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Higher mammographic density associated with more aggressive tumors, DCIS
Kerlikowske K. J Natl Cancer Inst. 2011;doi:10.1093/jnci/djr263
Yaghjyan L. J Natl Cancer Inst. 2011;doi:10.1093/jnci/djr225.
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Women with a breast density of at least 50% were at nearly four times the risk for developing breast cancer compared with women with less dense breasts, according to results of an analysis of data collected in the Nurses’ Health Study.
Researchers said women with more dense breasts were also at increased risk for developing ductal carcinoma in situ (DCIS).
In a prospective, case-control study, researchers reviewed mammograms of 1,042 postmenopausal women diagnosed with breast cancer from 1989 to 2004 and 1,794 matched control participants. Those in the study arm had a higher median percent breast density (27.8% vs. 20.5%), a higher proportion with breast density of at least 50% (16.4% vs. 9%) and a higher proportion with breast density from 25% to 49% (39.7% vs. 30.6%).
Multivariate analysis showed that the risk for breast cancer increased by 3.39-fold in women with breast density of at least 50% compared with women with 10% or less breast density (OR=3.39; 95% CI, 2.46-4.68). There was a lower risk for breast cancer associated with breast density in the fully adjusted model compared with the reduced logistic regression model, but researchers said the association remained statistically significant.
About 82% of cancers diagnosed were invasive. The rest (18.1%) were in situ. In a polychotomous logistic regression analysis comparing risk across categories of breast cancer according to tumor invasiveness, researchers observed that breast density of at least 50% was associated with DCIS compared with breast density of less than 10% (OR=6.58; 95% CI, 3.47-12.48), as well as invasive disease (OR=3.00; 95% CI, 2.13-4.23). However, they concluded that the association was stronger for DCIS.
In an accompanying editorial, Karla Kerlikowske, MD, of the University of California, San Francisco, and Amanda Phipps, PhD, of Fred Hutchinson Cancer Research Center in Seattle, said characterizing the association between risk factors such as breast density for specific breast cancer subtypes provides important insight into the ways tumor subtypes differ in their etiologies and could inform the biological mechanisms through which risk factors influence prognosis.
“The results presented in this study suggest that breast density is an important risk factor for a range of biologically diverse subtypes of breast cancer, including tumors exhibiting characteristics indicative of poorer prognosis,” they said. “Application of these results could contribute to risk prediction models with better discrimination than current overall breast cancer risk prediction models Given that the magnitude of the association with breast density is strong across all breast cancer subtypes and particularly for ER-negative disease, breast density should be included in risk prediction models across tumor subtypes.”
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