The association between mammographic density and breast cancer risk in Western Australian Aboriginal women

Abstract

Purpose

Mammographic density is an established breast cancer risk factor within many ethnically different populations. The distribution of mammographic density has been shown to be significantly lower in Western Australian Aboriginal women compared to age- and screening location-matched non-Aboriginal women. Whether mammographic density is a predictor of breast cancer risk in Aboriginal women is unknown.

Methods

We measured mammographic density from 103 Aboriginal breast cancer cases and 327 Aboriginal controls, 341 non-Aboriginal cases, and 333 non-Aboriginal controls selected from the BreastScreen Western Australia database using the Cumulus software program. Logistic regression was used to examine the associations of percentage dense area and absolute dense area with breast cancer risk for Aboriginal and non-Aboriginal women separately, adjusting for covariates.

Results

Both percentage density and absolute dense area were strongly predictive of risk in Aboriginal women with odds per adjusted standard deviation (OPERAS) of 1.36 (95% CI 1.09, 1.69) and 1.36 (95% CI 1.08, 1.71), respectively. For non-Aboriginal women, the OPERAS were 1.22 (95% CI 1.03, 1.46) and 1.26 (95% CI 1.05, 1.50), respectively.

Conclusions

Whilst mean mammographic density for Aboriginal women is lower than non-Aboriginal women, density measures are still higher in Aboriginal women with breast cancer compared to Aboriginal women without breast cancer. Thus, mammographic density strongly predicts breast cancer risk in Aboriginal women. Future efforts to predict breast cancer risk using mammographic density or standardize risk-associated mammographic density measures should take into account Aboriginal status when applicable.

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

Fig. 1

Data availability

The datasets generated and analysed during the current study are not publically available but can be made available upon request (and pending approval) from Western Australia’s Department of Health Data Linkage Branch and BreastScreen Western Australia.

Abbreviations

ARIA:

Accessibility/remoteness index of Australia

BMI:

Body mass index

CI:

Confidence interval

DA:

Dense area

FFDM:

Full-field digital mammogram

HT:

Hormone therapy

MD:

Mammographic density

OPERA:

Odds per adjusted standard deviation

OR:

Odd ratio

PDA:

Percent dense area

SD:

Standard deviation

SE:

Standard error

SEIFA:

Socio-economic indexes for areas

SES:

Socio-economic status

TA:

Total area (of the breast)

WA:

Western Australia

References

  1. 1.

    Hopper JL (2015) Odds per adjusted standard deviation: comparing strengths of associations for risk factors measured on different scales and across diseases and populations. Am J Epidemiol 182(10):863–867. https://doi.org/10.1093/aje/kwv193

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    McCormack VA, dos Santos Silva I (2006) Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis. Cancer Epidemiol Biomark Prev 15(6):1159–1169. https://doi.org/10.1158/1055-9965.EPI-06-0034

    Article  Google Scholar 

  3. 3.

    Evans DG, Astley S, Stavrinos P, Harkness E, Donnelly LS, Dawe S, Jacob I, Harvie M, Cuzick J, Brentnall A, Wilson M, Harrison F, Payne K, Howell A (2016) In: Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study. Programme Grants for Applied Research. Southampton (UK). https://doi.org/10.3310/pgfar04110

  4. 4.

    Evans DG, Donnelly LS, Harkness EF, Astley SM, Stavrinos P, Dawe S, Watterson D, Fox L, Sergeant JC, Ingham S, Harvie MN, Wilson M, Beetles U, Buchan I, Brentnall AR, French DP, Cuzick J, Howell A (2016) Breast cancer risk feedback to women in the UK NHS breast screening population. Br J Cancer 114(9):1045–1052. https://doi.org/10.1038/bjc.2016.56

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Stone J (2018) Should breast cancer screening programs routinely measure mammographic density? J Med Imaging Radiat Oncol 62(2):151–158. https://doi.org/10.1111/1754-9485.12652

    Article  PubMed  Google Scholar 

  6. 6.

    Burton A, Maskarinec G, Perez-Gomez B, Vachon C, Miao H, Lajous M, Lopez-Ridaura R, Rice M, Pereira A, Garmendia ML, Tamimi RM, Bertrand K, Kwong A, Ursin G, Lee E, Qureshi SA, Ma H, Vinnicombe S, Moss S, Allen S, Ndumia R, Vinayak S, Teo SH, Mariapun S, Fadzli F, Peplonska B, Bukowska A, Nagata C, Stone J, Hopper J, Giles G, Ozmen V, Aribal ME, Schuz J, Van Gils CH, Wanders JOP, Sirous R, Sirous M, Hipwell J, Kim J, Lee JW, Dickens C, Hartman M, Chia KS, Scott C, Chiarelli AM, Linton L, Pollan M, Flugelman AA, Salem D, Kamal R, Boyd N, Dos-Santos-Silva I, McCormack V (2017) Mammographic density and ageing: a collaborative pooled analysis of cross-sectional data from 22 countries worldwide. PLoS Med 14(6):e1002335. https://doi.org/10.1371/journal.pmed.1002335

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    McLean K, Darcey E, Cadby G, Lund H, Pilkington L, Redfern A, Thompson S, Saunders C, Wylie E, Stone J (2019) The distribution and determinants of mammographic density measures in Western Australian aboriginal women. Breast Cancer Res 21(1):33. https://doi.org/10.1186/s13058-019-1113-4

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Roder D, Webster F, Zorbas H, Sinclair S (2012) Breast screening and breast cancer survival in aboriginal and torres strait Islander women of Australia. Asian Pacific J Cancer Prev 13(1):147–155

    Article  Google Scholar 

  9. 9.

    Christensen D, Davis G, Draper G, Mitrou F, McKeown S, Lawrence D, McAullay D, Pearson G, Rikkers W, Zubrick SR (2016) Evidence for the use of an algorithm in resolving inconsistent and missing indigenous status in administrative data collections. Aust J Soc Issues 49(4):423–443

    Article  Google Scholar 

  10. 10.

    Statistics ABo (2018). http://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa

  11. 11.

    Statistics ABo (2018). http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure

  12. 12.

    Byng JW, Boyd NF, Fishell E, Jong RA, Yaffe MJ (1994) The quantitative analysis of mammographic densities. Phys Med Biol 39(10):1629–1638

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Stone J, Ding J, Warren RM, Duffy SW, Hopper JL (2010) Using mammographic density to predict breast cancer risk: dense area or percentage dense area. Breast Cancer Res 12(6):R97. https://doi.org/10.1186/bcr2778

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Burton A, Byrnes G, Stone J, Tamimi RM, Heine J, Vachon C, Ozmen V, Pereira A, Garmendia ML, Scott C, Hipwell JH, Dickens C, Schuz J, Aribal ME, Bertrand K, Kwong A, Giles GG, Hopper J, Perez Gomez B, Pollan M, Teo SH, Mariapun S, Taib NA, Lajous M, Lopez-Riduara R, Rice M, Romieu I, Flugelman AA, Ursin G, Qureshi S, Ma H, Lee E, Sirous R, Sirous M, Lee JW, Kim J, Salem D, Kamal R, Hartman M, Miao H, Chia KS, Nagata C, Vinayak S, Ndumia R, van Gils CH, Wanders JO, Peplonska B, Bukowska A, Allen S, Vinnicombe S, Moss S, Chiarelli AM, Linton L, Maskarinec G, Yaffe MJ, Boyd NF, Dos-Santos-Silva I, McCormack VA (2016) Mammographic density assessed on paired raw and processed digital images and on paired screen-film and digital images across three mammography systems. Breast Cancer Res 18(1):130. https://doi.org/10.1186/s13058-016-0787-0

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Meijer M, Bloomfield K, Engholm G (2013) Neighbourhoods matter too: the association between neighbourhood socioeconomic position, population density and breast, prostate and lung cancer incidence in Denmark between 2004 and 2008. J Epidemiol Community Health 67(1):6–13. https://doi.org/10.1136/jech-2011-200192

    Article  PubMed  Google Scholar 

  16. 16.

    Robert SA, Strombom I, Trentham-Dietz A, Hampton JM, McElroy JA, Newcomb PA, Remington PL (2004) Socioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects. Epidemiology 15(4):442–450

    Article  PubMed  Google Scholar 

  17. 17.

    Webster TF, Hoffman K, Weinberg J, Vieira V, Aschengrau A (2008) Community- and individual-level socioeconomic status and breast cancer risk: multilevel modeling on Cape Cod, Massachusetts. Environ Health Perspect 116(8):1125–1129. https://doi.org/10.1289/ehp.10818

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge BreastScreen Western Australia, The Aboriginal Women’s Reference Group and the Government of Western Australia Department of Health Data Linkage Branch.

Funding

This work was supported by Cancer Council Western Australia and Cancer Australia (APP1085750). Author JS is a National Breast Cancer Foundation Research Fellow.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jennifer Stone.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Western Australian Department of Health Human Research Ethics Committee (Project #2014/50) and the Western Australian Aboriginal Health Ethics Committee (Project 581)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

A waiver of informed consent was received to obtain access to de-identified linked data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 101 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Darcey, E., Lloyd, R., Cadby, G. et al. The association between mammographic density and breast cancer risk in Western Australian Aboriginal women. Breast Cancer Res Treat 176, 235–242 (2019). https://doi.org/10.1007/s10549-019-05225-9

Download citation

Keywords

  • Breast cancer risk
  • Mammographic breast density
  • Ethnicity
  • Aboriginal women
  • Mammographic screening