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Associations between mammographic density and tumor characteristics in Chinese women with breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Mammographic density (MD) is a strong risk factor for breast cancer, yet its relationship with tumor characteristics is not well established, particularly in Asian populations.

Methods

MD was assessed from a total of 2001 Chinese breast cancer patients using Breast Imaging Reporting and Data System (BI-RADS) categories. Molecular subtypes were defined using immunohistochemical status on ER, PR, HER2, and Ki-67, as well as tumor grade. Multinomial logistic regression was used to test associations between MD and molecular subtype (luminal A = reference) adjusting for age, body mass index (BMI), menopausal status, parity, and nodal status.

Results

The mean age at diagnosis was 51.7 years (SD = 10.7) and the average BMI was 24.7 kg/m2 (SD = 3.8). The distribution of BI-RADS categories was 7.4% A = almost entirely fat, 24.2% B = scattered fibroglandular dense, 49.4% C = heterogeneously dense, and 19.0% D = extremely dense. Compared to women with BI-RADS = A/B, women with BI-RADS = D were more likely to have HER2-enriched tumors (OR = 1.81, 95% CI 1.08–3.06, p = 0.03), regardless of menopausal status. The association was only observed in women with normal (< 25 kg/m2) BMI (OR = 2.43, 95% CI 1.24–4.76, p < 0.01), but not among overweight/obese women (OR: 0.98, 95% CI 0.38–2.52, p = 0.96).

Conclusions

Among Chinese women with normal BMI, higher breast density was associated with HER2-enriched tumors. The results may partially explain the higher proportion of HER2+ tumors previously reported in Asian women.

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Abbreviations

MD:

Mammographic density

ER+:

Estrogen receptor-positive

ER−:

Estrogen receptor-negative

PR+:

Progesterone receptor-positive

PR−:

Progesterone receptor-negative

CHCAMS:

Chinese Academy of Medical Sciences and Peking Union Medical College

BI-RADS:

Breast Imaging Reporting and Data System

IHC:

Immunohistochemical

FISH:

Fluorescence in situ hybridization

BMI:

Body mass index

ANOVA:

Analysis of variance

OR:

Odds ratio

CI:

Confidence interval

SD:

Standard deviation

DAS:

Density analysis software

SEER:

Surveillance, Epidemiology, and End Results

TDLU:

Terminal duct lobular involution

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Acknowledgement

This work was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics.

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Author notes

  1. Erni Li and Jennifer L. Guida contributed equally to this work.

Authors and Affiliations

  1. National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Erni Li, Yuan Tian, Changyuan Guo, Ning Lu & Jing Li

  2. Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA

    Jennifer L. Guida, Hyuna Sung, Hela Koka, Mengjie Li, Han Zhang, Eric Tang, Joseph Deng, Nan Hu, Gretchen L. Gierach & Xiaohong R. Yang

  3. Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA

    Jennifer L. Guida

  4. Cancer Surveillance and Health Services Program, American Cancer Society, Atlanta, GA, 30303, USA

    Hyuna Sung

  5. Vanderbilt University, Nashville, TN, USA

    Mengjie Li

  6. Volpara Health Technologies Ltd, Wellington, New Zealand

    Ariane Chan

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Li, E., Guida, J.L., Tian, Y. et al. Associations between mammographic density and tumor characteristics in Chinese women with breast cancer. Breast Cancer Res Treat 177, 527–536 (2019). https://doi.org/10.1007/s10549-019-05325-6

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