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

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

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.

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Acknowledgements

This study was supported by the National Institutes of Health (Grant Numbers CA140286 to C. M.V. and K.K., CA087969 to R.M.T., UM1 CA176726 to W.W., UM1 CA186107 to M.S.), Mayo Clinic Specialized Program of Research Excellence (SPORE) in Breast Cancer (Grant Number P50 CA116201 to M.P.G. and J.N.I.), Mayo Clinic Cancer Center, and Breast Cancer Research Foundation. We would like to thank the participants and staff of the NHS and NHSII for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data.

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Authors and Affiliations

  1. Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA

    Lusine Yaghjyan

  2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA

    Rulla M. Tamimi

  3. Department of Epidemiology, Harvard T.H Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Rulla M. Tamimi

  4. Slone Epidemiology Center at Boston University, Boston, MA, USA

    Kimberly A. Bertrand

  5. Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Christopher G. Scott, Matthew R. Jensen & V. Shane Pankratz

  6. Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA

    Kathy Brandt

  7. Department of Anatomic Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Daniel Visscher

  8. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Aaron Norman, Fergus Couch & Celine M. Vachon

  9. Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Fergus Couch

  10. Department of Radiology, University of California, 1 Irving Street, AC109, San Francisco, CA, 94143, USA

    John Shepherd

  11. Department of Pathology, University of California, 505 Parnassus AvenueRoom M559, Box 0102, San Francisco, CA, 94143, USA

    Bo Fan & Yunn-Yi Chen

  12. Department of Medicine, University of California, 1635 Divisadero St. Suite 600, Box 1793, San Francisco, CA, USA

    Lin Ma

  13. Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA

    Andrew H. Beck

  14. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, 475 Brannan Street, Suite 220, San Francisco, CA, 94107, USA

    Steven R. Cummings

  15. Departments of Medicine and Epidemiology and Biostatistics, University of California, 4150 Clement Street, Mailing Code 111A1, San Francisco, CA, 94121, USA

    Karla Kerlikowske

  16. General Internal Medicine Section, Department of Veterans Affairs, University of California, 4150 Clement Street, Mailing Code 111A1, San Francisco, CA, 94121, USA

    Karla Kerlikowske

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  1. Lusine Yaghjyan
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  2. Rulla M. Tamimi
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  3. Kimberly A. Bertrand
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  4. Christopher G. Scott
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  6. V. Shane Pankratz
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  7. Kathy Brandt
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  8. Daniel Visscher
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  9. Aaron Norman
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  11. John Shepherd
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  12. Bo Fan
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  13. Yunn-Yi Chen
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  14. Lin Ma
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  15. Andrew H. Beck
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  16. Steven R. Cummings
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  17. Karla Kerlikowske
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  18. Celine M. Vachon
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Corresponding author

Correspondence to Lusine Yaghjyan.

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This study was approved by the Institutional Review Boards at the Mayo Clinic, Brigham and Women’s Hospital, and the University of California, San Francisco. Informed consent was obtained or implied by return of questionnaires (NHS, NHSII).

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The authors declare that they have no conflict of interest.

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Yaghjyan, L., Tamimi, R.M., Bertrand, K.A. et al. Interaction of mammographic breast density with menopausal status and postmenopausal hormone use in relation to the risk of aggressive breast cancer subtypes. Breast Cancer Res Treat 165, 421–431 (2017). https://doi.org/10.1007/s10549-017-4341-2

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