Skip to main content

Advertisement

SpringerLink
Log in

Mammographic density as a marker of breast cancer risk?

  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Mammographic density is a strong, independent risk factor for breast cancer. Women with high mammographic density have a fourfold increased risk for breast cancer compared with women with low density. Because age and obesity are the strongest predictors of mammographic density, it is important to adjust for them in risk analyses. In randomized trials, tamoxifen decreased risk for breast cancer and also decreased mammographic density. Combined estrogen plus progestin therapy increased mammographic density. Density is a strong risk factor in low-risk groups (Asian women) and high-risk groups (BRCA mutation carriers). Several risk assessment tools now incorporate mammographic density, including an updated Gail model, though these models require additional validation before they should be used widely. Improvements in density measurements may allow risk assessment to occur routinely with mammography and improve targeting of breast cancer prevention efforts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Wolfe JN: Risk for breast cancer development determined by mammographic parenchymal pattern. Cancer. 1976, 37:2486–2492.

    Article  PubMed  CAS  Google Scholar 

  2. McCormack VA, dos Santos Silva I: Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2006, 15:1159–1169.

    Article  PubMed  Google Scholar 

  3. American College of Radiology: Breast Imaging Reporting and Data System (BI-RADS), edn 4. Reston, VA: American College of Radiology; 2003.

  4. Tice JA, Cummings SR, Smith-Bindman R, et al.: Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model. Ann Intern Med 2008, 148:337–347.

    PubMed  Google Scholar 

  5. Cummings SR, Tice JA, Bauer S, et al.: Prevention of breast cancer in postmenopausal women: approaches to estimating and reducing risk. J Natl Cancer Inst 2009, 101:384–398.

    Article  PubMed  Google Scholar 

  6. Byng JW, Boyd NF, Fishell E, et al.: The quantitative analysis of mammographic densities. Phys Med Biol 1994, 39:1629–1638.

    Article  PubMed  CAS  Google Scholar 

  7. Boyd NF, Guo H, Martin LJ, et al.: Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007, 356:227–236.

    Article  PubMed  CAS  Google Scholar 

  8. Byrne C, Schairer C, Wolfe J, et al.: Mammographic features and breast cancer risk: effects with time, age, and menopause status. J Natl Cancer Inst 1995, 87:1622–1629.

    Article  PubMed  CAS  Google Scholar 

  9. Pankow JS, Vachon CM, Kuni CC, et al.: Genetic analysis of mammographic breast density in adult women: evidence of a gene effect. J Natl Cancer Inst 1997, 89:549–556.

    Article  PubMed  CAS  Google Scholar 

  10. Kerlikowske K, Grady D, Barclay J, et al.: Effect of age, breast density, and family history on the sensitivity of first screening mammography. JAMA 1996, 276:33–38.

    Article  PubMed  CAS  Google Scholar 

  11. Grove JS, Goodman MJ, Gilbert FI Jr, Mi MP: Factors associated with mammographic pattern. Br J Radiol 1985, 58:21–25.

    Article  PubMed  CAS  Google Scholar 

  12. Boyd NF, Martin LJ, Sun L, et al.: Body size, mammographic density, and breast cancer risk. Cancer Epidemiol Biomarkers Prev 2006, 15:2086–2092.

    Article  PubMed  Google Scholar 

  13. Dite GS, Gurrin LC, Byrnes GB, et al.: Predictors of mammographic density: insights gained from a novel regression analysis of a twin study. Cancer Epidemiol Biomarkers Prev 2008, 17:3474–3481.

    Article  PubMed  Google Scholar 

  14. Martin LJ, Boyd NF: Mammographic density. Potential mechanisms of breast cancer risk associated with mammographic density: hypotheses based on epidemiological evidence. Breast Cancer Res 2008, 10:201.

    Article  PubMed  CAS  Google Scholar 

  15. Attam A, Kaur N, Saha S, Bhargava SK: Mammographic density as a risk factor for breast cancer in a low risk population. Indian J Cancer 2008, 45:50–53.

    Article  PubMed  CAS  Google Scholar 

  16. del Carmen MG, Halpern EF, Kopans DB, et al.: Mammographic breast density and race. AJR Am J Roentgenol 2007, 188:1147–1150.

    Article  PubMed  Google Scholar 

  17. Kotsuma Y, Tamaki Y, Nishimura T, et al.: Quantitative assessment of mammographic density and breast cancer risk for Japanese women. Breast 2008, 17:27–35.

    Article  PubMed  Google Scholar 

  18. Maskarinec G, Pagano I, Chen Z, et al.: Ethnic and geographic differences in mammographic density and their association with breast cancer incidence. Breast Cancer Res Treat 2007, 104:47–56.

    Article  PubMed  Google Scholar 

  19. Ziv E, Shepherd J, Smith-Bindman R, Kerlikowske K: Mammographic breast density and family history of breast cancer. J Natl Cancer Inst 2003, 95:556–558.

    PubMed  Google Scholar 

  20. Mitchell G, Antoniou AC, Warren R, et al.: Mammographic density and breast cancer risk in BRCA1 and BRCA2 mutation carriers. Cancer Res 2006, 66:1866–1872.

    Article  PubMed  CAS  Google Scholar 

  21. Cuzick J, Warwick J, Pinney E, et al.: Tamoxifen and breast density in women at increased risk of breast cancer. J Natl Cancer Inst 2004, 96:621–628.

    Article  PubMed  CAS  Google Scholar 

  22. Kelemen LE, Pankratz VS, Sellers TA, et al.: Age-specific trends in mammographic density: the Minnesota Breast Cancer Family Study. Am J Epidemiol 2008, 167:1027–1036.

    Article  PubMed  Google Scholar 

  23. Greendale GA, Reboussin BA, Slone S, et al.: Postmenopausal hormone therapy and change in mammographic density. J Natl Cancer Inst 2003, 95:30–37.

    Article  PubMed  CAS  Google Scholar 

  24. McTiernan A, Martin CF, Peck JD, et al.: Estrogenplus-progestin use and mammographic density in postmenopausal women: Women’s Health Initiative randomized trial. J Natl Cancer Inst 2005, 97:1366–1376.

    PubMed  CAS  Google Scholar 

  25. Greendale GA, Reboussin BA, Sie A, et al.: Effects of estrogen and estrogen-progestin on mammographic parenchymal density. Postmenopausal Estrogen/Progestin Interventions (PEPI) Investigators. Ann Intern Med 1999, 130(4 Pt 1):262–269.

    PubMed  CAS  Google Scholar 

  26. Chlebowski RT, Hendrix SL, Langer RD, et al.: Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA 2003, 289:3243–3253.

    Article  PubMed  CAS  Google Scholar 

  27. Stefanick ML, Anderson GL, Margolis KL, et al.: Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. JAMA 2006, 295:1647–1657.

    Article  PubMed  CAS  Google Scholar 

  28. Atkinson C, Warren R, Bingham SA, Day NE: Mammographic patterns as a predictive biomarker of breast cancer risk: effect of tamoxifen. Cancer Epidemiol Biomarkers Prev 1999, 8:863–866.

    PubMed  CAS  Google Scholar 

  29. Spicer DV, Ursin G, Parisky YR, et al.: Changes in mammographic densities induced by a hormonal contraceptive designed to reduce breast cancer risk. J Natl Cancer Inst 1994, 86:431–436.

    Article  PubMed  CAS  Google Scholar 

  30. Boyd NF, Greenberg C, Lockwood G, et al.: Effects at two years of a low-fat, high-carbohydrate diet on radiologic features of the breast: results from a randomized trial. Canadian Diet and Breast Cancer Prevention Study Group. J Natl Cancer Inst 1997, 89:488–496.

    Article  PubMed  CAS  Google Scholar 

  31. Becker S, Kaaks R: Exogenous and endogenous hormones, mammographic density and breast cancer risk: can mammographic density be considered an intermediate marker of risk? Recent Results Cancer Res 2009, 181:135–157.

    Article  PubMed  CAS  Google Scholar 

  32. Boyd NF, Martin LJ, Li Q, et al.: Mammographic density as a surrogate marker for the effects of hormone therapy on risk of breast cancer. Cancer Epidemiol Biomarkers Prev 2006, 15:961–966.

    Article  PubMed  CAS  Google Scholar 

  33. Grady D, Cauley JA, Geiger MJ, et al.: Reduced incidence of invasive breast cancer with raloxifene among women at increased coronary risk. J Natl Cancer Inst 2008, 100:854–861.

    Article  PubMed  CAS  Google Scholar 

  34. Martino S, Cauley JA, Barrett-Connor E, et al.: Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst 2004, 96:1751–1761.

    Article  PubMed  CAS  Google Scholar 

  35. Vogel VG, Costantino JP, Wickerham DL, et al.: Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006, 295:2727–2741.

    Article  PubMed  CAS  Google Scholar 

  36. Freedman M, San Martin J, O’Gorman J, et al.: Digitized mammography: a clinical trial of postmenopausal women randomly assigned to receive raloxifene, estrogen, or placebo. J Natl Cancer Inst 2001, 93:51–56.

    Article  PubMed  CAS  Google Scholar 

  37. Jackson VP, San Martin JA, Secrest RJ, et al.: Comparison of the effect of raloxifene and continuous-combined hormone therapy on mammographic breast density and breast tenderness in postmenopausal women. Am J Obstet Gynecol 2003, 188:389–394.

    Article  PubMed  CAS  Google Scholar 

  38. Li T, Sun L, Miller N, et al.: The association of measured breast tissue characteristics with mammographic density and other risk factors for breast cancer. Cancer Epidemiol Biomarkers Prev 2005, 14:343–349.

    Article  PubMed  Google Scholar 

  39. Boyd NF, Dite GS, Stone J, et al.: Heritability of mammographic density, a risk factor for breast cancer. N Engl J Med 2002, 347:886–894.

    Article  PubMed  Google Scholar 

  40. Ursin G, Lillie EO, Lee E, et al.: The relative importance of genetics and environment on mammographic density. Cancer Epidemiol Biomarkers Prev 2009, 18:102–112.

    Article  PubMed  Google Scholar 

  41. Kelemen LE, Sellers TA, Vachon CM: Can genes for mammographic density inform cancer aetiology? Nat Rev Cancer 2008, 8:812–823.

    Article  PubMed  CAS  Google Scholar 

  42. Lee E, Haiman CA, Ma H, et al.: The role of established breast cancer susceptibility loci in mammographic density in young women. Cancer Epidemiol Biomarkers Prev 2008, 17:258–260.

    Article  PubMed  CAS  Google Scholar 

  43. Woolcott CG, Maskarinec G, Haiman CA, et al.: Association between breast cancer susceptibility loci and mammographic density: the Multiethnic Cohort. Breast Cancer Res 2009, 11:R10.

    Article  PubMed  CAS  Google Scholar 

  44. Tamimi RM, Cox D, Kraft P, et al.: Breast cancer susceptibility loci and mammographic density. Breast Cancer Res 2008, 10:R66.

    Article  PubMed  CAS  Google Scholar 

  45. Vachon CM, Sellers TA, Carlson EE, et al.: Strong evidence of a genetic determinant for mammographic density, a major risk factor for breast cancer. Cancer Res 2007, 67:8412–8418.

    Article  PubMed  CAS  Google Scholar 

  46. Gail MH, Brinton LA, Byar DP, et al.: Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 1989, 81:1879–1886.

    Article  PubMed  CAS  Google Scholar 

  47. Visvanathan K, Chlebowski RT, Hurley P, et al.: American Society of Clinical Oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction. J Clin Oncol 2009, May 26 (ePub ahead of print).

  48. Rockhill B, Spiegelman D, Byrne C, et al.: Validation of the Gail et al. model of breast cancer risk prediction and implications for chemoprevention. J Natl Cancer Inst 2001, 93:358–366.

    Article  PubMed  CAS  Google Scholar 

  49. Gail MH, Costantino JP, Pee D, et al.: Projecting individualized absolute invasive breast cancer risk in African American Women. J Natl Cancer Inst 2007, 99:1782–1792.

    Article  PubMed  Google Scholar 

  50. Barlow WE, White E, Ballard-Barbash R, et al.: Prospective breast cancer risk prediction model for women undergoing screening mammography. J Natl Cancer Inst 2006, 98:1204–1214.

    PubMed  Google Scholar 

  51. Chen J, Pee D, Ayyagari R, et al.: Projecting absolute invasive breast cancer risk in white women with a model that includes mammographic density. J Natl Cancer Inst 2006, 98:1215–1226.

    Article  PubMed  Google Scholar 

  52. Shepherd JA, Herve L, Landau J, et al.: Novel use of single x-ray absorptiometry for measuring breast density. Technol Cancer Res Treat 2005, 4:173–182.

    PubMed  Google Scholar 

  53. Boyd N, Martin L, Gunasekara A, et al.: Mammographic density and breast cancer risk: evaluation of a novel method of measuring breast tissue volumes. Cancer Epidemiol Biomarkers Prev 2009, 18:1754–1762.

    Article  PubMed  Google Scholar 

  54. Heine JJ, Carston MJ, Scott CG, et al.: An automated approach for estimation of breast density. Cancer Epidemiol Biomarkers Prev 2008, 17:3090–3097.

    Article  PubMed  Google Scholar 

  55. Kataoka M, Atkinson C, Warren R, et al.: Mammographic density using two computer-based methods in an isoflavone trial. Maturitas 2008, 59:350–357.

    Article  PubMed  Google Scholar 

  56. Tamimi RM, Byrne C, Colditz GA, Hankinson SE: Endogenous hormone levels, mammographic density, and subsequent risk of breast cancer in postmenopausal women. J Natl Cancer Inst 2007, 99:1178–1187.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, 1701 Divisadero Street, Suite 554, San Francisco, CA, 94143, USA

    Jeffrey A. Tice

Authors
  1. Jeffrey A. Tice
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey A. Tice.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tice, J.A. Mammographic density as a marker of breast cancer risk?. Curr Breast Cancer Rep 1, 175–180 (2009). https://doi.org/10.1007/s12609-009-0025-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-009-0025-1

Keywords

Search

Navigation