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Impact of Breast Density on the Presenting Features of Malignancy

  • American Society of Breast Surgeons
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To determine the relationship between breast density, presenting features and molecular subtype of cancer, and surgical treatment received.

Methods

Retrospective review of a prospectively maintained database. Eligible patients had stage 1–3 cancer, were treated between 1/2005 and 6/2007, and had estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) measurements and films available for review. Density was classified at presentation as 1–4 using the Breast Imaging Reporting and Data System (BI-RADS) classification.

Results

1,323 patients were included. Significant differences across the four density groups were present in age, race, multicentricity/focality, and presence of an extensive intraductal component (EIC). When density was combined into two groups, after adjustment for age, only an EIC and mammographically occult cancer were significantly more common in the dense groups. Extremely dense breasts (BI-RADS density 4) more commonly had luminal A tumors (p = 0.05), lobular cancers (p = 0.03), multicentricity (p = 0.02), and occult tumors (p < 0.0001). Greater density was associated with increased mastectomy use, with 61% of the extremely dense group having mastectomy versus 43% of those of lesser density (p = 0.01).

Conclusions

Cancers in extremely dense breasts occur in younger women, are more often mammographically occult, and appear to be phenotypically different from those arising in other density groups. The more common use of mastectomy may be related to these features, although density itself is not a selection criterion for mastectomy.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, New York, NY, USA

    Nimmi Arora MD, Tari A. King MD, Michelle M. Stempel MPH & Monica Morrow MD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Lindsay M. Jacks MS & Sujata Patil PhD

  3. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Elizabeth Morris MD

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  1. Nimmi Arora MD
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  2. Tari A. King MD
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  3. Lindsay M. Jacks MS
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  4. Michelle M. Stempel MPH
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  5. Sujata Patil PhD
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  6. Elizabeth Morris MD
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  7. Monica Morrow MD
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Correspondence to Monica Morrow MD.

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Arora, N., King, T.A., Jacks, L.M. et al. Impact of Breast Density on the Presenting Features of Malignancy. Ann Surg Oncol 17 (Suppl 3), 211–218 (2010). https://doi.org/10.1245/s10434-010-1237-3

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  • DOI: https://doi.org/10.1245/s10434-010-1237-3

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