Advertisement

European Radiology

, Volume 26, Issue 7, pp 2308–2316 | Cite as

Association between breast cancer, breast density, and body adiposity evaluated by MRI

  • Wenlian Zhu
  • Peng Huang
  • Katarzyna J. Macura
  • Dmitri Artemov
Breast

Abstract

Objective

Despite the lack of reliable methods with which to measure breast density from 2D mammograms, numerous studies have demonstrated a positive association between breast cancer and breast density. The goal of this study was to study the association between breast cancer and body adiposity, as well as breast density quantitatively assessed from 3D MRI breast images.

Methods

Breast density was calculated from 3D T1-weighted MRI images. The thickness of the upper abdominal adipose layer was used as a surrogate marker for body adiposity. We evaluated the correlation between breast density, age, body adiposity, and breast cancer.

Results

Breast density was calculated for 410 patients with unilateral invasive breast cancer, 73 patients with ductal carcinoma in situ (DCIS), and 361 controls without breast cancer. Breast density was inversely related to age and the thickness of the upper abdominal adipose layer. Breast cancer was only positively associated with body adiposity and age.

Conclusion

Age and body adiposity are predictive of breast density. Breast cancer was not associated with breast density; however, it was associated with the thickness of the upper abdominal adipose layer, a surrogate marker for body adiposity. Our results based on a limited number of patients warrant further investigations.

Key points

MRI breast density is negatively associated with body adiposity.

MRI breast density is negatively associated with age.

Breast cancer is positively associated with body adiposity.

Breast Cancer is not associated with MRI breast density.

Keywords

Magnetic resonance imaging Breast cancer Breast density Adiposity Age 

Abbreviations

BI-RADS

Breast Imaging Reporting and Data System

2D

two-dimensional

3D

three-dimensional

BD

breast density

IC

invasive breast cancer

DCIS

ductal carcinoma in situ

NoCA

no breast cancer diagnosed

UAAL

upper abdominal adipose layer

TU

the thickness of the upper abdominal adipose layer

BMI

body mass index

Notes

Acknowledgments

We thank Dr. Vered Stearns for helpful discussions. We are grateful to Ms. Mary McAllister for editorial help with this manuscript. The scientific guarantor of this publication is Wenlian Zhu. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the National Cancer Institutes CA154738. Peng Huang kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, cross sectional, performed at one institution.

References

  1. 1.
    Wolfe JN (1976) Breast patterns as an index of risk for developing breast cancer. AJR Am J Roentgenol 126:1130–1137CrossRefPubMedGoogle Scholar
  2. 2.
    Vachon CM, van Gils CH, Sellers TA et al (2007) Mammographic density, breast cancer risk and risk prediction. Breast Cancer Res 9:217CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fowler EE, Vachon CM, Scott CG, Sellers TA, Heine JJ (2014) Automated percentage of breast density measurements for full-field digital mammography applications. Acad Radiol 21:958–970CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Boyd NF, Martin LJ, Yaffe MJ, Minkin S (2011) Mammographic density and breast cancer risk: current understanding and future prospects. Breast Cancer Res 13:223CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    D’Orsi CJ SE, Mendelson EB, Morris EA et al (2013) ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. American College of Radiology, RestonGoogle Scholar
  6. 6.
    (2013) American College of Radiology BI-RADS® ATLAS — MAMMOGRAPHY 5th Edition. Available via http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/BIRADS/01%20Mammography/02%20%20BIRADS%20Mammography%20Reporting.pdf
  7. 7.
    Kopans DB (2008) Basic physics and doubts about relationship between mammographically determined tissue density and breast cancer risk. Radiology 246:348–353CrossRefPubMedGoogle Scholar
  8. 8.
    Colin C, Schott AM, Valette PJ (2014) Mammographic density is not a worthwhile examination to distinguish high cancer risk women in screening. Eur Radiol 24:2412–2416CrossRefPubMedGoogle Scholar
  9. 9.
    Thompson DJ, Leach MO, Kwan-Lim G et al (2009) Assessing the usefulness of a novel MRI-based breast density estimation algorithm in a cohort of women at high genetic risk of breast cancer: the UK MARIBS study. Breast Cancer Res 11:R80CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hartman K, Highnam R, Warren R, Jackson V (2008) Volumetric Assessment of Breast Tissue Composition from FFDM Images. In: Krupinski E (ed) International Workshop on Digital Mammography. Lecture Notes in Computer Science, Tucson, pp 33–39CrossRefGoogle Scholar
  11. 11.
    van Engeland S, Snoeren PR, Huisman H, Boetes C, Karssemeijer N (2006) Volumetric breast density estimation from full-field digital mammograms. IEEE Trans Med Imaging 25:273–282CrossRefPubMedGoogle Scholar
  12. 12.
    Wang J, Azziz A, Fan B et al (2013) Agreement of mammographic measures of volumetric breast density to MRI. PLoS One 8, e81653CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Conant EF (2014) Clinical implementation of digital breast tomosynthesis. Radiol Clin North Am 52:499–518CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Khazen M, Warren RM, Boggis CR et al (2008) A pilot study of compositional analysis of the breast and estimation of breast mammographic density using three-dimensional T1-weighted magnetic resonance imaging. Cancer Epidemiol Biomarkers Prev 17:2268–2274CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Nie K, Chen JH, Chan S et al (2008) Development of a quantitative method for analysis of breast density based on three-dimensional breast MRI. Med Phys 35:5253–5262CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Boyd N, Martin L, Chavez S et al (2009) Breast-tissue composition and other risk factors for breast cancer in young women: a cross-sectional study. Lancet Oncol 10:569–580CrossRefPubMedGoogle Scholar
  17. 17.
    Wengert GJ, Helbich TH, Vogl WD et al (2015) Introduction of an automated user-independent quantitative volumetric magnetic resonance imaging breast density measurement system using the Dixon sequence: comparison with mammographic breast density assessment. Invest Radiol 50:73–80CrossRefPubMedGoogle Scholar
  18. 18.
    Calle EE, Kaaks R (2004) Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4:579–591CrossRefPubMedGoogle Scholar
  19. 19.
    Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D (2007) Cancer incidence and mortality in relation to body mass index in the million women study: cohort study. BMJ 335:1134CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578CrossRefPubMedGoogle Scholar
  21. 21.
    Benz CC (2008) Impact of aging on the biology of breast cancer. Crit Rev Oncol Hematol 66:65–74CrossRefPubMedGoogle Scholar
  22. 22.
    Ziv E, Shepherd J, Smith-Bindman R, Kerlikowske K (2003) Mammographic breast density and family history of breast cancer. J Natl Cancer Inst 95:556–558CrossRefPubMedGoogle Scholar
  23. 23.
    Martin LJ, Boyd NF (2008) Mammographic density. Potential mechanisms of breast cancer risk associated with mammographic density: hypotheses based on epidemiological evidence. Breast Cancer Res 10:201CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Ho JM, Jafferjee N, Covarrubias GM, Ghesani M, Handler B (2014) Dense breasts: a review of reporting legislation and available supplemental screening options. AJR Am J Roentgenol 203:449–456CrossRefPubMedGoogle Scholar
  25. 25.
    Peres J (2012) Understanding breast density and breast cancer risk. J Natl Cancer Inst 104:1345–1346CrossRefPubMedGoogle Scholar
  26. 26.
    Javitt MC (2015) Section editor’s notebook. Breast density and breast cancer risk-eyes wide open. AJR Am J Roentgenol 204:231–233CrossRefPubMedGoogle Scholar
  27. 27.
    Schautz B, Later W, Heller M, Muller MJ, Bosy-Westphal A (2011) Associations between breast adipose tissue, body fat distribution and cardiometabolic risk in women: cross-sectional data and weight-loss intervention. Eur J Clin Nutr 65:784–790CrossRefPubMedGoogle Scholar
  28. 28.
    Lahmann PH, Lissner L, Gullberg B, Olsson H, Berglund G (2003) A prospective study of adiposity and postmenopausal breast cancer risk: the Malmo Diet and Cancer Study. Int J Cancer 103:246–252CrossRefPubMedGoogle Scholar
  29. 29.
    Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R (2002) Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 75:683–688PubMedGoogle Scholar
  30. 30.
    Fanelli MT, Kuczmarski RJ (1984) Ultrasound as an approach to assessing body composition. Am J Clin Nutr 39:703–709PubMedGoogle Scholar
  31. 31.
    Lin M, Chan S, Chen JH et al (2011) A new bias field correction method combining N3 and FCM for improved segmentation of breast density on MRI. Med Phys 38:5–14CrossRefPubMedGoogle Scholar
  32. 32.
    Juntu J, Sijbers J, Van Dyck D, Gielen J (2005) Bias field correction for MRI images. Computer Recognition Systems, Proceedings:543-551Google Scholar
  33. 33.
    Titus-Ernstoff L, Tosteson AN, Kasales C et al (2006) Breast cancer risk factors in relation to breast density (United States). Cancer Causes Control 17:1281–1290CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Eng A, Gallant Z, Shepherd J et al (2014) Digital mammographic density and breast cancer risk: a case-control study of six alternative density assessment methods. Breast Cancer Res 16:439CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Novotny R, Daida Y, Morimoto Y, Shepherd J, Maskarinec G (2011) Puberty, body fat, and breast density in girls of several ethnic groups. Am J Hum Biol 23:359–365CrossRefPubMedGoogle Scholar
  36. 36.
    Woolcott CG, Courneya KS, Boyd NF et al (2010) Mammographic density change with 1 year of aerobic exercise among postmenopausal women: a randomized controlled trial. Cancer Epidemiol Biomarkers Prev 19:1112–1121CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Morimoto LM, White E, Chen Z et al (2002) Obesity, body size, and risk of postmenopausal breast cancer: the Women’s Health Initiative (United States). Cancer Causes Control 13:741–751CrossRefPubMedGoogle Scholar
  38. 38.
    Saslow D, Boetes C, Burke W et al (2007) American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57:75–89CrossRefPubMedGoogle Scholar
  39. 39.
    (2001) Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. Lancet 358:1389-1399Google Scholar
  40. 40.
    Rakow-Penner R, Daniel B, Yu H, Sawyer-Glover A, Glover GH (2006) Relaxation times of breast tissue at 1.5T and 3T measured using IDEAL. J Magn Reson Imaging 23:87–91CrossRefPubMedGoogle Scholar
  41. 41.
    Thomas EL, Saeed N, Hajnal JV et al (1985) (1998) Magnetic resonance imaging of total body fat. J Appl Physiol 85:1778–1785Google Scholar
  42. 42.
    Chen JH, Chan S, Tang YT et al (2015) Impact of positional difference on the measurement of breast density using MRI. Med Phys 42:2268–2275CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Wenlian Zhu
    • 1
  • Peng Huang
    • 2
  • Katarzyna J. Macura
    • 3
    • 4
  • Dmitri Artemov
    • 1
    • 4
  1. 1.Division of Cancer Imaging Research, Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Oncology, Biostatistics and Bioinformatics Division, School of Medicine; Department of Biostatistics, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  3. 3.Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations