Mammography features for early markers of aggressive breast cancer subtypes and tumor characteristics: A population‐based cohort study

Abstract

Current breast cancer risk models identify mostly less aggressive tumors, although only women developing fatal breast cancer will greatly benefit from early identification. Here, we evaluated the use of mammography features (microcalcification clusters, computer‐generated Breast Imaging Reporting and Data System [cBIRADS] density and lack of breast density reduction) as early markers of aggressive subtypes and tumor characteristics. Mammograms were retrieved from a population‐based cohort of women that were diagnosed with breast cancer from 2001 to 2008 in Stockholm‐Gotland County, Sweden. Tumor and patient characteristics were obtained from Stockholm Breast Cancer Quality Register and the Swedish Cancer Registry. Multinomial logistic regression was used to individually model each mammographic feature as a function of molecular subtypes, tumor characteristics and detection mode. A total of 4546 women with invasive breast cancer were included in the study. Women with microcalcification clusters in the affected breast were more likely to have human epidermal growth factor receptor 2 subtype (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.24‐2.54) and potentially less likely to have basal subtype (OR 0.54; 0.30‐0.96) compared to Luminal A subtype. High mammographic cBIRADS showed association with larger tumor size and interval vs screen‐detected cancers. Lack of density reduction was associated with interval vs screen‐detected cancers (OR 1.43; 1.11‐1.83) and potentially of Luminal B subtype vs Luminal A subtype (OR 1.76; 1.04‐2.99). In conclusion, microcalcification clusters, cBIRADS density and lack of breast density reduction could serve as early markers of particular subtypes and tumor characteristics of breast cancer. This information has the potential to be integrated into risk models to identify women at risk for developing aggressive breast cancer in need of supplemental screening.

Association between quantitative and qualitative image features of contrast-enhanced mammography and molecular subtypes of breast cancer

“…associated with the presence of calcifications and that no associated calcifications are signatures of TNBC (41,42). Tan et al found that women with microcalcification clusters in the affected breast are less likely to have TNBCs than those with luminal A breast cancers (43). Our study also showed that the presence of calcifications is associated with the HER2-enriched subtype.…”

The Role of PTX3 in Mineralization Processes and Aging-Related Bone Diseases

“…These elemental signs of human diseases are frequently detected in pathological tissues as consequence of cell homeostasis deregulation. The most common calcifications found in non-bone tissues are breast microcalcifications (21). Deposits of calcium salts in breast are associated to the presence of lesions, both benign and malignant.…”

“…Deposits of calcium salts in breast are associated to the presence of lesions, both benign and malignant. Thus, detection of microcalcifications in breast tissues by imaging analysis, such as echography, Magnetic Resonance Imaging (MRI) or most commonly by mammography, currently represents the main breast cancer screening investigation (21). After the pioneering studies of Morgan et al (22)(23)(24), numerous investigations have been performed about the origin of breast microcalcifications.…”

Breast Cancer Incidence After a False-Positive Mammography Result

“…High mammographic breast density may partly explain this finding, given that previous research has established an association between dense breasts and a false-positive result, as well as between dense breasts and larger tumor size. 5,34,35 In addition, larger tumors might result from a reluctance to undergo screening after a false-positive result, as we found that the next screening's attendance rate was lower for women with a false-positive result compared with those without one.…”