim of this study was to summarize the state of dense breast notification legislation across the country. The general intent of dense breast notification legislation is to increase awareness of dense breasts and encourage patients to discuss the clinical issues with their physicians. It was first enacted in Connecticut in 2009, and since then, 27 other states have passed, rejected, or considered dense breast notification legislation. At the federal level, a bill was introduced in October 2011, but it was not enacted. There are significant differences in the language of the laws from state to state that complicate implementation. Furthermore, legislated recommendations for possible additional testing are often unaccompanied by legal provisions for insurance coverage, which potentially results in unequal access.
Collapse
|
49
|
Similarity of fibroglandular breast tissue content measured from magnetic resonance and mammographic images and by a mathematical algorithm. Int J Breast Cancer 2014; 2014:961679. [PMID: 25132995 PMCID: PMC4123610 DOI: 10.1155/2014/961679] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 01/16/2023] Open
Abstract
Women with high breast density (BD) have a 4- to 6-fold greater risk for breast cancer than women with low BD. We found that BD can be easily computed from a mathematical algorithm using routine mammographic imaging data or by a curve-fitting algorithm using fat and nonfat suppression magnetic resonance imaging (MRI) data. These BD measures in a strictly defined group of premenopausal women providing both mammographic and breast MRI images were predicted as well by the same set of strong predictor variables as were measures from a published laborious histogram segmentation method and a full field digital mammographic unit in multivariate regression models. We also found that the number of completed pregnancies, C-reactive protein, aspartate aminotransferase, and progesterone were more strongly associated with amounts of glandular tissue than adipose tissue, while fat body mass, alanine aminotransferase, and insulin like growth factor-II appear to be more associated with the amount of breast adipose tissue. Our results show that methods of breast imaging and modalities for estimating the amount of glandular tissue have no effects on the strength of these predictors of BD. Thus, the more convenient mathematical algorithm and the safer MRI protocols may facilitate prospective measurements of BD.
Collapse
|
50
|
Mammographic density is not a worthwhile examination to distinguish high cancer risk women in screening. Eur Radiol 2014; 24:2412-6. [PMID: 24972955 DOI: 10.1007/s00330-014-3278-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/07/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
Numerous studies established high mammographic density (MD) as a significant breast cancer risk. By adopting both radiological and epidemiological perspectives, we analysed the capacity of this radiological parameter to express an individual level of risk and the methods for assessing the relationship between MD categories and risk. MD is unable to identify individual underlying anatomical and physiological components. Many factors affect accurate and reproducible measurements and consequently classifications of MD. Significant relative risks were found by comparing the MD categories in the tails of distribution (i.e. the group of women with the lowest MD to that with the highest MD), which represent <10 % of women in each group: the majority of the population was ignored. When a relevant threshold of MD was applied to compare another group and the entire population was included to compare the two groups, some studies showed no significant or only moderate relative risk (RR) between women with readings above and those below the threshold. Sensitivity and specificity remain unknown. MD cannot be considered a worthwhile test by which to categorically identify high-risk women in screening. Key points • Unknown individual anatomical and physiological components do not express the risk level.• The epidemiological conditions are not relevant to distinguish a high-risk category.• The most relevant studies show no or moderate risks.
Collapse
|