Interaction of mammographic breast density with menopausal status and postmenopausal hormone use in relation to the risk of aggressive breast cancer subtypes. Academic Article uri icon

Overview

abstract

  • PURPOSE: We examined the associations of mammographic breast density with breast cancer risk by tumor aggressiveness and by menopausal status and current postmenopausal hormone therapy. METHODS: This study included 2596 invasive breast cancer cases and 4059 controls selected from participants of four nested case-control studies within four established cohorts: the Mayo Mammography Health Study, the Nurses' Health Study, Nurses' Health Study II, and San Francisco Mammography Registry. Percent breast density (PD), absolute dense (DA), and non-dense areas (NDA) were assessed from digitized film-screen mammograms using a computer-assisted threshold technique and standardized across studies. We used polytomous logistic regression to quantify the associations of breast density with breast cancer risk by tumor aggressiveness (defined as presence of at least two of the following tumor characteristics: size ≥2 cm, grade 2/3, ER-negative status, or positive nodes), stratified by menopausal status and current hormone therapy. RESULTS: Overall, the positive association of PD and borderline inverse association of NDA with breast cancer risk was stronger in aggressive vs. non-aggressive tumors (≥51 vs. 11-25% OR 2.50, 95% CI 1.94-3.22 vs. OR 2.03, 95% CI 1.70-2.43, p-heterogeneity = 0.03; NDA 4th vs. 2nd quartile OR 0.54, 95% CI 0.41-0.70 vs. OR 0.71, 95% CI 0.59-0.85, p-heterogeneity = 0.07). However, there were no differences in the association of DA with breast cancer by aggressive status. In the stratified analysis, there was also evidence of a stronger association of PD and NDA with aggressive tumors among postmenopausal women and, in particular, current estrogen+progesterone users (≥51 vs. 11-25% OR 3.24, 95% CI 1.75-6.00 vs. OR 1.93, 95% CI 1.25-2.98, p-heterogeneity = 0.01; NDA 4th vs. 2nd quartile OR 0.43, 95% CI 0.21-0.85 vs. OR 0.56, 95% CI 0.35-0.89, p-heterogeneity = 0.01), even though the interaction was not significant. CONCLUSION: Our findings suggest that associations of mammographic density with breast cancer risk differ by tumor aggressiveness. While there was no strong evidence that these associations differed by menopausal status or hormone therapy, they did appear more prominent among current estrogen+progesterone users.

authors

  • Yaghjyan, Lusine
  • Tamimi, Rulla
  • Bertrand, Kimberly A
  • Scott, Christopher G
  • Jensen, Matthew R
  • Pankratz, V Shane
  • Brandt, Kathy
  • Visscher, Daniel
  • Norman, Aaron
  • Couch, Fergus
  • Shepherd, John
  • Fan, Bo
  • Chen, Yunn-Yi
  • Ma, Lin
  • Beck, Andrew H
  • Cummings, Steven R
  • Kerlikowske, Karla
  • Vachon, Celine M

publication date

  • June 17, 2017

Research

keywords

  • Breast
  • Breast Density
  • Breast Neoplasms
  • Estrogen Replacement Therapy
  • Menopause

Identity

PubMed Central ID

  • PMC5773252

Scopus Document Identifier

  • 85020537610

Digital Object Identifier (DOI)

  • 10.1007/s10549-017-4341-2

PubMed ID

  • 28624977

Additional Document Info

volume

  • 165

issue

  • 2