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Han Y, Moore JX, Colditz GA, Toriola AT. Family History of Breast Cancer and Mammographic Breast Density in Premenopausal Women. JAMA Netw Open 2022; 5:e2148983. [PMID: 35175341 PMCID: PMC8855232 DOI: 10.1001/jamanetworkopen.2021.48983] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/28/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Family history of breast cancer (FHBC) and mammographic breast density are independent risk factors for breast cancer, but the association of FHBC and mammographic breast density in premenopausal women is not well understood. Objectives To investigate the association of FHBC and mammographic breast density in premenopausal women using both quantitative and qualitative measurements. Design, Setting, and Participants This single-center cohort study examined 2 retrospective cohorts: a discovery set of 375 premenopausal women and a validation set of 14 040 premenopausal women. Data from women in the discovery set was collected between December 2015 and October 2016, whereas data from women in the validation set was collected between June 2010 and December 2015. Data analysis was performed between June 2018 and June 2020. Exposures Family history of breast cancer (FHBC). Main Outcomes and Measures The primary outcomes were mammographic breast density measured quantitatively as volumetric percent density using Volpara (discovery set) and qualitatively using BI-RADS (Breast Imaging Reporting and Data System) breast density (validation set). Multivariable regressions were performed using a log-transformed normal distribution for the discovery set and a logistic distribution for the validation set. Results Of 14 415 premenopausal women included in the study, the discovery set and validation set had similar characteristics (discovery set with FHBC: mean [SD] age, 47.1 [5.6] years; 15 [17.2%] were Black or African American women and 64 [73.6%] were non-Hispanic White women; discovery set with no FHBC: mean [SD] age, 47.7 [4.5] years; 87 [31.6%] were Black or African American women and 178 [64.7%] were non-Hispanic White women; validation set with FHBC: mean [SD] age, 46.8 [7.3] years; 720 [33.4%] were Black or African American women and 1378 [64.0%] were non-Hispanic White women]; validation set with no FHBC: mean [SD] age, 47.5 [6.1] years; 4572 [38.5%] were Black or African American women and 6632 [55.8%] were non-Hispanic White women]). In the discovery set, participants who had FHBC were more likely to have a higher mean volumetric percent density compared with participants with no FHBC (11.1% vs 9.0%). In the multivariable-adjusted model, volumetric percent density was 25% higher (odds ratio [OR], 1.25 ;95% CI, 1.12-1.41) in women with FHBC compared with women without FHBC; and 24% higher (OR, 1.24; 95% CI, 1.10-1.40) in women who had 1 affected relative, but not significantly higher in women who had at least 2 affected relatives (OR, 1.40; 95% CI, 0.95-2.07) compared with women with no relatives affected. In the validation set, women with a positive FHBC were more likely to have dense breasts (BI-RADS 3-4) compared with women with no FHBC (BI-RADS 3: 41.1% vs 38.8%; BI-RADS 4: 10.5% vs 7.7%). In the multivariable-adjusted model, the odds of having dense breasts (BI-RADS 3-4) were 30% higher (OR, 1.30; 95% CI, 1.17-1.45) in women with FHBC compared with women without FHBC; and 29% higher (OR, 1.29; 95% CI, 1.14-1.45) in women who had 1 affected relative, but not significantly higher in women who had at least 2 affected relatives (OR, 1.38; 95% CI, 0.85-2.23) compared with women with no relatives affected. Conclusions and Relevance In this cohort study, having an FHBC was positively associated with mammographic breast density in premenopausal women. Our findings highlight the heritable component of mammographic breast density and underscore the need to begin annual screening early in premenopausal women with a family history of breast cancer.
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Affiliation(s)
- Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Justin Xavier Moore
- Cancer Prevention, Control, and Population Health Program, Department of Medicine, Augusta University, Augusta, Georgia
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
| | - Adetunji T. Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
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Reye G, Huang X, Haupt LM, Murphy RJ, Northey JJ, Thompson EW, Momot KI, Hugo HJ. Mechanical Pressure Driving Proteoglycan Expression in Mammographic Density: a Self-perpetuating Cycle? J Mammary Gland Biol Neoplasia 2021; 26:277-296. [PMID: 34449016 PMCID: PMC8566410 DOI: 10.1007/s10911-021-09494-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
Regions of high mammographic density (MD) in the breast are characterised by a proteoglycan (PG)-rich fibrous stroma, where PGs mediate aligned collagen fibrils to control tissue stiffness and hence the response to mechanical forces. Literature is accumulating to support the notion that mechanical stiffness may drive PG synthesis in the breast contributing to MD. We review emerging patterns in MD and other biological settings, of a positive feedback cycle of force promoting PG synthesis, such as in articular cartilage, due to increased pressure on weight bearing joints. Furthermore, we present evidence to suggest a pro-tumorigenic effect of increased mechanical force on epithelial cells in contexts where PG-mediated, aligned collagen fibrous tissue abounds, with implications for breast cancer development attributable to high MD. Finally, we summarise means through which this positive feedback mechanism of PG synthesis may be intercepted to reduce mechanical force within tissues and thus reduce disease burden.
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Affiliation(s)
- Gina Reye
- School of Biomedical Sciences, Gardens Point, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
- Translational Research Institute, Woolloongabba, QLD, Australia
| | - Xuan Huang
- School of Biomedical Sciences, Gardens Point, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
- Translational Research Institute, Woolloongabba, QLD, Australia
| | - Larisa M Haupt
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Ryan J Murphy
- School of Mathematical Sciences, Gardens Point, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Jason J Northey
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Erik W Thompson
- School of Biomedical Sciences, Gardens Point, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
- Translational Research Institute, Woolloongabba, QLD, Australia
| | - Konstantin I Momot
- School of Chemistry and Physics, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Honor J Hugo
- School of Biomedical Sciences, Gardens Point, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia.
- Translational Research Institute, Woolloongabba, QLD, Australia.
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His M, Lajous M, Gómez-Flores-Ramos L, Monge A, Dossus L, Viallon V, Gicquiau A, Biessy C, Gunter MJ, Rinaldi S. Biomarkers of mammographic density in premenopausal women. Breast Cancer Res 2021; 23:75. [PMID: 34301304 PMCID: PMC8305592 DOI: 10.1186/s13058-021-01454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND While mammographic density is one of the strongest risk factors for breast cancer, little is known about its determinants, especially in young women. We applied targeted metabolomics to identify circulating metabolites specifically associated with mammographic density in premenopausal women. Then, we aimed to identify potential correlates of these biomarkers to guide future research on potential modifiable determinants of mammographic density. METHODS A total of 132 metabolites (acylcarnitines, amino acids, biogenic amines, glycerophospholipids, sphingolipids, hexose) were measured by tandem liquid chromatography/mass spectrometry in plasma samples from 573 premenopausal participants in the Mexican Teachers' Cohort. Associations between metabolites and percent mammographic density were assessed using linear regression models, adjusting for breast cancer risk factors and accounting for multiple tests. Mean concentrations of metabolites associated with percent mammographic density were estimated across levels of several lifestyle and metabolic factors. RESULTS Sphingomyelin (SM) C16:1 and phosphatidylcholine (PC) ae C30:2 were inversely associated with percent mammographic density after correction for multiple tests. Linear trends with percent mammographic density were observed for SM C16:1 only in women with body mass index (BMI) below the median (27.4) and for PC ae C30:2 in women with a BMI over the median. SM C16:1 and PC ae C30:2 concentrations were positively associated with cholesterol (total and HDL) and inversely associated with number of metabolic syndrome components. CONCLUSIONS We identified new biomarkers associated with mammographic density in young women. The association of these biomarkers with mammographic density and metabolic parameters may provide new perspectives to support future preventive actions for breast cancer.
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Affiliation(s)
- Mathilde His
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, 62100, Cuernavaca, México.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Liliana Gómez-Flores-Ramos
- Center for Research on Population Health, National Institute of Public Health, 62100, Cuernavaca, México
- Cátedras-CONACYT, Mexico City, Mexico
| | - Adriana Monge
- Center for Research on Population Health, National Institute of Public Health, 62100, Cuernavaca, México
| | - Laure Dossus
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Vivian Viallon
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Audrey Gicquiau
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Carine Biessy
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Marc J Gunter
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, CEDEX 08, 69372, Lyon, France
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Shang MY, Guo S, Cui MK, Zheng YF, Liao ZX, Zhang Q, Piao HZ. Influential factors and prediction model of mammographic density among Chinese women. Medicine (Baltimore) 2021; 100:e26586. [PMID: 34260538 PMCID: PMC8284716 DOI: 10.1097/md.0000000000026586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
To evaluate the characteristics and influential factors of breast density and establish a new model for predicting breast density in Chinese women, so as to provide a basis for breast cancer screening techniques and duration.A total of 9412 women who were selected from screening and intervention techniques for Breast and Cervical Cancer Project between April 2018 and June 2019 were enrolled in this study. Selected women were randomly assigned to training and validation sets in a ratio of 1:1. Univariable and multivariable analyzes were performed by Logistic regression model. Nomogram was generated according to the results of multivariate analysis. Calibration, area under curve (AUC) and akaike information criterion (AIC) were used for measuring accuracy of prediction model.There were 377 (4.0%) women in breast imaging reporting and data system (BI-RADS) A category, 2164 (23.0%) in B category, 5749 (61.1%) in C category and 1122 (11.9%) in D category. Age duration, educational attainment, history of benign diseases, breastfeeding history, menopausal status, and body mass index (BMI) were imputed as independent influential factors for breast density in multivariable analysis. The AUC and AIC of training and validation set were 0.7158, 0.7139, and 4915.378, 4998.665, respectively.This study indicated that age, educational attainment, history of benign breast disease, breastfeeding history, menopausal status and BMI were independent influential factors of breast density. Nomogram generated on the basis of these factors could relatively predict breast density, which in turn could be used for recommendations of breast cancer screening techniques.
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Affiliation(s)
- Mu Yan Shang
- Department of Breast Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Shuai Guo
- Department of Gastric Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Ming Ke Cui
- Department of Breast Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Yan Fu Zheng
- Department of Breast Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Zhi Xuan Liao
- Department of Breast Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Qiang Zhang
- Department of Breast Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Hao Zhe Piao
- Department of Neurosurgery, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
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5
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Garzia NA, Cushing-Haugen K, Kensler TW, Tamimi RM, Harris HR. Adolescent and early adulthood inflammation-associated dietary patterns in relation to premenopausal mammographic density. Breast Cancer Res 2021; 23:71. [PMID: 34233736 PMCID: PMC8261986 DOI: 10.1186/s13058-021-01449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Adolescence and early adulthood has been identified as a critical time window for establishing breast cancer risk. Mammographic density is an independent risk factor for breast cancer that may be influenced by diet, but there has been limited research conducted on the impact of diet on mammographic density. Thus, we sought to examine the association between adolescent and early adulthood inflammatory dietary patterns, which have previously been associated with breast cancer risk, and premenopausal mammographic density among women in the Nurses' Health Study II (NHSII). METHODS This study included control participants with premenopausal mammograms from an existing breast cancer case-control study nested within the NHSII who completed a Food Frequency Questionnaire in 1998 about their diet during high school (HS-FFQ) (n = 685) and/or a Food Frequency Questionnaire in 1991 (Adult-FFQ) when they were 27-44 years old (n = 1068). Digitized analog film mammograms were used to calculate the percent density, absolute dense, and non-dense areas. Generalized linear models were fit to evaluate the associations of a pro-inflammatory dietary pattern and the Alternative Healthy Eating Index (AHEI, an anti-inflammatory dietary pattern) with each breast density measure. RESULTS Significant associations were observed between an adolescent pro-inflammatory dietary pattern and mammographic density in some age-adjusted models; however, these associations did not remain after adjustment for BMI and other breast cancer risk factors. No associations were observed with the pro-inflammatory pattern or with the AHEI pattern in adolescence or early adulthood in fully adjusted models. CONCLUSIONS To our knowledge, this is the first study to evaluate the dietary patterns during adolescence and early adulthood in relation to mammographic density phenotypes. Our findings do not support an association between adolescent and early adulthood diet and breast density in mid-adulthood that is independent of BMI or other breast cancer risk factors.
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Affiliation(s)
- Nichole A Garzia
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, Seattle, WA, 98109-1024, USA.
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195-002, USA.
| | - Kara Cushing-Haugen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, Seattle, WA, 98109-1024, USA
| | - Thomas W Kensler
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, Seattle, WA, 98109-1024, USA
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115-6028, USA
- Department of Population Health Sciences, Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065-4805, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, Seattle, WA, 98109-1024, USA
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195-002, USA
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Wieler J, Berger N, Frauenfelder T, Marcon M, Boss A. Breast density in dedicated breast computed tomography: Proposal of a classification system and interreader reliability. Medicine (Baltimore) 2021; 100:e25844. [PMID: 33950998 PMCID: PMC8104213 DOI: 10.1097/md.0000000000025844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/17/2021] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to develop a new breast density classification system for dedicated breast computed tomography (BCT) based on lesion detectability analogous to the ACR BI-RADS breast density scale for mammography, and to evaluate its interrater reliability.In this retrospective study, 1454 BCT examinations without contrast media were screened for suitability. Excluding datasets without additional ultrasound and exams without any detected lesions resulted in 114 BCT examinations. Based on lesion detectability, an atlas-based BCT density (BCTD) classification system of breast parenchyma was defined using 4 categories. Interrater reliability was examined in 40 BCT datasets between 3 experienced radiologists.Among the included lesions were 63 cysts (55%), 18 fibroadenomas (16%), 7 lesions of fatty necrosis (6%), and 6 breast cancers (5%) with a median diameter of 11 mm. X-ray absorption was identical between lesions and breast tissue; therefore, the lack of fatty septae was identified as the most important criteria for the presence of lesions in glandular tissue. Applying a lesion diameter of 10 mm as desired cut-off for the recommendation of an additional ultrasound, an atlas of 4 BCTD categories was defined resulting in a distribution of 17.5% for density A, 39.5% (B), 31.6% (C), and 11.4% (D) with an intraclass correlation coefficient (ICC) among 3 readers of 0.85 to 0.87.We propose a dedicated atlas-based BCTD classification system, which is calibrated to lesion detectability. The new classification system exhibits a high interrater reliability and may be used for the decision whether additional ultrasound is recommended.
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Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
| | - Janie M. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
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Lope V, Del Pozo MDP, Criado-Navarro I, Pérez-Gómez B, Pastor-Barriuso R, Ruiz E, Castelló A, Lucas P, Sierra Á, Salas-Trejo D, Llobet R, Martínez I, Romieu I, Chajès V, Priego-Capote F, Pollán M. Serum Phospholipid Fatty Acids and Mammographic Density in Premenopausal Women. J Nutr 2020; 150:2419-2428. [PMID: 32584993 DOI: 10.1093/jn/nxaa168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of fatty acids (FAs) on mammographic density (MD) is unclear, and available studies are based on self-reported dietary intake. OBJECTIVES This study assessed the association between specific serum phospholipid fatty acids (PLFAs) and MD in premenopausal women. METHODS The cross-sectional study DDM-Madrid recruited 1392 Spanish premenopausal women, aged 39-50 y, who attended a screening in a breast radiodiagnosis unit of Madrid City Council. Women completed lifestyle questionnaires and FFQs. Percentage MD was estimated using a validated computer tool (DM-Scan), and serum PLFA percentages were measured by GC-MS. Multivariable linear regression models were used to quantify the association of FA tertiles with MD. Models were adjusted for age, education, BMI, waist circumference, parity, oral contraceptive use, previous breast biopsies, and energy intake, and they were corrected for multiple testing. RESULTS Women in the third tertile of SFAs showed significantly higher MD compared with those in the first tertile (βT3vsT1 = 7.53; 95% CI: 5.44, 9.61). Elevated relative concentrations of palmitoleic (βT3vsT1 = 3.12; 95% CI: 0.99, 5.25) and gondoic (βT3vsT1 = 2.67; 95% CI: 0.57, 4.77) MUFAs, as well as high relative concentrations of palmitelaidic (βT3vsT1 = 5.22; 95% CI: 3.15, 7.29) and elaidic (βT3vsT1 = 2.69; 95% CI: 0.59, 4.79) trans FAs, were also associated with higher MD. On the contrary, women with elevated relative concentrations of n-6 (ω-6) linoleic (βT3vsT1 = -5.49; 95% CI; -7.62, -3.35) and arachidonic (βT3vsT1 = -4.68; 95% CI: -6.79, -2.58) PUFAs showed lower MD. Regarding desaturation indices, an elevated palmitoleic to palmitic ratio and a low ratio of oleic to steric and arachidonic to dihomo-γ-linolenic acids were associated with higher MD. CONCLUSIONS Spanish premenopausal women with high relative concentrations of most SFAs and some MUFAs and trans FAs showed an increased MD, whereas those with high relative concentrations of some n-6 PUFAs presented lower density. These results, which should be confirmed in further studies, underscore the importance of analyzing serum FAs individually.
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Affiliation(s)
- Virginia Lope
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
| | - María Del Pilar Del Pozo
- Department of Preventive Medicine, Public Health, and Microbiology, Autonomous University of Madrid, Madrid, Spain
| | - Inmaculada Criado-Navarro
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Cordoba, Cordoba, Spain
- Maimónides Institute of Biomedical Research, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Beatriz Pérez-Gómez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
| | - Roberto Pastor-Barriuso
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
| | - Emma Ruiz
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
| | - Adela Castelló
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
- Faculty of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Pilar Lucas
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
| | - Ángeles Sierra
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
| | - Dolores Salas-Trejo
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
- Valencian Breast Cancer Screening Program, General Directorate of Public Health, Valencia, Spain
- Center for Public Health Research CSISP, FISABIO, Valencia, Spain
| | - Rafael Llobet
- Institute of Computer Technology, Polytechnic University of Valencia, Valencia, Spain
| | - Inmaculada Martínez
- Valencian Breast Cancer Screening Program, General Directorate of Public Health, Valencia, Spain
- Center for Public Health Research CSISP, FISABIO, Valencia, Spain
| | - Isabelle Romieu
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
- Huber Department of Global Health, Emory University, Atlanta, GA, USA
| | - Véronique Chajès
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | - Feliciano Priego-Capote
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Cordoba, Cordoba, Spain
- Maimónides Institute of Biomedical Research, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
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Lowry KP, Coley RY, Miglioretti DL, Kerlikowske K, Henderson LM, Onega T, Sprague BL, Lee JM, Herschorn S, Tosteson ANA, Rauscher G, Lee CI. Screening Performance of Digital Breast Tomosynthesis vs Digital Mammography in Community Practice by Patient Age, Screening Round, and Breast Density. JAMA Netw Open 2020; 3:e2011792. [PMID: 32721031 PMCID: PMC7388021 DOI: 10.1001/jamanetworkopen.2020.11792] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Importance Digital mammography (DM) and digital breast tomosynthesis (DBT) are used for routine breast cancer screening. There is minimal evidence on performance outcomes by age, screening round, and breast density in community practice. Objective To compare DM vs DBT performance by age, baseline vs subsequent screening round, and breast density category. Design, Setting, and Participants This comparative effectiveness study assessed 1 584 079 screening examinations of women aged 40 to 79 years without prior history of breast cancer, mastectomy, or breast augmentation undergoing screening mammography at 46 participating Breast Cancer Surveillance Consortium facilities from January 2010 to April 2018. Exposures Age, Breast Imaging Reporting and Data System breast density category, screening round, and modality. Main Outcomes and Measures Absolute rates and relative risks (RRs) of screening recall and cancer detection. Results Of 1 273 492 DM and 310 587 DBT examinations analyzed, 1 028 891 examinations (65.0%) were of white non-Hispanic women; 399 952 women (25.2%) were younger than 50 years; and 671 136 women (42.4%) had heterogeneously dense or extremely dense breasts. Adjusted differences in DM vs DBT performance were largest on baseline examinations: for example, per 1000 baseline examinations in women ages 50 to 59, recall rates decreased from 241 examinations for DM to 204 examinations for DBT (RR, 0.84; 95% CI, 0.73-0.98), and cancer detection rates increased from 5.9 with DM to 8.8 with DBT (RR, 1.50; 95% CI, 1.10-2.08). On subsequent examinations, women aged 40 to 79 years with heterogeneously dense breasts had improved recall rates and improved cancer detection with DBT. For example, per 1000 examinations in women aged 50 to 59 years, the number of recall examinations decreased from 102 with DM to 93 with DBT (RR, 0.91; 95% CI, 0.84-0.98), and cancer detection increased from 3.7 with DM to 5.3 with DBT (RR, 1.42; 95% CI, 1.23-1.64). Women aged 50 to 79 years with scattered fibroglandular density also had improved recall and cancer detection rates with DBT. Women aged 40 to 49 years with scattered fibroglandular density and women aged 50 to 79 years with almost entirely fatty breasts benefited from improved recall rates without change in cancer detection rates. No improvements in recall or cancer detection rates were observed in women with extremely dense breasts on subsequent examinations for any age group. Conclusions and Relevance This study found that improvements in recall and cancer detection rates with DBT were greatest on baseline mammograms. On subsequent screening mammograms, the benefits of DBT varied by age and breast density. Women with extremely dense breasts did not benefit from improved recall or cancer detection with DBT on subsequent screening rounds.
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Affiliation(s)
- Kathryn P. Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | | | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Brian L. Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
- Department of Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
| | - Janie M. Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | - Sally Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hamsphire
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago
| | - Christoph I. Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
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Dabrosin N, Dabrosin C. Postmenopausal Dense Breasts Maintain Premenopausal Levels of GH and Insulin-like Growth Factor Binding Proteins in Vivo. J Clin Endocrinol Metab 2020; 105:5695904. [PMID: 31900484 DOI: 10.1210/clinem/dgz323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/01/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Dense breast tissue is associated with 4 to 6 times higher risk of breast cancer by poorly understood mechanisms. No preventive therapy for this high-risk group is available. After menopause, breast density decreases due to involution of the mammary gland. In dense breast tissue, this process is haltered by undetermined biological actions. Growth hormone (GH) and insulin-like binding proteins (IGFBPs) play major roles in normal mammary gland development, but their roles in maintaining breast density are unknown. OBJECTIVE To reveal in vivo levels of GH, IGFBPs, and other pro-tumorigenic proteins in the extracellular microenvironment in breast cancer, in normal breast tissue with various breast density in postmenopausal women, and premenopausal breasts. We also sought to determine possible correlations between these determinants. SETTING AND DESIGN Microdialysis was used to collect extracellular in vivo proteins intratumorally from breast cancers before surgery and from normal human breast tissue from premenopausal women and postmenopausal women with mammographic dense or nondense breasts. RESULTS Estrogen receptor positive breast cancers exhibited increased extracellular GH (P < .01). Dense breasts of postmenopausal women exhibited similar levels of GH as premenopausal breasts and significantly higher levels than in nondense breasts (P < .001). Similar results were found for IGFBP-1, -2, -3, and -7 (P < .01) and for IGFBP-6 (P <.05). Strong positive correlations were revealed between GH and IGFBPs and pro-tumorigenic matrix metalloproteinases, urokinase-type plasminogen activator, Interleukin 6, Interleukin 8, and vascular endothelial growth factor in normal breast tissue. CONCLUSIONS GH pathways may be targetable for cancer prevention therapeutics in postmenopausal women with dense breast tissue.
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Affiliation(s)
- Nina Dabrosin
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotta Dabrosin
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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López A, Garmendia ML, Shepherd J, Michels K, Corvalán C, Pereira A. Effect of excessive gestational weight on daughters' breast density at the end of puberty onset. Sci Rep 2020; 10:6636. [PMID: 32313106 PMCID: PMC7171116 DOI: 10.1038/s41598-020-63260-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/21/2020] [Indexed: 11/19/2022] Open
Abstract
The effect of excessive gestational weight gain (EGWG) is related to adverse health outcomes in the offspring; however, its effect on the daughters' breast density is unclear. We aimed to assess the association between EGWG and daughters' breast composition (% of fibroglandular volume (%FGV) and absolute fibroglandular volume (AFGV)) at Tanner stage 4 (Tanner B4)). We included 341 girls and their mothers from an ongoing cohort of low-income Chilean girls born from 2002-2003. Maternal gestational weight gain was self-reported in 2007, and breast density by digital mammography was measured in 2010. Weight, height and breast composition by dual X-ray absorptiometry (DXA) were measured in daughters at Tanner B4. Logistic regression models were run to assess the association between EGWG and the 80th percentile of %FGV and AFGV. Mean gestational weight gain was 13.7 kg (SD = 6.9 kg). Women with pregestational overweight or obesity exceeded the recommended gestational weight gain (58.8% vs. 31.8%, respectively). Daughters of women who had EGWG had higher levels of AFGV (OR: 2.02; 95%CI 1.16-3.53) at Tanner B4, which could be explained by metabolic and hormonal exposure in utero. However, we did not observe an association with %FGV.
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Affiliation(s)
- Ana López
- Master in Nutrition Program, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | | | - John Shepherd
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Karin Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile.
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12
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Oh H, Rice MS, Warner ET, Bertrand KA, Fowler EE, Eliassen AH, Rosner BA, Heine JJ, Tamimi RM. Early-Life and Adult Anthropometrics in Relation to Mammographic Image Intensity Variation in the Nurses' Health Studies. Cancer Epidemiol Biomarkers Prev 2020; 29:343-351. [PMID: 31826913 PMCID: PMC7007347 DOI: 10.1158/1055-9965.epi-19-0832] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/29/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The V measure captures grayscale intensity variation on a mammogram and is positively associated with breast cancer risk, independent of percent mammographic density (PMD), an established marker of breast cancer risk. We examined whether anthropometrics are associated with V, independent of PMD. METHODS The analysis included 1,700 premenopausal and 1,947 postmenopausal women without breast cancer within the Nurses' Health Study (NHS) and NHSII. Participants recalled their body fatness at ages 5, 10, and 20 years using a 9-level pictogram (level 1: most lean) and reported weight at age 18 years, current adult weight, and adult height. V was estimated by calculating standard deviation of pixels on screening mammograms. Linear mixed models were used to estimate beta coefficients (ß) and 95% confidence intervals (CI) for the relationships between anthropometric measures and V, adjusting for confounders and PMD. RESULTS V and PMD were positively correlated (Spearman r = 0.60). Higher average body fatness at ages 5 to 10 years (level ≥ 4.5 vs. 1) was significantly associated with lower V in premenopausal (ß = -0.32; 95% CI, -0.48 to -0.16) and postmenopausal (ß = -0.24; 95% CI, -0.37 to -0.10) women, independent of current body mass index (BMI) and PMD. Similar inverse associations were observed with average body fatness at ages 10 to 20 years and BMI at age 18 years. Current BMI was inversely associated with V, but the associations were largely attenuated after adjustment for PMD. Height was not associated with V. CONCLUSIONS Our data suggest that early-life body fatness may reflect lifelong impact on breast tissue architecture beyond breast density. However, further studies are needed to confirm the results. IMPACT This study highlights strong inverse associations of early-life adiposity with mammographic image intensity variation.
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Affiliation(s)
- Hannah Oh
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea.
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Megan S Rice
- Biostatistics, Sanofi Genzyme, Cambridge, Massachusetts
| | - Erica T Warner
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Erin E Fowler
- Division of Population Sciences, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bernard A Rosner
- Channing Division of Network 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
| | - John J Heine
- Division of Population Sciences, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Ruby L, Sanabria SJ, Obrist AS, Martini K, Forte S, Goksel O, Frauenfelder T, Kubik-Huch RA, Rominger MB. Breast Density Assessment in Young Women with Ultrasound based on Speed of Sound: Influence of the Menstrual Cycle. Medicine (Baltimore) 2019; 98:e16123. [PMID: 31232962 PMCID: PMC6636937 DOI: 10.1097/md.0000000000016123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To investigate changes in breast density (BD) during the menstrual cycle in young women in comparison to inter-breast and -segment changes as well as reproducibility of a novel Speed-of-Sound (SoS) Ultrasound (US) method.SoS-US uses a conventional US system with a reflector and a software add-on to quantify SoS in the retro-mammillary, inner and outer segments of both breasts. Twenty healthy women (18-40 years) with regular menstrual cycles were scanned twice with two weeks in-between. Three of these were additionally measured twice per week for 25 days. Average SoS (m/s) and ΔSoS (segment-variation SoS; m/s) were measured. Variations between follicular and luteal phases and changes over the four-week period were assessed. Inter-examiner and inter-reader agreements were also evaluated. Variances between cycle phases, examiners and readers were compared.No significant SoS difference was observed between follicular and luteal phases for the twenty women (P = .126), and between all different days for the three more frequently measured women (P = .892). Inter-reader (ICC = 0.999) and inter-examiner (ICC = 0.990) agreements were high. The SoS variance due to menstrual variations was not significantly larger than the inter-examiner uncertainty (P = .461). Inter-reader variations were significantly smaller than menstrual and examiner variations (P < .001).SoS-US showed high inter-examiner and inter-reader reproducibility. The alterations during the menstrual cycles were not significantly larger than the confidence interval of measurements.
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Affiliation(s)
- Lisa Ruby
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100
| | - Sergio J. Sanabria
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100
- Computer-assisted Applications in Medicine, ETH Zurich, Sternwartstrasse 7, Zürich
| | - Anika S. Obrist
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100
| | - Katharina Martini
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100
| | - Serafino Forte
- Department of Radiology, Kantonsspital Baden, Im Ergel 1, Baden, Switzerland
| | - Orcun Goksel
- Computer-assisted Applications in Medicine, ETH Zurich, Sternwartstrasse 7, Zürich
| | - Thomas Frauenfelder
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100
| | - Rahel A. Kubik-Huch
- Department of Radiology, Kantonsspital Baden, Im Ergel 1, Baden, Switzerland
| | - Marga B. Rominger
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100
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Gastounioti A, McCarthy AM, Pantalone L, Synnestvedt M, Kontos D, Conant EF. Effect of Mammographic Screening Modality on Breast Density Assessment: Digital Mammography versus Digital Breast Tomosynthesis. Radiology 2019; 291:320-327. [PMID: 30888933 PMCID: PMC6493215 DOI: 10.1148/radiol.2019181740] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 01/14/2023]
Abstract
Background Breast Imaging Reporting and Data System (BI-RADS) breast density categories assigned by interpreting radiologists often influence decisions surrounding supplemental breast cancer screening and risk assessment. The landscape of mammographic screening continuously evolves, and different mammographic screening modalities may result in different perception of density, reflected in different assignment of BI-RADS density categories. Purpose To investigate the effect of screening mammography modality on BI-RADS breast density assessments. Materials and Methods Data were retrospectively analyzed from 24 736 individual women (42.3% [10 455 of 24 736] white women, 57.7% [14 281 of 24 736] black women; mean age, 56.3 years; age range, 40.0-74.9 years) who underwent from one to seven mammographic screening examinations from September 2010 through February 2017 (60 766 examinations). Three screening modalities were used: digital mammography alone (8935 examinations); digital mammography with digital breast tomosynthesis (DBT; 30 779 examinations); and synthetic mammography with DBT (21 052 examinations). Random-effects logistic regression analysis was performed to estimate the likelihood of assignment to high versus low BI-RADS density category according to each modality, adjusted for ethnicity, age, body mass index (BMI), and radiologist. The interactions of modality with ethnicity and BMI on density categorization were also tested with the model. Results Women screened with DBT versus digital mammography alone had lower likelihood regarding categorization of high density breasts (digital mammography and DBT vs digital mammography: odds ratio, 0.69 [95% confidence interval: 0.61, 0.80], P < .001; synthetic mammography and DBT vs digital mammography: odds ratio, 0.43 [95% confidence interval: 0.37, 0.50], P < .001). Lower likelihood of high density was also observed at synthetic mammography and DBT compared with digital mammography and DBT (odds ratio, 0.62; 95% confidence interval: 0.56, 0.69; P < .001). There were interactions of modality with ethnicity (P = .007) and BMI (P = .003) on breast density assessment, with greater differences in density categorization according to modality observed for black women than for white women and groups with higher BMI. Conclusion Breast density categorization may vary by screening mammographic modality, and this effect appears to vary by ethnicity and body mass index. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Philpotts in this issue.
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Affiliation(s)
- Aimilia Gastounioti
- From the Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, 3710 Hamilton Walk, Room G601E Goddard Building,
Philadelphia, PA 19104 (A.G., L.P., M.S., D.K., E.F.C.); and Department of
Medicine, Massachusetts General Hospital, Boston, Mass (A.M.M.)
| | - Anne Marie McCarthy
- From the Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, 3710 Hamilton Walk, Room G601E Goddard Building,
Philadelphia, PA 19104 (A.G., L.P., M.S., D.K., E.F.C.); and Department of
Medicine, Massachusetts General Hospital, Boston, Mass (A.M.M.)
| | - Lauren Pantalone
- From the Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, 3710 Hamilton Walk, Room G601E Goddard Building,
Philadelphia, PA 19104 (A.G., L.P., M.S., D.K., E.F.C.); and Department of
Medicine, Massachusetts General Hospital, Boston, Mass (A.M.M.)
| | - Marie Synnestvedt
- From the Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, 3710 Hamilton Walk, Room G601E Goddard Building,
Philadelphia, PA 19104 (A.G., L.P., M.S., D.K., E.F.C.); and Department of
Medicine, Massachusetts General Hospital, Boston, Mass (A.M.M.)
| | - Despina Kontos
- From the Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, 3710 Hamilton Walk, Room G601E Goddard Building,
Philadelphia, PA 19104 (A.G., L.P., M.S., D.K., E.F.C.); and Department of
Medicine, Massachusetts General Hospital, Boston, Mass (A.M.M.)
| | - Emily F. Conant
- From the Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, 3710 Hamilton Walk, Room G601E Goddard Building,
Philadelphia, PA 19104 (A.G., L.P., M.S., D.K., E.F.C.); and Department of
Medicine, Massachusetts General Hospital, Boston, Mass (A.M.M.)
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15
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Alsheik NH, Dabbous F, Pohlman SK, Troeger KM, Gliklich RE, Donadio GM, Su Z, Menon V, Conant EF. Comparison of Resource Utilization and Clinical Outcomes Following Screening with Digital Breast Tomosynthesis Versus Digital Mammography: Findings From a Learning Health System. Acad Radiol 2019; 26:597-605. [PMID: 30057195 DOI: 10.1016/j.acra.2018.05.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVES To compare outcomes associated with breast cancer screening with digital mammography (DM) alone versus in combination with digital breast tomosynthesis (DBT) in a large representative cohort. MATERIALS AND METHODS A total of 325,729 screening mammograms from 247,431 women were analyzed, across two healthcare systems, from June 2015 to September 2017. Patient level demographic, calculated risk levels, and clinical outcomes were extracted from radiology information system and electronic medical records. Multivariable regression modeling adjusting for institution, age, breast density, and first exam was conducted to compare patient characteristics, recall rates, time to biopsy and final diagnosis, clinical outcomes, and diagnostic performance. Participating institutions and the Coordinating Center received Institutional Review Board approval for a waiver of consent to collect and link data and perform analysis. RESULTS A total of 194,437 (59.7%) screens were DBT versus 131,292 (40.3%) with DM. Women with dense breasts and higher calculated risk were more likely to be screened with DBT. Recall rates were lower for DBT overall (8.83% DBT vs 10.98% DM, adjusted odds ratio, 95% confidence interval = 0.85, 0.83-0.87) and across all age groups, races, and breast densities, and at facilities that used predominantly DBT (8.05%) versus predominantly DM (11.22%), or a combination (10.73%). The most common diagnostic pathway after recall was mammography and ultrasound. Women recalled from DBT were more likely to proceed directly to ultrasound. The median time to biopsy (18 vs 22 days) and final diagnosis (10 vs 13 days) was shorter for DBT. The adjusted cancer rate, cancer detection rate, and specificity were higher for DBT. CONCLUSION DBT demonstrated a more efficient screening pathway and improved quality measures with lower recall rates in all patient types, reduced diagnostic mammography and shorter time to biopsy and final diagnosis.
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Affiliation(s)
- Nila H Alsheik
- Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL
| | - Firas Dabbous
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital-Center for Advanced Care, 1700 Luther Lane, Suite 1410, Park Ridge, IL 60068
| | | | | | | | | | - Zhaohui Su
- OM1 Inc., 800 Boylston Street, Suite 1410, Boston, MA 02199
| | - Vandana Menon
- OM1 Inc., 800 Boylston Street, Suite 1410, Boston, MA 02199
| | - Emily F Conant
- Department of Radiology, 3400 Spruce Street, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.
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Li H, Mendel KR, Lan L, Sheth D, Giger ML. Digital Mammography in Breast Cancer: Additive Value of Radiomics of Breast Parenchyma. Radiology 2019; 291:15-20. [PMID: 30747591 PMCID: PMC6445042 DOI: 10.1148/radiol.2019181113] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 11/11/2022]
Abstract
Background Previous studies have suggested that breast parenchymal texture features may reflect the biologic risk factors associated with breast cancer development. Therefore, combining the characteristics of normal parenchyma from the contralateral breast with radiomic features of breast tumors may improve the accuracy of digital mammography in the diagnosis of breast cancer. Purpose To determine whether the addition of radiomic analysis of contralateral breast parenchyma to the characterization of breast lesions with digital mammography improves lesion classification over that with radiomic tumor features alone. Materials and Methods This HIPAA-compliant, retrospective study included 182 patients (age range, 25-90 years; mean age, 55.9 years ± 14.9) who underwent mammography between June 2002 and July 2009. There were 106 malignant and 76 benign lesions. Automatic lesion segmentation and radiomic analysis were performed for each breast lesion. Radiomic texture analysis was applied in the normal regions of interest in the contralateral breast parenchyma to assess the mammographic parenchymal patterns. The classification performance of both individual features and the output from a Bayesian artificial neural network classifier was evaluated with the leave-one-patient-out method by using the area under the receiver operating characteristic curve (AUC) as the figure of merit in the task of differentiating between malignant and benign lesions. Results The performance of the combined lesion and parenchyma classifier in the differentiation between malignant and benign mammographic lesions was better than that with the lesion features alone (AUC = 0.84 ± 0.03 vs 0.79 ± 0.03, respectively; P = .047). Overall, six radiomic features-spiculation, margin sharpness, size, circularity from the tumor feature set, and skewness and power law beta from the parenchymal feature set-were selected more than 50% of the time during the feature selection process on the combined feature set. Conclusion Combining quantitative radiomic data from tumors with contralateral parenchyma characterizations may improve diagnostic accuracy for breast cancer. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Shaffer in this issue.
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Affiliation(s)
- Hui Li
- From the Department of Radiology, University of Chicago, 5841 S
Maryland Ave, Chicago, IL 60637
| | - Kayla R. Mendel
- From the Department of Radiology, University of Chicago, 5841 S
Maryland Ave, Chicago, IL 60637
| | - Li Lan
- From the Department of Radiology, University of Chicago, 5841 S
Maryland Ave, Chicago, IL 60637
| | - Deepa Sheth
- From the Department of Radiology, University of Chicago, 5841 S
Maryland Ave, Chicago, IL 60637
| | - Maryellen L. Giger
- From the Department of Radiology, University of Chicago, 5841 S
Maryland Ave, Chicago, IL 60637
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Euler-Chelpin MV, Lillholm M, Napolitano G, Vejborg I, Nielsen M, Lynge E. Screening mammography: benefit of double reading by breast density. Breast Cancer Res Treat 2018; 171:767-776. [PMID: 29974357 PMCID: PMC6133172 DOI: 10.1007/s10549-018-4864-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The currently recommended double reading of all screening mammography examinations is an economic burden for screening programs. The sensitivity of screening is higher for women with low breast density than for women with high density. One may therefore ask whether single reading could replace double reading at least for women with low density. We addressed this question using data from a screening program where the radiologists coded their readings independently. METHODS Data include all screening mammography examinations in the Capital Region of Denmark from 1 November 2012 to 31 December 2013. Outcome of screening was assessed by linkage to the Danish Pathology Register. We calculated sensitivity, specificity, number of interval cancers, and false positive-tests per 1000 screened women by both single reader and consensus BI-RADS density code. RESULTS In total 54,808 women were included. The overall sensitivity of double reading was 72%, specificity was 97.6%, 3 women per 1000 screened experienced an interval cancer, and 24 a false-positive test. Across all BI-RADS density codes, single reading consistently decreased sensitivity as compared with consensus reading. The same was true for specificity, apart from results across BI-RADS density codes set by reader 2. CONCLUSIONS Single reading decreased sensitivity as compared with double reading across all BI-RADS density codes. This included results based on consensus BI-RADS density codes. This means that replacement of double with single reading would have negative consequences for the screened women, even if density could be assessed automatically calibrated to the usual consensus level.
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Affiliation(s)
- My von Euler-Chelpin
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Martin Lillholm
- Biomediq, Fruebjergvej 3, 2100, Copenhagen Ø, Denmark
- Department of Computer Sciences, University of Copenhagen, Universitetsparken 5, 2100, Copenhagen Ø, Denmark
| | - George Napolitano
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Ilse Vejborg
- Department of Radiology, University Hospital Copenhagen Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Mads Nielsen
- Biomediq, Fruebjergvej 3, 2100, Copenhagen Ø, Denmark
- Department of Computer Sciences, University of Copenhagen, Universitetsparken 5, 2100, Copenhagen Ø, Denmark
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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Jung S, Goloubeva O, Hylton N, Klifa C, LeBlanc E, Shepherd J, Snetselaar L, Van Horn L, Dorgan JF. Intake of dietary carbohydrates in early adulthood and adolescence and breast density among young women. Cancer Causes Control 2018; 29:631-642. [PMID: 29802491 PMCID: PMC7365352 DOI: 10.1007/s10552-018-1040-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/16/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Carbohydrate intake increases postprandial insulin secretion and may affect breast density, a strong risk factor for breast cancer, early in life. We examined associations of adolescent and early adulthood intakes of total carbohydrates, glycemic index/load, fiber, and simple sugars with breast density among 182 young women. METHODS Diet was assessed using three 24-h recalls at each of five Dietary Intervention Study in Children (DISC) clinic visits when participants were age 10-19 years and at the DISC06 Follow-Up Study clinic visit when participants were age 25-29 years. Associations between energy-adjusted carbohydrates and MRI-measured percent dense breast volume (%DBV) and absolute dense breast volume (ADBV) at 25-29 years were quantified using multivariable-adjusted mixed-effects linear models. RESULTS Adolescent sucrose intakes and premenarcheal total carbohydrates intakes were modestly associated with higher %DBV (mean %DBVQ1 vs Q4, 16.6 vs 23.5% for sucrose; and 17.2 vs 22.3% for premenarcheal total carbohydrates, all Ptrend ≤ 0.02), but not with ADBV. However, adolescent intakes of fiber and fructose were not associated with %DBV and ADBV. Early adulthood intakes of total carbohydrates, glycemic index/load, fiber, and simple sugars were not associated with %DBV and ADBV. CONCLUSIONS Insulinemic carbohydrate diet during puberty may be associated with adulthood breast density, but our findings need replication in larger studies. Clinical Trials Registration ClinicalTrials.gov Identifier, NCT00458588 April 9, 2007; NCT00000459 October 27, 1999.
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Affiliation(s)
- Seungyoun Jung
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA
| | - Olga Goloubeva
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA
| | - Nola Hylton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | - Erin LeBlanc
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - John Shepherd
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Linda Snetselaar
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA.
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19
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Oskar S, Engmann NJ, Azus AR, Tehranifar P. Gestational diabetes, type II diabetes, and mammographic breast density in a U.S. racially diverse population screened for breast cancer. Cancer Causes Control 2018; 29:731-736. [PMID: 29948515 DOI: 10.1007/s10552-018-1048-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/02/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE Type II diabetes mellitus (T2DM) has consistently been associated with an increased risk of breast cancer, but the association of gestational diabetes mellitus (GDM) with breast cancer is less clear. T2DM and GDM may influence breast cancer risk through mammographic breast density, a strong risk factor for breast cancer. We examined whether T2DM and GDM are associated with higher mammographic breast density in a largely racial/ethnic minority sample. METHODS We collected digital mammograms, anthropometric measures, and interview data from 511 racially diverse women recruited during screening mammography appointments between 2012 and 2016 (mean age 51 years; 70% Hispanic). We examined the associations of self-reported GDM, T2DM, and medication use (metformin and insulin) with mammographic breast density, measured as percent and area of dense tissue using Cumulus software. RESULTS In multivariable linear regression models, history of T2DM and/or GDM and length of time since diagnosis were not associated with percent density or dense breast area, either before or after adjustment for current BMI. Use of metformin in diabetic women was associated with lower percent density (β = - 5.73, 95% CI - 10.27, - 1.19), only before adjusting for BMI. These associations were not modified by menopausal status. CONCLUSIONS Our results do not support associations between T2DM and/or GDM and higher amount of mammographically dense breast tissue, suggesting that the mechanism linking diabetes with breast cancer risk may not include mammographic breast density in midlife.
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Affiliation(s)
- Sabine Oskar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Natalie J Engmann
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aisia R Azus
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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van Veen EM, Brentnall AR, Byers H, Harkness EF, Astley SM, Sampson S, Howell A, Newman WG, Cuzick J, Evans DGR. Use of Single-Nucleotide Polymorphisms and Mammographic Density Plus Classic Risk Factors for Breast Cancer Risk Prediction. JAMA Oncol 2018; 4:476-482. [PMID: 29346471 PMCID: PMC5885189 DOI: 10.1001/jamaoncol.2017.4881] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/05/2017] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Single-nucleotide polymorphisms (SNPs) have demonstrated an association with breast cancer susceptibility, but there is limited evidence on how to incorporate them into current breast cancer risk prediction models. OBJECTIVE To determine whether a panel of 18 SNPs (SNP18) may be used to predict breast cancer in combination with classic risk factors and mammographic density. DESIGN, SETTING, AND PARTICIPANTS This cohort study enrolled a subcohort of 9363 women, aged 46 to 73 years, without a previous breast cancer diagnosis from the larger prospective cohort of the PROCAS study (Predicting Risk of Cancer at Screening) specifically to evaluate breast cancer risk-assessment methods. Enrollment took place from October 2009 through June 2015 from multiple population-based screening centers in Greater Manchester, England. Follow-up continued through January 5, 2017. EXPOSURES Genotyping of 18 SNPs, visual-assessment percentage mammographic density, and classic risk assessed by the Tyrer-Cuzick risk model from a self-completed questionnaire at cohort entry. MAIN OUTCOMES AND MEASURES The predictive ability of SNP18 for breast cancer diagnosis (invasive and ductal carcinoma in situ) was assessed using logistic regression odds ratios per interquartile range of the predicted risk. RESULTS A total of 9363 women were enrolled in this study (mean [range] age, 59 [46-73] years). Of these, 466 were found to have breast cancer (271 prevalent; 195 incident). SNP18 was similarly predictive when unadjusted or adjusted for mammographic density and classic factors (odds ratios per interquartile range, respectively, 1.56; 95% CI, 1.38-1.77 and 1.53; 95% CI, 1.35-1.74), with observed risks being very close to expected (adjusted observed-to-expected odds ratio, 0.98; 95% CI, 0.69-1.28). A combined risk assessment indicated 18% of the subcohort to be at 5% or greater 10-year risk, compared with 30% of all cancers, 35% of interval-detected cancers, and 42% of stage 2+ cancers. In contrast, 33% of the subcohort were at less than 2% risk but accounted for only 18%, 17%, and 15% of the total, interval, and stage 2+ breast cancers, respectively. CONCLUSIONS AND RELEVANCE SNP18 added substantial information to risk assessment based on the Tyrer-Cuzick model and mammographic density. A combined risk is likely to aid risk-stratified screening and prevention strategies.
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Affiliation(s)
- Elke M. van Veen
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Adam R. Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Charterhouse Square, Barts and The London, Queen Mary University of London, London, England
| | - Helen Byers
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Elaine F. Harkness
- Prevention Breast Cancer Centre and Nightingale Breast Screening Centre, Manchester University Hospital Foundation Trust, Manchester, England
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England
- Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Susan M. Astley
- Prevention Breast Cancer Centre and Nightingale Breast Screening Centre, Manchester University Hospital Foundation Trust, Manchester, England
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England
- Manchester Academic Health Science Centre, University of Manchester, Manchester, England
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, England
| | - Sarah Sampson
- Prevention Breast Cancer Centre and Nightingale Breast Screening Centre, Manchester University Hospital Foundation Trust, Manchester, England
| | - Anthony Howell
- Prevention Breast Cancer Centre and Nightingale Breast Screening Centre, Manchester University Hospital Foundation Trust, Manchester, England
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, England
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - William G. Newman
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, England
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Charterhouse Square, Barts and The London, Queen Mary University of London, London, England
| | - D. Gareth R. Evans
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
- Prevention Breast Cancer Centre and Nightingale Breast Screening Centre, Manchester University Hospital Foundation Trust, Manchester, England
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, England
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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McDonald JA, Tehranifar P, Flom JD, Terry MB, James-Todd T. Hair product use, age at menarche and mammographic breast density in multiethnic urban women. Environ Health 2018; 17:1. [PMID: 29301538 PMCID: PMC5753455 DOI: 10.1186/s12940-017-0345-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/07/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Select hair products contain endocrine disrupting chemicals (EDCs) that may affect breast cancer risk. We hypothesize that, if EDCs are related to breast cancer risk, then they may also affect two important breast cancer risk factors: age at menarche and mammographic breast density. METHODS In two urban female cohorts (N = 248): 1) the New York site of the National Collaborative Perinatal Project and 2) the New York City Multiethnic Breast Cancer Project, we measured childhood and adult use of hair oils, lotions, leave-in conditioners, root stimulators, perms/relaxers, and hair dyes using the same validated questionnaire. We used multivariable relative risk regression models to examine the association between childhood hair product use and early age at menarche (defined as <11 years of age) and multivariable linear regression models to examine the association between childhood and adult hair product use and adult mammographic breast density. RESULTS Early menarche was associated with ever use of childhood hair products (RR 2.3, 95% CI 1.1, 4.8) and hair oil use (RR 2.5, 95% CI 1.2, 5.2); however, additional adjustment for race/ethnicity, attenuated associations (hair products RR 1.8, 95% CI 0.8, 4.1; hair oil use RR 2.3, 95% CI 1.0, 5.5). Breast density was not associated with adult or childhood hair product or hair oil use. CONCLUSIONS If confirmed in larger prospective studies, these data suggest that exposure to EDCs through hair products in early life may affect breast cancer risk by altering timing of menarche, and may operate through a mechanism distinct from breast density.
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Affiliation(s)
- Jasmine A. McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY 10032 USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032 USA
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY 10032 USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032 USA
| | - Julie D. Flom
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY 10032 USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY 10032 USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032 USA
| | - Tamarra James-Todd
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Bldg. 1, 14th Floor, Boston, MA 02115 USA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115 USA
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Casas RS, Ramachandran A, Gunn CM, Weinberg JM, Shaffer K. Explaining Breast Density Recommendations: An Introductory Workshop for Breast Health Providers. MedEdPORTAL 2017; 13:10654. [PMID: 30800855 PMCID: PMC6338146 DOI: 10.15766/mep_2374-8265.10654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/01/2017] [Indexed: 05/22/2023]
Abstract
Introduction High breast density is an independent risk factor for breast cancer and can decrease the sensitivity of mammography. However, evidence surrounding recommendations for patient risk stratification and supplemental screening is evolving, and providers receive limited training on breast density counseling. Methods We implemented an introductory, interactive workshop about breast density including current evidence behind supplemental screening and risk stratification. Designed for providers who counsel women on breast health, this workshop was evaluated with internal medicine providers, primary care residents, and radiology residents. We surveyed participants about knowledge and attitudes at baseline, postintervention (residents and providers), and 3-month follow-up (providers only). We compared baseline and postintervention scores and postintervention and 3-month follow-up scores using paired t tests and McNemar's tests. Results Internal medicine providers had significant gains in knowledge when comparing baseline to postintervention surveys (6.5-8.5 on a 10-point scale, p < .0001), with knowledge gains maintained when comparing postintervention to 3-month follow-up surveys (p = .06). Primary care and radiology residents also had significant gains in knowledge when comparing baseline to postintervention surveys (p < .004 for both). All learner groups reported increases in their confidence regarding counseling women about breast density and referring for supplemental screening. Discussion Through this breast density session, we showed trends for increased knowledge and change in attitudes for multiple learner groups. Because we aim to prepare providers with the best currently available recommendations, these materials will require frequent updating as breast density evidence and national consensus evolve.
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Affiliation(s)
- Rachel S. Casas
- Assistant Professor, Department of Medicine, Pennsylvania State University College of Medicine
| | - Ambili Ramachandran
- Assistant Professor, Department of Medicine, University of Texas Health San Antonio
| | - Christine M. Gunn
- Assistant Professor, Department of Public Health, Boston University
- Assistant Professor, Evans Department of Medicine, Boston University School of Medicine
| | - Janice M. Weinberg
- Professor, Department of Biostatistics, Boston University School of Public Health
| | - Kitt Shaffer
- Professor, Department of Radiology, Boston University School of Medicine
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Soguel L, Durocher F, Tchernof A, Diorio C. Adiposity, breast density, and breast cancer risk: epidemiological and biological considerations. Eur J Cancer Prev 2017; 26:511-520. [PMID: 27571214 PMCID: PMC5627530 DOI: 10.1097/cej.0000000000000310] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 01/29/2016] [Indexed: 12/16/2022]
Abstract
Excess total body fat and abdominal adipose tissue are recognized risk factors for metabolic diseases but also for some types of cancers, including breast cancer. Several biological mechanisms in connection with local and systemic effects of adiposity are believed to be implicated in breast cancer development, and may involve breast fat. Breast adipose tissue can be studied through mammography by looking at breast density features such as the nondense area mainly composed of fat, or the percent breast density, which is the proportion of fibroglandular tissue in relation to fat. The relation between adiposity, breast density features, and breast cancer is complex. Studies suggest a paradoxical association as adiposity and absolute nondense area correlate positively with each other, but in contrast to adiposity, absolute nondense area seems to be associated negatively with breast cancer risk. As breast density is one of the strongest risk factors for breast cancer, it is therefore critical to understand how these factors interrelate. In this review, we discuss these relations by first presenting how adiposity measurements and breast density features are linked to breast cancer risk. Then, we used a systematic approach to capture the literature to review the relation between adiposity and breast density features. Finally, the role of adipose tissue in carcinogenesis is discussed briefly from a biological perspective.
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Affiliation(s)
- Ludivine Soguel
- Departments of Social and Preventive Medicine
- CHU de Québec Research Center
- Department of Nutrition and Dietetics, University of Applied Sciences Western Switzerland (HES-SO) Geneva, 25 rue des Caroubiers, Carouge, Switzerland
| | - Francine Durocher
- Molecular Medicine, Cancer Research Center, Laval University, 2325 rue de l’Université
- CHU de Québec Research Center, CHUL, 2724 Laurier Boulevard
| | - André Tchernof
- CHU de Québec Research Center, CHUL, 2724 Laurier Boulevard
- Department of Nutrition, Laval University, 2425 rue de l’Agriculture, Quebec City, Quebec, Canada
| | - Caroline Diorio
- Departments of Social and Preventive Medicine
- CHU de Québec Research Center
- Deschênes-Fabia Center for Breast Diseases, Saint-Sacrement Hospital, 1050 Chemin Ste-Foy
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Vega S, Basurto L, Saucedo R, Barrera S, Reyes-Maldonado E, Garcia-Latorre EA, Zarate A. Similar to Adiponectin, Serum Levels of Osteocalcin are Associated with Mammographic Breast Density in Postmenopausal Women. J Obstet Gynaecol Can 2017; 40:186-192. [PMID: 28927816 DOI: 10.1016/j.jogc.2017.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Breast cancer is the most common type of cancer in Canadian women and worldwide. Mammographic density is a well-established breast cancer risk. Recent evidence suggested inverse correlations among adiponectin, osteocalcin, and the risk developing breast cancer. The objective of the study was to evaluate the relationship between breast density and adiponectin and osteocalcin concentrations. METHODS A cross-sectional study was performed in 239 women, age range 40 to 60. Mammographic density, serum adiponectin, and osteocalcin levels were measured. According to the Wolfe method, participants were divided into those with low-risk and high-risk pattern mammograms. RESULTS The study population included 107 premenopausal and 132 postmenopausal women. Parameters were no different between women with low-risk and high-risk patterns. In obese postmenopausal women, the high-risk pattern mammogram group had significantly higher values of adiponectin and osteocalcin compared with the low-risk pattern group. Multiple linear regression analyses showed that adiponectin and osteocalcin levels were associated with high-risk pattern mammograms. CONCLUSION Adiponectin and osteocalcin levels were directly associated with high-risk pattern mammograms in obese postmenopausal women. These results do not support the use of adipokines as biomarkers; nevertheless, the most important factor is to assess the risk through breast density.
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Affiliation(s)
- Sara Vega
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lourdes Basurto
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Renata Saucedo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Susana Barrera
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elba Reyes-Maldonado
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Ethel A Garcia-Latorre
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Arturo Zarate
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Ko KH, Jung HK, Kim I. Analysis of background parenchymal echogenicity on breast ultrasound: Correlation with mammographic breast density and background parenchymal enhancement on magnetic resonance imaging. Medicine (Baltimore) 2017; 96:e7850. [PMID: 28816987 PMCID: PMC5571724 DOI: 10.1097/md.0000000000007850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to analyze the background parenchymal echotexture (BP echo) on breast ultrasound in detail and to evaluate the relation BP echo with menopausal status. In addition, we correlated BP echo with mammographic breast density (MGD) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI).The institutional review board of our hospital approved this retrospective study, and the requirement of informed consent was waived. We studied 138 women (mean age 51.6 years, range from 26 to 79 years) with newly diagnosed invasive breast cancer, who had performed preoperative mammography, ultrasound, and MR from June 2013 to June 2015. BP echo was classified as homogeneous and heterogeneous according to the BI-RADS US lexicon. MGD was described into fatty, scattered, heterogeneously dense, and extremely dense. BPE was categorized as minimal, mild, moderate, and marked. The relationship between the BP echo and menopausal status was investigated. Associations between the degree of BP echo with MGD grades and BPE grades were also evaluated.Of the 138 women, 74 (54%) were premenopausal and 64 (46%) were postmenopausal. Premenopausal women were more likely to have heterogeneous BP echo (60/74, 81%) compared with postmenopausal women (10/64, 16%) (P = .000). BP echo showed significant correlation with BPE in both premenopausal and postmenopausal women (P = .000). However, MGD showed no significant correlation with BP echo or BPE, regardless of menopausal states. In the postmenopausal group, 70% women (21/30) with dense MGD showed homogeneous BP echo and 77% women (23/30) with dense MGD showed nondense BPE.In conclusion, we demonstrated that the BP echo was influenced by menopausal status. Our data support the concept that BP echo is influenced by breast hormonal changes. Because there was a significant association between BP echo and BPE in pre- and post-menopausal women, the BP echo might be a good predictor for BPE.
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Abstract
The approach to breast cancer screening has changed over time from a general approach to a more personalized, risk-based approach. Women with dense breasts, one of the most prevalent risk factors, are now being informed that they are at increased risk of developing breast cancer and should consider supplemental screening beyond mammography. This article reviews the current evidence regarding the impact of breast density relative to other known risk factors, the evidence regarding supplemental screening for women with dense breasts, supplemental screening options, and recommendations for physicians having shared decision-making discussions with women who have dense breasts.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA; Department of Health Services, University of Washington School of Public Health, 1959 Northeast Pacific Street, Seattle, WA 98195, USA; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Research Cancer Center, 1100 Fairview Avenue N, Box 19024, Seattle, WA 98109, USA.
| | - Linda E Chen
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA; Department of Epidemiology, University of Washington School of Public Health, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA
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Secco JM, Elias S, de Carvalho CV, da Silva IDCG, de Campos KJ, Facina G, Nazário ACP. Mammographic density among indigenous women in forested areas in the state of Amapá, Brazil: a cross-sectional study. SAO PAULO MED J 2017; 135:355-362. [PMID: 28767986 PMCID: PMC10016001 DOI: 10.1590/1516-3180.2016.0146150317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE: There is no register of breast cancer cases among indigenous populations in Brazil. The objective here was to evaluate the association of clinical and demographic characteristics with mammographic density among indigenous women. DESIGN AND SETTING: Cross-sectional analytical study conducted in indigenous territories in the state of Amapá, Brazil. METHODS: Women were recruited from three indigenous territories and underwent bilateral mammography and blood collection for hormonal analysis. They were interviewed with the aid of an interpreter. Mammographic density was calculated using computer assistance, and was expressed as dense or non-dense. RESULTS: A total of 137 indigenous women were included in this study, with an average age of 50.4 years, and an average age at the menarche of 12.8 years. Half (50.3%) of the 137 participants had not reached the menopause at the time of this study. The women had had an average of 8.7 children, and only two had never breastfed. The average body mass index of the population as a whole was 25.1 kg/m2. The mammographic evaluation showed that 82% of women had non-dense breasts. The clinical characteristics associated with mammographic density were age (P = 0.0001), follicle-stimulating hormone (FSH) (P < 0.001) and estrogen levels (P < 0.01). CONCLUSIONS: The majority of the indigenous women had non-dense breasts. Age, menopausal status and FSH and estrogen levels were associated with mammographic density.
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Affiliation(s)
- José Mauro Secco
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), and Adjunct Professor, Universidade Federal do Amapá (Unifap), Amapá (AP), Brazil.
| | - Simone Elias
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
| | - Cristina Valletta de Carvalho
- BSc, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), and Adjunct Professor, Department of Biological Sciences, Centro Universitário Fundação Santo André, and Department of Genetics, Fundação ABC, São Paulo (SP), Brazil.
| | - Ismael Dale Cotrim Guerreiro da Silva
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp); Adjunct Professor and Coordinator of Molecular Gynecology Laboratory, Department of Gynecology; and Coordinator of Research and Technological Innovation within Biology, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
| | - Kátia Jung de Campos
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), and Attending Physician and Residency Coordinator, Department of Gynecology, Universidade Federal do Amapá, Amapá (AP), Brazil.
| | - Gil Facina
- MD, PhD. Full Professor, Department of Gynecology and Head of Department of Mastology, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
| | - Afonso Celso Pinto Nazário
- MD, PhD. Researcher and Full Professor, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
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O'Flynn EA, Fromageau J, Ledger AE, Messa A, D'Aquino A, Schoemaker MJ, Schmidt M, Duric N, Swerdlow AJ, Bamber JC. Ultrasound Tomography Evaluation of Breast Density: A Comparison With Noncontrast Magnetic Resonance Imaging. Invest Radiol 2017; 52:343-348. [PMID: 28121639 PMCID: PMC5417582 DOI: 10.1097/rli.0000000000000347] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Ultrasound tomography (UST) is an emerging whole-breast 3-dimensional imaging technique that obtains quantitative tomograms of speed of sound of the entire breast. The imaged parameter is the speed of sound which is used as a surrogate measure of density at each voxel and holds promise as a method to evaluate breast density without ionizing radiation. This study evaluated the technique of UST and compared whole-breast volume averaged speed of sound (VASS) with MR percent water content from noncontrast magnetic resonance imaging (MRI). MATERIALS AND METHODS Forty-three healthy female volunteers (median age, 40 years; range, 29-59 years) underwent bilateral breast UST and MRI using a 2-point Dixon technique. Reproducibility of VASS was evaluated using Bland-Altman analysis. Volume averaged speed of sound and MR percent water were evaluated and compared using Pearson correlation coefficient. RESULTS The mean ± standard deviation VASS measurement was 1463 ± 29 m s (range, 1434-1542 m s). There was high similarity between right (1464 ± 30 m s) and left (1462 ± 28 m s) breasts (P = 0.113) (intraclass correlation coefficient, 0.98). Mean MR percent water content was 35.7% ± 14.7% (range, 13.2%-75.3%), with small but significant differences between right and left breasts (36.3% ± 14.9% and 35.1% ± 14.7%, respectively; P = 0.004). There was a very strong correlation between VASS and MR percent water density (r = 0.96, P < 0.0001). CONCLUSIONS Ultrasound tomography holds promise as a reliable and reproducible 3-dimensional technique to provide a surrogate measure of breast density and correlates strongly with MR percent water content.
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Affiliation(s)
- Elizabeth A.M. O'Flynn
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Jeremie Fromageau
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Araminta E. Ledger
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Alessandro Messa
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Ashley D'Aquino
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Minouk J. Schoemaker
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Maria Schmidt
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Neb Duric
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Anthony J. Swerdlow
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Jeffrey C. Bamber
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
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Chen SQ, Huang M, Shen YY, Liu CL, Xu CX. Application of Abbreviated Protocol of Magnetic Resonance Imaging for Breast Cancer Screening in Dense Breast Tissue. Acad Radiol 2017; 24:316-320. [PMID: 27916594 DOI: 10.1016/j.acra.2016.10.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to evaluate the usefulness of an abbreviated protocol (AP) of magnetic resonance imaging (MRI) in comparison to a full diagnostic protocol (FDP) of MRI in the breast cancer screening with dense breast tissue. MATERIALS AND METHODS There are 478 female participants with dense breast tissue and negative mammography results, who were imaged with MRI using AP and FDP. The AP and FDP images were analyzed separately, and the sensitivity and specificity of breast cancer detection were calculated. The chi-square test and receiver operating characteristics curves were used to assess the breast cancer diagnostic capabilities of the two protocols. RESULTS Sixteen cases of breast cancer from 478 patients with dense breasts were detected using the FDP method, with pathologic confirmation of nine cases of ductal carcinoma in situ, six cases of invasive ductal carcinoma, and one case of mucinous carcinoma. Fifteen cases of breast cancer were successfully screened using the AP method. The sensitivity showed no obvious significant difference between AP and FDP (χ2 = 0.592, P = 0.623), but the specificity showed a statistically significant difference (χ2 = 4.619, P = 0.036). The receiver operating characteristics curves showed high efficacy of both methods in the detection of breast cancer in dense breast tissue (the areas under the curve were 0.931 ± 0.025 and 0.947 ± 0.024, respectively), and the ability to diagnose breast cancer was not statistically significantly different between the two methods. CONCLUSIONS The AP of MRI may improve the detection rate of breast cancer in dense breast tissue, and it may be useful in efficient breast cancer screening.
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Affiliation(s)
- Shuang-Qing Chen
- Department of Radiology, The Affiliated Suzhou Hospital, Nanjing Medical University, No.16, Bai-Ta-Xi Road, Suzhou 215001, China.
| | - Min Huang
- Breast Imaging Screening Center, The Affiliated Suzhou Hospital, Nanjing Medical University, Suzhou, China
| | - Yu-Ying Shen
- Department of Radiology, The Affiliated Suzhou Hospital, Nanjing Medical University, No.16, Bai-Ta-Xi Road, Suzhou 215001, China
| | - Chen-Lu Liu
- Department of Radiology, The Affiliated Suzhou Hospital, Nanjing Medical University, No.16, Bai-Ta-Xi Road, Suzhou 215001, China
| | - Chuan-Xiao Xu
- Breast Imaging Screening Center, The Affiliated Suzhou Hospital, Nanjing Medical University, Suzhou, China
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Wengert GJ, Pinker-Domenig K, Helbich TH, Vogl WD, Clauser P, Bickel H, Marino MA, Magometschnigg HF, Baltzer PA. Influence of fat-water separation and spatial resolution on automated volumetric MRI measurements of fibroglandular breast tissue. NMR Biomed 2016; 29:702-708. [PMID: 27061174 DOI: 10.1002/nbm.3516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/04/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to investigate the influence of fat-water separation and spatial resolution in MRI on the results of automated quantitative measurements of fibroglandular breast tissue (FGT). Ten healthy volunteers (age range, 28-71 years; mean, 39.9 years) were included in this Institutional Review Board-approved prospective study. All measurements were performed on a 1.5-T scanner (Siemens, AvantoFit) using an 18-channel breast coil. The protocols included isotropic (Di) [TR/TE1 /TE2 = 6.00 ms/2.45 ms/2.67 ms; flip angle, 6.0°; 256 slices; matrix, 360 × 360; 1 mm isotropic; field of view, 360°; acquisition time (TA) = 3 min 38 s] and anisotropic (Da) (TR/TE1 /TE2 = 10.00 ms/2.39 ms/4.77 ms; flip angle, 24.9°; 80 slices; matrix 360 × 360; voxel size, 0.7 × 0.7 × 2.0 mm(3) ; field of view, 360°; TA = 1 min 25 s) T1 three-dimensional (3D) fast low-angle shot (FLASH) Dixon sequences, and a T1 3D FLASH sequence with the same resolution (T1 ) without (TR/TE = 11.00 ms/4.76 ms; flip angle, 25.0°; 80 slices; matrix, 360 × 360; voxel size, 0.7 × 0.7 × 2.0 mm(3) ; field of view, 360°; TA = 50 s) and with (TR/TE = 29.00 ms/4.76 ms; flip angle, 25.0°; 80 slices; matrix, 360 × 360; voxel size, 0.7 × 0.7 × 2.0 mm(3) ; field of view, 360°; TA = 2 min 35 s) fat saturation. Repeating volunteer measurements after 20 min and repositioning were used to assess reproducibility. An automated and quantitative volumetric breast density measurement system was used for FGT calculation. FGT with Di, Da and T1 measured 4.6-63.0% (mean, 30.6%), 3.2-65.3% (mean, 32.5%) and 1.7-66.5% (mean, 33.7%), respectively. The highest correlation between different MRI sequences was found with the Di and Da sequences (R(2) = 0.976). Coefficients of variation (CVs) for FGT calculation were higher in T1 (CV = 21.5%) compared with Dixon (Di, CV = 5.1%; Da, CV = 4.2%) sequences. Dixon-type sequences worked well for FGT measurements, even at lower resolution, whereas the conventional T1 -weighted sequence was more sensitive to decreasing resolution. The Dixon fat-water separation technique showed superior repeatability of FGT measurements compared with conventional sequences. A standard dynamic protocol using Dixon fat-water separation is best suited for combined diagnostic purposes and prognostic measurements of FGT. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Georg J Wengert
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker-Domenig
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Vogl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Hubert Bickel
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Maria-Adele Marino
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Heinrich F Magometschnigg
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
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Chen JH, Lee YW, Chan SW, Yeh DC, Chang RF. Breast Density Analysis with Automated Whole-Breast Ultrasound: Comparison with 3-D Magnetic Resonance Imaging. Ultrasound Med Biol 2016; 42:1211-1220. [PMID: 26831342 DOI: 10.1016/j.ultrasmedbio.2015.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/28/2015] [Accepted: 12/16/2015] [Indexed: 06/05/2023]
Abstract
In this study, a semi-automatic breast segmentation method was proposed on the basis of the rib shadow to extract breast regions from 3-D automated whole-breast ultrasound (ABUS) images. The density results were correlated with breast density values acquired with 3-D magnetic resonance imaging (MRI). MRI images of 46 breasts were collected from 23 women without a history of breast disease. Each subject also underwent ABUS. We used Otsu's thresholding method on ABUS images to obtain local rib shadow information, which was combined with the global rib shadow information (extracted from all slice projections) and integrated with the anatomy's breast tissue structure to determine the chest wall line. The fuzzy C-means classifier was used to extract the fibroglandular tissues from the acquired images. Whole-breast volume (WBV) and breast percentage density (BPD) were calculated in both modalities. Linear regression was used to compute the correlation of density results between the two modalities. The consistency of density measurement was also analyzed on the basis of intra- and inter-operator variation. There was a high correlation of density results between MRI and ABUS (R(2) = 0.798 for WBV, R(2) = 0.825 for PBD). The mean WBV from ABUS images was slightly smaller than the mean WBV from MR images (MRI: 342.24 ± 128.08 cm(3), ABUS: 325.47 ± 136.16 cm(3), p < 0.05). In addition, the BPD calculated from MR images was smaller than the BPD from ABUS images (MRI: 24.71 ± 15.16%, ABUS: 28.90 ± 17.73%, p < 0.05). The intra-operator and inter-operator variant analysis results indicated that there was no statistically significant difference in breast density measurement variation between the two modalities. Our results revealed a high correlation in WBV and BPD between MRI and ABUS. Our study suggests that ABUS provides breast density information useful in the assessment of breast health.
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Affiliation(s)
- Jeon-Hor Chen
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California, USA; Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Yan-Wei Lee
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Si-Wa Chan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Dah-Cherng Yeh
- Breast Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ruey-Feng Chang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
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Kallenberg M, Petersen K, Nielsen M, Ng AY, Igel C, Vachon CM, Holland K, Winkel RR, Karssemeijer N, Lillholm M. Unsupervised Deep Learning Applied to Breast Density Segmentation and Mammographic Risk Scoring. IEEE Trans Med Imaging 2016; 35:1322-1331. [PMID: 26915120 DOI: 10.1109/tmi.2016.2532122] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Mammographic risk scoring has commonly been automated by extracting a set of handcrafted features from mammograms, and relating the responses directly or indirectly to breast cancer risk. We present a method that learns a feature hierarchy from unlabeled data. When the learned features are used as the input to a simple classifier, two different tasks can be addressed: i) breast density segmentation, and ii) scoring of mammographic texture. The proposed model learns features at multiple scales. To control the models capacity a novel sparsity regularizer is introduced that incorporates both lifetime and population sparsity. We evaluated our method on three different clinical datasets. Our state-of-the-art results show that the learned breast density scores have a very strong positive relationship with manual ones, and that the learned texture scores are predictive of breast cancer. The model is easy to apply and generalizes to many other segmentation and scoring problems.
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Sartor H, Lång K, Rosso A, Borgquist S, Zackrisson S, Timberg P. Measuring mammographic density: comparing a fully automated volumetric assessment versus European radiologists' qualitative classification. Eur Radiol 2016; 26:4354-4360. [PMID: 27011371 PMCID: PMC5101269 DOI: 10.1007/s00330-016-4309-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/17/2016] [Accepted: 02/23/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Breast Imaging-Reporting and Data System (BI-RADS) mammographic density categories are associated with considerable interobserver variability. Automated methods of measuring volumetric breast density may reduce variability and be valuable in risk and mammographic screening stratification. Our objective was to assess agreement of mammographic density by a volumetric method with the radiologists' classification. METHODS Eight thousand seven hundred and eighty-two examinations from the Malmö Breast Tomosynthesis Screening Trial were classified according to BI-RADS, 4th Edition. Volumetric breast density was assessed using automated software for 8433 examinations. Agreement between volumetric breast density and BI-RADS was descriptively analyzed. Agreement between radiologists and between categorical volumetric density and BI-RADS was calculated, rendering kappa values. RESULTS The observed agreement between BI-RADS scores of different radiologists was 80.9 % [kappa 0.77 (0.76-0.79)]. A spread of volumetric breast density for each BI-RADS category was seen. The observed agreement between categorical volumetric density and BI-RADS scores was 57.1 % [kappa 0.55 (0.53-0.56)]. CONCLUSIONS There was moderate agreement between volumetric density and BI-RADS scores from European radiologists indicating that radiologists evaluate mammographic density differently than software. The automated method may be a robust and valuable tool; however, differences in interpretation between radiologists and software require further investigation. KEY POINTS • Agreement between qualitative and software density measurements has not been frequently studied. • There was substantial agreement between different radiologists´ qualitative density assessments. • There was moderate agreement between software and radiologists' density assessments. • Differences in interpretation between software and radiologists require further investigation.
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Affiliation(s)
- Hanna Sartor
- Medical Radiology, Department of Translational Medicine, Lund University, Lund, Sweden.
- Department of Medical Imaging and Physiology, Skåne University Hospital, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden.
| | - Kristina Lång
- Medical Radiology, Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden
| | - Aldana Rosso
- Epidemiology and Register Centre South (ERC Syd), Skåne University Hospital, Klinkgatan 22, SE-221 85, Lund, Sweden
| | - Signe Borgquist
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Getingevägen 4, SE-221 85, Lund, Sweden
| | - Sophia Zackrisson
- Medical Radiology, Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden
| | - Pontus Timberg
- Department of Medical Radiation Physics, Department of Translational Medicine, Lund University, Lund, Sweden
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Hruska CB, Conners AL, Vachon CM, O'Connor MK, Shuster LT, Bartley AC, Rhodes DJ. Effect of menstrual cycle phase on background parenchymal uptake at molecular breast imaging. Acad Radiol 2015; 22:1147-56. [PMID: 26112057 PMCID: PMC4532620 DOI: 10.1016/j.acra.2015.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/10/2015] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The level of Tc-99m sestamibi uptake within normal fibroglandular tissue on molecular breast imaging (MBI), termed background parenchymal uptake (BPU), has been anecdotally observed to fluctuate with menstrual cycle. Our objective was to assess the impact of menstrual cycle phase on BPU appearance. MATERIALS AND METHODS Premenopausal volunteers who reported regular menstrual cycles and no exogenous hormone use were recruited to undergo serial MBI examinations during the follicular and luteal phase. A study radiologist, blinded to cycle phase, categorized BPU as photopenic, minimal mild, moderate, or marked. Change in BPU with cycle phase was determined, as well as correlations of BPU with mammographic density and hormone levels. RESULTS In 42 analyzable participants, high BPU (moderate or marked) was observed more often in luteal phase compared to follicular (P = .016). BPU did not change with phase in 30 of 42 participants (71%) and increased in the luteal phase compared to follicular in 12 (29%). High BPU was more frequent in dense breasts compared to nondense breasts at both the luteal (58% [15 of 26] vs. 13% [2 of 16], P = .004) and follicular phases (35% [9 of 26] vs. 6% [1 of 16], P = .061). Spearman correlation coefficients did not show any correlation of BPU with hormone levels measured at either cycle phase and suggested a weak correlation between change in BPU and changes in estrone and estradiol between phases. CONCLUSIONS We observed variable effects of menstrual cycle on BPU among our cohort of premenopausal women; however, when high BPU was observed, it was most frequently seen during the luteal phase compared to follicular phase and in women with dense breasts compared to nondense breasts.
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Affiliation(s)
- Carrie B Hruska
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Amy Lynn Conners
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Michael K O'Connor
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | | | - Adam C Bartley
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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