A Longitudinal Investigation of Mammographic Density: The Multiethnic Cohort

Maskarinec, Gertraud; Pagano, Ian; Lurie, Galina; Kolonel, Laurence N.

doi:10.1158/1055-9965.epi-05-0798

Cited by 148 publications

(211 citation statements)

References 31 publications

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“…A similar trend was observed in a previous study evaluating reproductive factors in relation to dense and non-dense breast area, with the hypothesis that factors associated with dense breast area were more etiologically relevant [35]. Most previous studies reported no association between age at menarche and percent density [12,[15][16][17]35,36].…”

Section: Discussionsupporting

confidence: 80%

“…Parity, or having a full-term birth, is most consistently reported to be inversely associated with density [12,13], although stronger associations with greater number of births has only been reported for qualitative density measures, such as parenchymal patterns, and not with quantitative measures such as the percent of the breast occupied by dense tissue [14]. Less consistently, later age at FFTB has been directly associated with mammographic density [12,15], whereas little evidence has been reported for an association between age at menarche and density [12,16,17].…”

Section: Introductionmentioning

confidence: 99%

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Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN)

Butler¹,

Gold²,

Greendale

et al. 2007

Breast Cancer Res Treat

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Menstrual and reproductive factors may increase breast cancer risk through a pathway that includes increased mammographic density. We assessed whether known or suspected menstrual and reproductive breast cancer risk factors were cross-sectionally associated with mammographic density, by measuring area of radiographic density and total breast area on mammograms from 801 participants in the Study of Women's Health Across the Nation (SWAN), a multi-ethnic cohort of pre-and early perimenopausal women. From multivariable linear regression, the following menstrual or reproductive factors were independently associated with percent mammographic density (area of dense breast/breast area): older age at menarche (β = 10.3, P < 0.01, for >13 vs. <12 years), premenstrual cravings and bloating (β = −3.36, P = 0.02), younger age at first full-term birth (β = −8.12, P < 0.01 for ≤23 years versus no births), greater number of births (β = −6.80, P < 0.01 for ≥3 births versus no births), and premenopausal status (β = 3.78, P < 0.01 versus early perimenopausal). Only number of births remained associated with percent density after adjustment for age, race/ ethnicity, study site, body mass index (BMI), and smoking. In addition, stratified analyses revealed that the association with number of births was confined to women within the lowest BMI tertile (β = −12.2, P < 0.01 for ≥3 births versus no births). Our data support a mechanism for parity and breast cancer that involves mammographic density among pre-and early perimenopausal women that may be modified by body size.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN)

Butler¹,

Gold²,

Greendale

et al. 2007

Breast Cancer Res Treat

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“…Cross-sectional and longitudinal studies show that average percent mammographic density declines with increasing age (Figure 1) (Maskarinec et al, 2006;Martin and Boyd, 2008). This may seem paradoxical as breast cancer risk increases with age.…”

Section: Mammographic Density and Breast Cancer Riskmentioning

confidence: 99%

“…Two longitudinal studies have examined the relationship between change in density and breast cancer risk, one over an average of 4 -5 years (Maskarinec et al, 2006) and the other over an average of 7 years (Vachon et al, 2007a). Both used computer-assisted quantitative measurement of mammographic density and both showed that change in density with time was similar in women who developed breast cancer and those who remained free of disease (an example is shown in Figure 1B), but that at all ages, density was more extensive in women who develop breast cancer.…”

Section: Mammographic Density Involution and 'Breast Tissue Age'mentioning

confidence: 99%

“…With the exception of the study of Kerlikowske, the available evidence suggests that it is the extent of density at a given age, rather than the rate of change of density with increasing age, that is related to breast cancer risk (Maskarinec et al, 2006;Vachon et al, 2007a). However, there are important gaps in knowledge concerning cumulative exposure.…”

Section: Mammographic Density Involution and 'Breast Tissue Age'mentioning

confidence: 99%

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Mammographic density, lobular involution, and risk of breast cancer

2008

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In this review, we propose that age-related changes in mammographic density and breast tissue involution are closely related phenomena, and consider their potential relevance to the aetiology of breast cancer. We propose that the reduction in mammographic density that occurs with increasing age, parity and menopause reflects the involution of breast tissue. We further propose that age-related changes in both mammographic density and breast tissue composition are observable and measurable phenomena that resemble Pike's theoretical construct of 'breast tissue ageing'. Extensive mammographic density and delayed breast involution are both associated with an increased risk of breast cancer and are consistent with the hypothesis of the Pike model that cumulative exposure of breast tissue to hormones and growth factors that stimulate cell division, as well as the accumulation of genetic damage in breast cells, are major determinants of breast cancer incidence. (1994) proposed that variations in the rate or extent of the decrease in the number and size of breast lobules with increasing age, referred to as breast tissue involution, might be an important factor in the aetiology of breast cancer. They also drew attention to similarities between the histological changes of involution and changes in radiological features of the breast, which were then described in terms of Wolfe's patterns and are now usually referred to as 'mammographic density'.Since then, there have been advances in our understanding of the relationship between both breast histology and mammographic density to the risk of breast cancer, and of the factors that influence these features. Vachon et al (2007a) recently drew attention to similarities between age-related breast involution and mammographic density.In this review, we discuss some of the literature related to mammographic density, breast tissue involution, and breast cancer risk. We propose that age-related changes in mammographic density and breast involution are closely related phenomena, and consider their potential relevance to the aetiology of breast cancer in the light of the Pike model of mammary carcinogenesis. MAMMOGRAPHIC DENSITY AND BREAST CANCER RISKThe radiographic appearance of the breast varies among women of the same age because of variations in breast tissue composition (see further in 'Age and breast tissue composition' section below) and the X-ray attenuation properties of the different types of tissue (Johns and Yaffe, 1987). Fat attenuates X-rays least and appears dark on a mammogram, whereas stroma and epithelium attenuate X-rays more and appear white.Wolfe (1976a, b) related these variations in the appearance of the mammogram to the risk of breast cancer using a qualitative classification with four categories: N1 for breast tissue comprising mainly fat; P1 and P2 for the appearance of ductal prominence of less than 25% or greater than 25%, respectively, or more of the breast area; and DY extensive 'dysplasia'. Subsequently, the American College of Radiology introduced the ...

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Insights Into Breast Cancer in the East vs the West

Yap

Takagi³

et al. 2019

JAMA Oncol

110

120

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IMPORTANCEDuring the past few decades, the incidence of breast cancer (BC) has been increasing rapidly in East Asia, and BC is currently the most common cancer in several countries. The rising incidence is likely related to changing lifestyle and environmental factors in addition to the increase in early diagnosis with BC awareness and screening. The understanding and management of BC are generally based on research and data from the West. However, emerging differences in BC epidemiology and tumor and host biology in Asian populations may be clinically relevant.OBSERVATIONS A higher proportion of premenopausal BCs occur in Asia, although this factor is possibly an age-cohort effect. Although the relative frequencies of different immunohistochemical subtypes of BC may be similar between the East and West, the higher prevalence of luminal B subtypes with more frequent mutations in TP53 may be confounded by disparities in early detection. In addition, Asian BCs appear to harbor a more immune-active microenvironment than BCs in the West. The spectra of germline mutations in BC predisposition genes and single-nucleotide polymorphisms contributing to BC risk vary with ethnicity as well. Differences in tolerability of certain cytotoxic and targeted agents used in BC treatment may be associated with pharmacogenomic factors, whereas the lower body mass of the average woman in East Asia may contribute to higher toxicities from drugs administered at fixed doses. Phenotypic characteristics, such as lower breast volume, may influence the type of surgery performed in East Asian women. On the other hand, increased breast density may affect the sensitivity of mammography in detecting BCs, limiting the benefits of screening mammography. CONCLUSIONS AND RELEVANCEBreast cancer has become a major health problem in Asia. The inclusion of more women from Asia in clinical trials and epidemiologic and translational studies may help unravel the interethnic heterogeneity of BCs and elucidate the complex interplay between environmental and intrinsic factors in its pathogenesis. These insights may help to refine prevention, diagnosis, and management strategies for BC in the setting of ethnic diversity.

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A Longitudinal Investigation of Mammographic Density: The Multiethnic Cohort

Cited by 148 publications

References 31 publications

Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN)

Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN)

Mammographic density, lobular involution, and risk of breast cancer

Insights Into Breast Cancer in the East vs the West

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