Percent Mammographic Density and Dense Area as Risk Factors for Breast Cancer

Abstract

Purpose: Mammographic characteristics are known to be correlated to breast cancer risk. Percent mammographic density (PMD), as assessed by computer-assisted methods, is an established risk factor for breast cancer. Along with this assessment the absolute dense area (DA) of the breast is reported as well. Aim of this study was to assess the predictive value of DA concerning breast cancer risk in addition to other risk factors and in addition to PMD. Methods: We conducted a case control study with hospital-based patients with a diagnosis of invasive breast cancer and healthy women as controls. A total of 561 patients and 376 controls with available mammographic density were included into this study. We describe the differences concerning the common risk factors BMI, parital status, use of hormone replacement therapy (HRT) and menopause between cases and controls and estimate the odds ratios for PMD and DA, adjusted for the mentioned risk factors. Furthermore we compare the prediction models with each other to find out whether the addition of DA improves the model. Results: Mammographic density and DA were highly correlated with each other. Both variables were as well correlated to the commonly known risk factors with an expected direction and strength, however PMD (ρ = −0.56) was stronger correlated to BMI than DA (ρ = −0.11). The group of women within the highest quartil of PMD had an OR of 2.12 (95 % CI: 1.25–3.62). This could not be seen for the fourth quartile concerning DA. However the assessment of breast cancer risk could be improved by including DA in a prediction model in addition to common risk factors and PMD. Conclusions: The inclusion of the parameter DA into a prediction model for breast cancer in addition to established risk factors and PMD could improve the breast cancer risk assessment. As DA is measured together with PMD in the process of computer-assisted assessment of PMD it might be considered to include it as one additional breast cancer risk factor that is obtained from breast imaging.

Zusammenfassung

Ziel: Das Erscheinungsbild der Brustdrüse in der Mammografie konnte mit dem Brustkrebsrisiko in Zusammenhang gebracht werden. Die prozentuale mammografische Dichte (PMD) ist ein etablierter Risikofaktor für das Mammakarzinom. Bei der computergestützten Bestimmung der PMD wird gleichzeitig die Fläche der dichten Anteile (DA) berechnet. Ziel dieser Studie ist es festzustellen, ob durch die Hinzunahme der DA die Prädiktion des Brustkrebsrisikos verbessert werden kann. Methoden: Wir führten eine Fallkontrollstudie durch, die krankenhausbasierte Brustkrebspatientinnen als Fälle und gesunde Individuen als Kontrollen rekrutiert hat. Insgesamt 561 Patientinnen und 376 Kontrollindividuen mit einer mammografischen Dichte wurden in diese Untersuchung eingeschlossen. Die Unterschiede zwischen Fällen und Kontrollen in Bezug auf allgemeine Brustkrebsrisikofaktoren werden beschrieben und die adjustierten Odds Ratios (OR) für die PMD und die DA in Bezug auf das Brustkrebsrisiko berechnet. Außerdem werden die verschiedenen Prädiktionsmodelle in Bezug auf ihre Stärke, den Fallkontrollstatus vorherzusagen, verglichen. Ergebnisse: PMD und DA waren hochgradig miteinander korreliert. Beide Variablen waren auch mit den üblichen Risikofaktoren wie dem Alter, dem BMI, der Parität, und der Benutzung von Hormonersatztherapie (HRT) assoziiert. PMD (ρ = −0.56) war deutlicher mit dem BMI assoziiert als die DA (ρ = −0.11). Die Gruppe von Frauen in der höchsten Quartile der PMD hatten eine OR von 2,12 (95 %-KI: 1,25–3,62) verglichen mit Frauen in der niedrigsten Quartile. Dies konnte nicht für die DA gezeigt werden. Jedoch bei der Bildung eines Prädiktionsmodells für den Fallkontrollstatus hatte das Modell, welches die Risikofaktoren, die PMD und die DA einschloss, die beste Vorhersagekraft. Schlussfolgerung: Die Fläche der dichten Anteile der Brust bei einer Mammografie (DA) kann die Bestimmung des Brustkrebsrisikos verbessern, wenn sie zusammen mit üblichen Risikofaktoren und der prozentualen mammografischen Dichte (PMD) benutzt wird. Da die DA bei computergestützten Messungen der mammografischen Dichte ohnehin bestimmt wird, sollte überlegt werden, ob dieser Faktor nicht generell bei der Risikobestimmung integriert werden sollte.

Key words

mammographic density - breast cancer - risk

Schlüsselwörter

mammografische Dichte - Mammakarzinom - Erkrankungsrisiko

• References

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