Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis

 

by F.T.H. Bodewes, A.A. van Asselt, M.D. Dorrius, M.J.W. Greuter, G.H. de Bock 

 

The Breast: Published: September 26, 2022

 

Objectives

Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.

Methods

Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I2 statistic, stratified and sensitivity analyses.

Results

Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84–2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52–2.21) increased. Both results were statistically significant and homogenous.

Conclusions

Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.

 

 

Family history of breast cancer, mammographic breast density and breast cancer risk: Findings from a cohort study of Korean women

 

by Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park 

 

The Breast: August 23, 2022

 

Background

This study investigated whether the association between family history of breast cancer in first-degree relatives and breast cancer risk varies by breast density.

Methods

Women aged 40 years and older who underwent screening between 2009 and 2010 were followed up until 2020. Family history was assessed using a self-reported questionnaire. Using Breast Imaging Reporting and Data System (BI-RADS), breast density was categorized into dense breast (heterogeneously or extremely dense) and non-dense breast (almost entirely fatty or scattered areas of fibro-glandular). Cox regression model was used to assess the association between family history and breast cancer risk.

Results

Of the 4,835,507 women, 79,153 (1.6%) reported having a family history of breast cancer and 77,238 women developed breast cancer. Family history led to an increase in the 5-year cumulative incidence in women with dense- and non-dense breasts. Results from the regression model with and without adjustment for breast density yielded similar HRs in all age groups, suggesting that breast density did not modify the association between family history and breast cancer. After adjusting for breast density and other factors, family history of breast cancer was associated with an increased risk of breast cancer in all three age groups (age 40–49 years: aHR 1.96, 95% confidence interval [CI] 1.85–2.08; age 50–64 years: aHR 1.70, 95% CI 1.58–1.82, and age ≥65 years: aHR 1.95, 95% CI 1.78–2.14).

Conclusion

Family history of breast cancer and breast density are independently associated with breast cancer. Both factors should be carefully considered in future risk prediction models of breast cancer.

 

Information needs on breast cancer genetic and non-genetic risk factors in relatives of women with a BRCA1/2 or PALB2 pathogenic variant

 

by Anne Brédart, Antoine De Pauw, Amélie Anota, Anja Tüchler, Julia Dick, Anita Müller, Jean-Luc Kop, Kerstin Rhiem, Rita Schmutzler, Peter Devilee, Dominique Stoppa-Lyonnet, Sylvie Dolbeault 

 

The Breast: August 23, 2021

 

Objectives

Comprehensive breast cancer (BC) risk models integrating effects of genetic (GRF) and non-genetic risk factors (NGRF) may refine BC prevention recommendations. We explored the perceived information received on BC risk factors, and related characteristics, in female relatives of women with a BRCA1/2 or PALB2 pathogenic variant, undergoing BC risk assessment using the CanRisk© prediction tool.

Methods

Of 200 consecutive cancer-free women approached after the initial genetic consultation, 161 (80.5%) filled in questionnaires on their perception of information received and wished further information on BC risk factors (e.g., being a carrier of a moderate risk altered gene, personal genetic profile, lifestyles). Multilevel multivariate linear models were performed accounting for the clinician who met the counselee and exploring the effect of counselees’ socio-demographic, familial and psychological characteristics on the perceived extent of information received.

Results

Perceived no/little information received and wish for further information were more frequent for NGRF (>50%) than for GRF, especially high-risk genes (<20%). Perceived amount of information received and desire for further information were inversely correlated (p=<0.0001). Higher education level related to lower perceived levels of information received on GRF. Younger counselees' age (β = 0.13, p = 0.02) and less frequent engagement coping (e.g., inclination to solicit information) (β = 0.24, p = 0.02) related to lower perceived information received about NGRF. Other assessed counselees’ features were not found to be associated to GRF and NGRF information perception.

Conclusions

Awareness of counselees’ perceived lack of information on BC risk factors indicates a need to enhance evidence-based information on BC NGRF especially.

Mammographic density and prognosis in primary breast cancer patients

 

Mammographic density and prognosis in primary breast cancer patients

 

by Felix Heindl, Peter A. Fasching, Alexander Hein, Carolin C. Hack, Katharina Heusinger, Paul Gass, Patrik Pöschke, Frederik A. Stübs, Rüdiger Schulz-Wendtland, Arndt Hartmann, Ramona Erber, Matthias W. Beckmann, Julia Meyer, Lothar Häberle, Sebastian M. Jud, Julius Emons 

 

The Breast: Published: June 16, 2021

 

Purpose

Mammographic density (MD) is one of the strongest risk factors for breast cancer (BC). However, the influence of MD on the BC prognosis is unclear. The objective of this study was therefore to investigate whether percentage MD (PMD) is associated with a difference in disease-free or overall survival in primary BC patients.

Methods

A total of 2525 patients with primary, metastasis-free BC were followed up retrospectively for this analysis. For all patients, PMD was evaluated by two readers using a semi-automated method. The association between PMD and prognosis was evaluated using Cox regression models with disease-free survival (DFS) and overall survival (OS) as the outcome, and the following adjustments: age at diagnosis, year of diagnosis, body mass index, tumor stage, grading, lymph node status, hormone receptor and HER2 status.

Results

After median observation periods of 9.5 and 10.0 years, no influence of PMD on DFS (p = 0.46, likelihood ratio test (LRT)) or OS (p = 0.22, LRT), respectively, was found. In the initial unadjusted analysis higher PMD was associated with longer DFS and OS. The effect of PMD on DFS and OS disappeared after adjustment for age and was caused by the underlying age effect.

Conclusions

Although MD is one of the strongest independent risk factors for BC, in our collective PMD is not associated with disease-free and overall survival in patients with BC.

Differences in breast cancer risk after benign breast disease by type of screening diagnosis

 Differences in breast cancer risk after benign breast disease by type of screening diagnosis

 

by Javier Louro, Marta Román, Margarita Posso, Laura Comerma, Carmen Vidal, Francina Saladié, Rodrigo Alcantara, Mar Sanchez, M. Jesús Quintana, Javier del Riego, Joana Ferrer, Lupe Peñalva, Xavier Bargalló, Miguel Prieto, María Sala, Xavier Castells

 

The Breast: Open Access: Published: October 03, 2020

 

We aimed to assess differences in breast cancer risk across benign breast disease diagnosed at prevalent or incident screens.

 

Highlights

•Breast cancer risk after a benign breast disease varied with the screening type.

•Incident benign breast disease had a higher breast cancer risk than prevalent.

•The risk remained increased regardless of benign breast disease subtype.

[Comment] Assessment of breast cancer risk: which tools to use?

[Comment] Assessment of breast cancer risk: which tools to use?

by Montserrat Garcia-Closas, Nilanjan Chatterjee  

The Lancet Oncology: Comment, Volume 20 issue 4, p.463-464, April 01 2019

Risk-assessment tools are used in routine clinical practice to identify women at increased risk of breast cancer and to inform counselling about lifestyle changes, genetic testing, screening timing or modality, and eligibility for risk-reducing drugs or surgery. In The Lancet Oncology, Mary Beth Terry and colleagues1 report a comparative validation of four models—the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm model (BOADICEA), BRCAPRO, the Breast Cancer Risk Assessment Tool (BCRAT), and the International Breast Cancer Intervention Study model (IBIS)—used in clinical practice to provide absolute risk estimates for breast cancer on the basis of different sets of factors.