Volumetric Mammographic Density, Age-Related Decline, and Breast Cancer Risk Factors in a National Breast Cancer Screening Program

Hjerkind, Kirsti Vik; Ellingjord-Dale, Merete; Johansson, Anna L.V.; Aase, Hildegunn Siv; Hoff, Solveig Roth; Hofvind, Solveig; Fagerheim, Siri; dos‐Santos‐Silva, Isabel; Ursin, Giske

doi:10.1158/1055-9965.epi-18-0151

Cited by 23 publications

(31 citation statements)

References 54 publications

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“…However, the three positive studies had a combined sample size of 542 (13,15,16), whereas the two studies with no significant overall associations were comparatively larger studies of 1,147 and 2,251 women, respectively, in Sweden (17) and Norway (18). Two more recent Scandinavian studies found that alcohol use was positively associated with fully automated measures of DA (20) or dense volume (21) in models adjusted only for age, BMI, and menopausal status (20) or with additional adjustment for education and number of pregnancies (21). To our knowledge, only two previous studies have examined alcohol use in relation to NDA (17,19).…”

Section: Comparison With Prior Studiesmentioning

confidence: 99%

“…Plausible mechanisms underlying this association include increased sex hormone levels and carcinogenic DNA damage with greater alcohol consumption (11). Alcohol use has also been associated with higher PD (6,(12)(13)(14)(15), but associations with absolute DA have been inconsistent (13,(15)(16)(17)(18)(19)(20)(21). It remains unknown whether alcohol influences PD by increasing DA or decreasing NDA because few prior studies have examined all three MD phenotypes.…”

Section: Introductionmentioning

confidence: 99%

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Alcohol and Tobacco Use in Relation to Mammographic Density in 23,456 Women

McBride

Fei

Rothstein

et al. 2020

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Percent density (PD) is a strong risk factor for breast cancer that is potentially modifiable by lifestyle factors. PD is a composite of the dense (DA) and nondense (NDA) areas of a mammogram, representing predominantly fibroglandular or fatty tissues, respectively. Alcohol and tobacco use have been associated with increased breast cancer risk. However, their effects on mammographic density (MD) phenotypes are poorly understood.Methods: We examined associations of alcohol and tobacco use with PD, DA, and NDA in a population-based cohort of 23,456 women screened using full-field digital mammography machines manufactured by Hologic or General Electric. MD was measured using Cumulus. Machine-specific effects were estimated using linear regression, and combined using random effects meta-analysis.Results: Alcohol use was positively associated with PD (P trend ¼ 0.01), unassociated with DA (P trend ¼ 0.23), and inversely associated with NDA (P trend ¼ 0.02) adjusting for age, body mass index, reproductive factors, physical activity, and family history of breast cancer. In contrast, tobacco use was inversely associated with PD (P trend ¼ 0.0008), unassociated with DA (P trend ¼ 0.93), and positively associated with NDA (P trend <0.0001). These trends were stronger in normal and overweight women than in obese women.Conclusions: These findings suggest that associations of alcohol and tobacco use with PD result more from their associations with NDA than DA.Impact: PD and NDA may mediate the association of alcohol drinking, but not tobacco smoking, with increased breast cancer risk. Further studies are needed to elucidate the modifiable lifestyle factors that influence breast tissue composition, and the important role of the fatty tissues on breast health.

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Section: Comparison With Prior Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Alcohol and Tobacco Use in Relation to Mammographic Density in 23,456 Women

McBride

Fei

Rothstein

et al. 2020

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Women attending the stationary unit in our study had smaller and more mammographically dense breasts than women attending the mobile unit, which indicates that they have a different risk for breast cancer; however, small breast volume is also associated with low body mass index (decreased risk of breast cancer in post-menopausal women) and high mammographic density (increased risk of breast cancer). 11,19 These two effects may counterbalance each other. Additionally, more accessible mammographic screening has been proposed as a possible explanation for higher breast cancer incidence in urban populations.…”

Section: Discussionmentioning

confidence: 99%

Screening at stationary versus mobile units in BreastScreen Norway

et al. 2019

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Objective To compare breast characteristics, compression parameters, and early performance measures (rates of recall, screen-detected and interval breast cancer, and histopathologic tumour characteristics) for mammographic screening at a stationary versus mobile screening unit. Methods Results from 92,408 mammographic screening examinations performed as part of BreastScreen Norway during 2008–2017 at either a stationary ( n = 52,620) or mobile ( n = 39,788) unit in Hordaland county were compared using descriptive statistics and generalized estimating equations. A generalized estimating equation for a binary outcome was used to estimate crude and adjusted odds ratios with 95% confidence intervals for the outcomes of interest. Adjusted generalized estimating equation models included age, breast volume, and density grade as covariates. Results Screening at the stationary unit was performed on smaller breasts with higher mammographic density, using lower compression force but higher pressure than at the mobile unit. Using the stationary screening unit as reference, for women screened at the mobile unit, the adjusted odds ratio was: for recall 0.94 (95% CI: 0.87--1.01), screen-detected breast cancer 0.92 (95% CI: 0.78--1.10), and interval breast cancer 1.17 (95% CI: 0.83–1.64). Conclusions The quality of care did not differ for women screened at the stationary versus the mobile unit, but there were differences between the women who attended the two units. Sociodemographic factors should be included in future analyses to fully understand the risk of breast cancer among women residing in urban versus rural areas.

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“…One study estimated that women undergoing menopause had a decline in dense area that was 3.39 cm 2 larger than agematched women who remained premenopausal during the same time period (4). Cross-sectional studies comparing breast density in premenopausal and postmenopausal women support this finding (11), with a recent study including women from 22 countries estimating that postmenopausal women had a mean dense area that was 3.5 cm 2 lower than premenopausal women (12).…”

Section: Introductionmentioning

confidence: 86%

Longitudinal Changes in Volumetric Breast Density in Healthy Women across the Menopausal Transition

Engmann

Scott

Jensen

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Mammographic breast density declines during menopause. We assessed changes in volumetric breast density across the menopausal transition and factors that influence these changes. Methods: Women without a history of breast cancer, who had full field digital mammograms during both pre-and postmenopausal periods, at least 2 years apart, were sampled from four facilities within the San Francisco Mammography Registry from 2007 to 2013. Dense breast volume (DV) was assessed using Volpara on mammograms across the time period. Annualized change in DV from pre-to postmenopause was estimated using linear mixed models adjusted for covariates and per-woman random effects. Multiplicative interactions were evaluated between premenopausal risk factors and time to determine whether these covariates modified the annualized changes. Results: Among the 2,586 eligible women, 1,802 had one premenopausal and one postmenopausal mammogram, 628 had an additional perimenopausal mammogram, and 156 had two perimenopausal mammograms. Women experienced an annualized decrease in DV [À2.2 cm 3 (95% confidence interval, À2.7 to À1.7)] over the menopausal transition. Declines were greater among women with a premenopausal DV above the median (54 cm 3) versus below (DV, À3.5 cm 3 vs. À1.0 cm 3 ; P < 0.0001). Other breast cancer risk factors, including race, body mass index, family history, alcohol, and postmenopausal hormone therapy, had no effect on change in DV over the menopausal transition. Conclusions: High premenopausal DV was a strong predictor of greater reductions in DV across the menopausal transition. Impact: We found that few factors other than premenopausal density influence changes in DV across the menopausal transition, limiting targeted prevention efforts.

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Volumetric Mammographic Density, Age-Related Decline, and Breast Cancer Risk Factors in a National Breast Cancer Screening Program

Cited by 23 publications

References 54 publications

Alcohol and Tobacco Use in Relation to Mammographic Density in 23,456 Women

Alcohol and Tobacco Use in Relation to Mammographic Density in 23,456 Women

Screening at stationary versus mobile units in BreastScreen Norway

Longitudinal Changes in Volumetric Breast Density in Healthy Women across the Menopausal Transition

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