Mammographic Density: Intersection of Science, the Law, and Clinical Practice

2013 ◽  
pp. e63-e69
Author(s):  
Scott Hollenbeck ◽  
Patricia Keely ◽  
Victoria Seewaldt
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Mammographic Density ◽  
Menopausal Status ◽  
Increased Risk ◽  
Reduction Strategies ◽  
High Mammographic Density ◽  
Risk Reduction Strategies

High mammographic density is associated with a two- to sixfold increased risk of breast cancer. Mammographic density can be altered by endogenous and exogenous hormonal factors and generally declines with age. Mammographic density is affected by confounding factors such as age, parity, menopausal status, and body mass index (BMI), thus making interpretation of mammographic density challenging. None of the established means of measuring mammographic density are entirely satisfactory because they are time consuming and/or subjective. Although mammographic density has been shown to predict breast cancer risk, the role of mammographic density in precisely assessing a woman's breast cancer risk over her lifetime and evaluating response to risk-reduction strategies cannot be fully realized until we have a better understanding of the biology that links mammographic density to breast cancer risk.

scholarly journals Biological Mechanisms and Therapeutic Opportunities in Mammographic Density and Breast Cancer Risk

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5391
Author(s):  
Maddison Archer ◽  
Pallave Dasari ◽  
Andreas Evdokiou ◽  
Wendy V. Ingman
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Mammographic Density ◽  
Transforming Growth Factor ◽  
Breast Development ◽  
Inflammatory Factors ◽  
Biological Mechanisms ◽  
Increased Risk ◽  
High Mammographic Density

Mammographic density is an important risk factor for breast cancer; women with extremely dense breasts have a four to six fold increased risk of breast cancer compared to women with mostly fatty breasts, when matched with age and body mass index. High mammographic density is characterised by high proportions of stroma, containing fibroblasts, collagen and immune cells that suggest a pro-tumour inflammatory microenvironment. However, the biological mechanisms that drive increased mammographic density and the associated increased risk of breast cancer are not yet understood. Inflammatory factors such as monocyte chemotactic protein 1, peroxidase enzymes, transforming growth factor beta, and tumour necrosis factor alpha have been implicated in breast development as well as breast cancer risk, and also influence functions of stromal fibroblasts. Here, the current knowledge and understanding of the underlying biological mechanisms that lead to high mammographic density and the associated increased risk of breast cancer are reviewed, with particular consideration to potential immune factors that may contribute to this process.

scholarly journals Preferences for breast cancer prevention among women with a BRCA1 or BRCA2 mutation

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Carol A. Mansfield ◽  
◽  
Kelly A. Metcalfe ◽  
Carrie Snyder ◽  
Geoffrey J. Lindeman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Reduction ◽  
Online Survey ◽  
Brca2 Mutation ◽  
Bilateral Mastectomy ◽  
Reduction Strategies ◽  
Risk Reduction Strategies ◽  
Cancer Risk Reduction

Abstract Background Women with a BRCA1 or BRCA2 mutation have high lifetime risks of developing breast and ovarian cancer. The decision to embark on risk reduction strategies is a difficult and personal one. We surveyed an international group of women with BRCA mutations and measured choices and sequence of breast cancer risk reduction strategies. Methods Women with a BRCA1/2 mutation and no previous cancer diagnosis were recruited from the US, Canada, the UK, Australia, and from a national advocacy group. Using an online survey, we asked about cancer-risk reduction preferences including for one of two hypothetical medicines, randomly assigned, and women’s recommendations for a hypothetical woman (Susan, either a 25- or 36-year-old). Sunburst diagrams were generated to illustrate hierarchy of choices. Results Among 598 respondents, mean age was 40.9 years (range 25–55 years). Timing of the survey was 4.8 years (mean) after learning their positive test result and 33% had risk-reducing bilateral salpingo-oophorectomy (RRBSO) and bilateral mastectomy (RRBM), while 19% had RRBSO only and 16% had RRBM only. Although 30% said they would take a hypothetical medicine, 6% reported taking a medicine resembling tamoxifen. Respondents were 1.5 times more likely to select a hypothetical medicine for risk reduction when Susan was 25 than when Susan was 36. Women assigned to 36-year-old Susan were more likely to choose a medicine if they had a family member diagnosed with breast cancer and personal experience taking tamoxifen. Conclusions Women revealed a willingness to undergo surgeries to achieve largest reduction in breast cancer risk, although this would not be recommended for a younger woman in her 20s. The goal of achieving the highest degree of cancer risk reduction is the primary driver for women with BRCA1 or BRCA2 mutations in selecting an intervention and a sequence of interventions, regardless of whether it is non-surgical or surgical.

scholarly journals Dietary pattern and breast cancer risk in Japanese women: the Japan Public Health Center-based Prospective Study (JPHC Study)

2016 ◽  
Vol 115 (10) ◽  
pp. 1769-1779 ◽  
Author(s):  
Sangah Shin ◽  
Eiko Saito ◽  
Manami Inoue ◽  
Norie Sawada ◽  
Junko Ishihara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
Menopausal Status ◽  
Japanese Women ◽  
Hazard Ratios ◽  
Increased Risk

AbstractEvidence that diet is associated with breast cancer risk is inconsistent. Most of the studies have focused on risks associated with specific foods and nutrients, rather than overall diet. In this study, we aimed to evaluate the association between dietary patterns and breast cancer risk in Japanese women. A total of 49 552 Japanese women were followed-up from 1995 to 1998 (5-year follow-up survey) until the end of 2012 for an average of 14·6 years. During 725 534 person-years of follow-up, 718 cases of breast cancer were identified. We identified three dietary patterns (prudent, westernised and traditional Japanese). The westernised dietary pattern was associated with a 32 % increase in breast cancer risk (hazard ratios (HR) 1·32; 95 % CI 1·03, 1·70; Ptrend=0·04). In particular, subjects with extreme intake of the westernised diet (quintile (Q) Q5_5th) had an 83 % increase in risk of breast cancer in contrast to those in the lowest Q1 (HR 1·83; 95 % CI 1·25, 2·68; Ptrend=0·01). In analyses stratified by menopausal status, postmenopausal subjects in the highest quintile of the westernised dietary pattern had a 29 % increased risk of breast cancer (HR 1·29; 95 % CI 0·99, 1·76; Ptrend=0·04). With regard to hormone receptor status, the westernised dietary pattern was associated with an increased risk of oestrogen receptor-positive/progesterone receptor-positivetumours (HR 2·49; 95 % CI 1·40, 4·43; Ptrend<0·01). The other dietary patterns were not associated with the risk of breast cancer in Japanese women. A westernised dietary pattern is associated with an increased risk of breast cancer in Japanese women.

scholarly journals Specific serum carotenoids are inversely associated with breast cancer risk among Chinese women: a case–control study

2015 ◽  
Vol 115 (1) ◽  
pp. 129-137 ◽  
Author(s):  
Bo Yan ◽  
Min-Shan Lu ◽  
Lian Wang ◽  
Xiong-Fei Mo ◽  
Wei-Ping Luo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Chinese Women ◽  
Menopausal Status ◽  
Premenopausal Women ◽  
Protective Role ◽  
Teaching Hospitals ◽  
Serum Carotenoids

AbstractPrevious epidemiological studies have revealed the anti-cancer effect of dietary circulating carotenoids. However, the protective role of specific individual circulating carotenoids has not been elucidated. The purpose of this study was to examine whether serum carotenoids, includingα-carotene,β-carotene,β-cryptoxanthin, lycopene and lutein/zeaxanthin, could lower the risk for breast cancer among Chinese women. A total of 521 women with breast cancer and age-matched controls (5-year interval) were selected from three teaching hospitals in Guangzhou, China. Concentrations ofα-carotene,β-carotene,β-cryptoxanthin, lycopene and lutein/zeaxanthin were measured using HPLC. Unconditional logistic regression models were used to calculate OR and 95 % CI using quartiles defined in the control subjects. Significant inverse associations were observed between serumα-carotene,β-carotene, lycopene, lutein/zeaxanthin and the risk for breast cancer. The multivariate OR for the highest quartile of serum concentration compared with the lowest quartile were 0·44 (95 % CI 0·30, 0·65) forα-carotene, 0·27 (95 % CI 0·18, 0·40) forβ-carotene, 0·41 (95 % CI 0·28, 0·61) for lycopene and 0·26 (95 % CI 0·17, 0·38) for lutein/zeaxanthin. However, no significant association was found between serumβ-cryptoxanthin and the risk for breast cancer. Stratified analysis by menopausal status and oestrogen receptor (ER)/progesterone receptor (PR) showed that serumα-carotene,β-carotene, lycopene and lutein/zeaxanthin were inversely associated with breast cancer risk among premenopausal women and among all subtypes of ER or PR status. The results suggest a protective role ofα-carotene,β-carotene, lycopene and lutein/zeaxanthin, but notβ-cryptoxanthin, in breast cancer risk.

scholarly journals Mammographic density and breast cancer risk: the role of the fat surrounding the fibroglandular tissue

2011 ◽  
Vol 13 (5) ◽  
Author(s):  
Mariëtte Lokate ◽  
Petra HM Peeters ◽  
Linda M Peelen ◽  
Gerco Haars ◽  
Wouter B Veldhuis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Mammographic Density ◽  
Fibroglandular Tissue

scholarly journals Mammographic Density Changes over Time and Breast Cancer Risk: A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4805
Author(s):  
Arezo Mokhtary ◽  
Andreas Karakatsanis ◽  
Antonis Valachis
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cohort Studies ◽  
Mammographic Density ◽  
Breast Density ◽  
Meta Analysis ◽  
Increased Risk ◽  
Changes Over Time ◽  
Over Time

The aim of this meta-analysis was to evaluate the association between mammographic density changes over time and the risk of breast cancer. We performed a systematic literature review based on the PubMed and ISI Web of Knowledge databases. A meta-analysis was conducted by computing extracted hazard ratios (HRs) and 95% confidence intervals (CIs) for cohort studies or odds ratios (ORs) and 95% confidence interval using inverse variance method. Of the nine studies included, five were cohort studies that used HR as a measurement type for their statistical analysis and four were case–control or cohort studies that used OR as a measurement type. Increased breast density over time in cohort studies was associated with higher breast cancer risk (HR: 1.61; 95% CI: 1.33–1.96) whereas decreased breast density over time was associated with lower breast cancer risk (HR: 0.78; 95% CI: 0.71–0.87). Similarly, increased breast density over time was associated with higher breast cancer risk in studies presented ORs (pooled OR: 1.85; 95% CI: 1.29–2.65). Our findings imply that an increase in breast density over time seems to be linked to an increased risk of breast cancer, whereas a decrease in breast density over time seems to be linked to a lower risk of breast cancer.

American Society of Clinical Oncology Technology Assessment on Breast Cancer Risk Reduction Strategies: Tamoxifen and Raloxifene

1999 ◽  
Vol 17 (6) ◽  
pp. 1939-1939 ◽  
Author(s):  
Rowan T. Chlebowski ◽  
Deborah E. Collyar ◽  
Mark R. Somerfield ◽  
David G. Pfister
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Reduction ◽  
Technology Assessment ◽  
Reduction Strategies ◽  
Breast Cancer Risk Reduction ◽  
American Society ◽  
Risk Reduction Strategies ◽  
Cancer Risk Reduction

OBJECTIVE: To conduct an evidence-based technology assessment to determine whether tamoxifen and raloxifene as breast cancer risk-reduction strategies are appropriate for broad-based conventional use in clinical practice. POTENTIAL INTERVENTION: Tamoxifen and raloxifene. OUTCOME: Outcomes of interest include breast cancer incidence, breast cancer-specific survival, overall survival, and net health benefits. EVIDENCE: A comprehensive, formal literature review was conducted for tamoxifen and raloxifene on the following topics: breast cancer risk reduction; tamoxifen side effects and toxicity, including endometrial cancer risk; tamoxifen influences on nonmalignant diseases, including coronary heart disease and osteoporosis; and decision making by women at risk for breast cancer. Testimony was collected from invited experts and interested parties. VALUES: More weight was given to publications that described randomized trials. BENEFITS/HARMS/COSTS: The American Society of Clinical Oncology (ASCO) Working Group acknowledges that a woman's decision regarding breast cancer risk-reduction strategies will depend on the importance and weight attributed to the information provided regarding both cancer and non–cancer-related risks. CONCLUSIONS: For women with a defined 5-year projected risk of breast cancer of ≥ 1.66%, tamoxifen (at 20 mg/d for up to 5 years) may be offered to reduce their risk. It is premature to recommend raloxifene use to lower the risk of developing breast cancer outside of a clinical trial setting. On the basis of available information, use of raloxifene should currently be reserved for its approved indication to prevent bone loss in postmenopausal women. Conclusions are based on single-agent use of the drugs. At the present time, the effect of using tamoxifen or raloxifene with other medications (such as hormone replacement therapy), or using tamoxifen and raloxifene in combination or sequentially, has not been studied adequately. The continuing use of placebo-controlled trials in other risk-reduction trials highlights the current unanswered issues concerning the use of such interventions, especially when the influence on net health benefit remains to be determined. Breast cancer risk reduction is a rapidly evolving area. This technology assessment represents an ongoing process with existing plans to monitor and review data and to update recommendations in a timely matter. (See Table 1 for a summary of conclusions.) VALIDATION: The conclusions of the Working Group were evaluated by the ASCO Health Services Research Committee and by the ASCO Board of Directors. SPONSOR: American Society of Clinical Oncology.

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