Variation in Mammographic Breast Density by Race

El-Bastawissi, Amira Y.; White, Emily; Mandelson, Margaret T.; Taplin, Stephen H.

doi:10.1016/s1047-2797(00)00225-8

Cited by 99 publications

(65 citation statements)

References 27 publications

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“…215 White, Hispanic, Asian, Native American and black women participated in a study of 28,501 women in a breast-screening programme in Washington, USA. 216 After adjusting for age, differences in MD were found between Native American and white women, and between white and Asian women. However, when BMI, HRT use, menopausal status and parity were taken into account, the difference between Native American and white women was no longer significant.…”

Section: Introduction and Aimsmentioning

confidence: 96%

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Evans

Astley

Stavrinos³

et al. 2016

Programme Grants Appl Res

112

126

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BackgroundIn the UK, women are invited for 3-yearly mammography screening, through the NHS Breast Screening Programme (NHSBSP), from the ages of 47–50 years to the ages of 69–73 years. Women with family histories of breast cancer can, from the age of 40 years, obtain enhanced surveillance and, in exceptionally high-risk cases, magnetic resonance imaging. However, no NHSBSP risk assessment is undertaken. Risk prediction models are able to categorise women by risk using known risk factors, although accurate individual risk prediction remains elusive. The identification of mammographic breast density (MD) and common genetic risk variants [single nucleotide polymorphisms (SNPs)] has presaged the improved precision of risk models.ObjectivesTo (1) identify the best performing model to assess breast cancer risk in family history clinic (FHC) and population settings; (2) use information from MD/SNPs to improve risk prediction; (3) assess the acceptability and feasibility of offering risk assessment in the NHSBSP; and (4) identify the incremental costs and benefits of risk stratified screening in a preliminary cost-effectiveness analysis.DesignTwo cohort studies assessing breast cancer incidence.SettingHigh-risk FHC and the NHSBSP Greater Manchester, UK.ParticipantsA total of 10,000 women aged 20–79 years [Family History Risk Study (FH-Risk); UK Clinical Research Network identification number (UKCRN-ID) 8611] and 53,000 women from the NHSBSP [aged 46–73 years; Predicting the Risk of Cancer At Screening (PROCAS) study; UKCRN-ID 8080].InterventionsQuestionnaires collected standard risk information, and mammograms were assessed for breast density by a number of techniques. All FH-Risk and 10,000 PROCAS participants participated in deoxyribonucleic acid (DNA) studies. The risk prediction models Manual method, Tyrer–Cuzick (TC), BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) and Gail were used to assess risk, with modelling based on MD and SNPs. A preliminary model-based cost-effectiveness analysis of risk stratified screening was conducted.Main outcome measuresBreast cancer incidence.Data sourcesThe NHSBSP; cancer registration.ResultsA total of 446 women developed incident breast cancers in FH-Risk in 97,958 years of follow-up. All risk models accurately stratified women into risk categories. TC had better risk precision than Gail, and BOADICEA accurately predicted risk in the 6268 single probands. The Manual model was also accurate in the whole cohort. In PROCAS, TC had better risk precision than Gail [area under the curve (AUC) 0.58 vs. 0.54], identifying 547 prospective breast cancers. The addition of SNPs in the FH-Risk case–control study improved risk precision but was not useful inBRCA1(breast cancer 1 gene) families. Risk modelling of SNPs in PROCAS showed an incremental improvement from using SNP18 used in PROCAS to SNP67. MD measured by visual assessment score provided better risk stratification than automatic measures, despite wide intra- and inter-reader variability. Using a MD-adjusted TC model in PROCAS improved risk stratification (AUC = 0.6) and identified significantly higher rates (4.7 per 10,000 vs. 1.3 per 10,000;p < 0.001) of high-stage cancers in women with above-average breast cancer risks. It is not possible to provide estimates of the incremental costs and benefits of risk stratified screening because of lack of data inputs for key parameters in the model-based cost-effectiveness analysis.ConclusionsRisk precision can be improved by using DNA and MD, and can potentially be used to stratify NHSBSP screening. It may also identify those at greater risk of high-stage cancers for enhanced screening. The cost-effectiveness of risk stratified screening is currently associated with extensive uncertainty. Additional research is needed to identify data needed for key inputs into model-based cost-effectiveness analyses to identify the impact on health-care resource use and patient benefits.Future workA pilot of real-time NHSBSP risk prediction to identify women for chemoprevention and enhanced screening is required.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. The DNA saliva collection for SNP analysis for PROCAS was funded by the Genesis Breast Cancer Prevention Appeal.

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Section: Introduction and Aimsmentioning

confidence: 96%

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Evans

Astley

Stavrinos³

et al. 2016

Programme Grants Appl Res

112

126

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“…The higher false-positive rate in this study might be caused by physicians who had lower mammography reading skills when the NCSP was expanded to cover the entire population in [2002][2003]. Another possible reason could be the substantially higher breast density of Asian women than White women (El-Bastawissi et al, 2001). In a previous study, about 68.8% of Korean women in their 40s were found to have dense breasts (Jeon et al, 2011).…”

Section: Discussionmentioning

confidence: 84%

The National Cancer Screening Program for Breast Cancer in the Republic of Korea: Is it Cost-Effective?

Kang

Park²,

Choi

et al. 2013

Asian Pacific Journal of Cancer Prevention

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This goal of this research was to evaluate the cost-effectiveness of the National Cancer Screening Program (NCSP) for breast cancer in the Republic of Korea from a government expenditure perspective. In 2002-2003 (baseline), a total of 8,724,860 women aged 40 years or over were invited to attend breast cancer screening by the NCSP. Those who attended were identified using the NCSP database, and women were divided into two groups, women who attended screening at baseline (screened group) and those who did not (non-screened group). Breast cancer diagnosis in both groups at baseline, and during 5-year follow-up was identified using the Korean Central Cancer Registry. The effectiveness of the NCSP for breast cancer was estimated by comparing 5-year survival and life years saved (LYS) between the screened and the unscreened groups, measured using mortality data from the Korean National Health Insurance Corporation and the National Health Statistical Office. Direct screening costs, indirect screening costs, and productivity costs were considered in different combinations in the model. When all three of these costs were considered together, the incremental cost to save one life year of a breast cancer patient was 42,305,000 Korean Won (KW) (1 USD=1,088 KW) for the screened group compared to the non-screened group. In sensitivity analyses, reducing the false-positive rate of the screening program by half was the most cost-effective (incremental cost-effectiveness ratio, ICER=30,110,852 KW/LYS) strategy. When the upper age limit for screening was set at 70 years, it became more cost-effective (ICER=39,641,823 KW/LYS) than when no upper age limit was set. The NCSP for breast cancer in Korea seems to be accepted as cost-effective as ICER estimates were around the Gross Domestic Product. However, cost-effectiveness could be further improved by increasing the sensitivity of breast cancer screening and by setting appropriate age limits.

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“…In fact, it is thought that the relatively advantageous reproductive profile (with respect to breast cancer) generally observed for African Americans is the explanation for the lower incidence of postmenopausal breast cancer in African American women. 92 However, if the greater prevalence of high risk patterns among younger African American compared with younger white women 87 is confirmed in other investigations using standardized methodology and controlling for potential confounders (likely negative confounders), breast density may play a role in the higher incidence of breast cancer observed in young African American women. Furthermore, a higher prevalence of very dense breasts in young African American women could also complicate the reading of their mammograms, contributing to a delay in diagnosis and more advanced stage at diagnosis, as has been observed in SEER data.…”

Section: Breast Densitymentioning

confidence: 86%

“…However, results from a recently published study in which a large number of African American women were included (n ϭ 883) showed a race difference in breast density among women aged 65 years and younger after controlling for potential confounders. 87 In the only other known report on the prevalence of highrisk breast density patterns in African American women, in the results of a small hospital-based study (97 African American women, 100 white women), Patterson et al revealed no significant race difference in breast cancer cases. 88 However, these investigators were unable to control for a number of variables that could have potentially obscured a true relationship.…”

Section: Breast Densitymentioning

confidence: 96%

“…Indeed, the results of one study now suggest that African American women, particularly those under the age of 65 years, may have a higher prevalence of dense breasts than observed in other groups. 87 Yet there is also mounting evidence that breast cancer in African American women may be biologically more aggressive than in white women. 114,115 In addition to tumor characteristics associated with poorer prognosis (e.g., estrogen receptor negative tumors), there may be other factors that are more prevalent among African American women and that may also contribute to more aggressive disease (e.g., obesity).…”

Section: Adequacy Of Current Screening Guidelines For Young African Amentioning

confidence: 99%

See 1 more Smart Citation

Jones BA, Patterson EA, Calvocoressi L. Mammography screening in African American women: evaluating the research. Cancer. (2003) 97(1 Suppl):258–272.

2003

Cancer

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Variation in Mammographic Breast Density by Race

Cited by 99 publications

References 27 publications

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

The National Cancer Screening Program for Breast Cancer in the Republic of Korea: Is it Cost-Effective?

Jones BA, Patterson EA, Calvocoressi L. Mammography screening in African American women: evaluating the research. Cancer. (2003) 97(1 Suppl):258–272.

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