Association of Longitudinal Mammographic Breast Density Changes with Subsequent Breast Cancer Risk
Association of Longitudinal Mammographic Breast Density Changes with Subsequent Breast Cancer Risk
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DOI：
10.1148/radiol.220291
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发表时间：
2023-02-01
期刊：
影响因子：
19.7
通讯作者：
Park, Boyoung
中科院分区：
文献类型：
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作者：
Tran, Thi Xuan Mai;Kim, Soyeoun;Park, Boyoung
背景：虽然乳腺成像报告和数据系统（BI-RADS）密度分类已被用于评估未来乳腺癌风险，但其可靠性和有效性在文献中仍存在争议。目的：确定乳房x线摄影乳腺密度的总体纵向变化与按绝经状态分层的乳腺癌风险之间的关系。材料和方法：在一项使用韩国国民健康保险服务数据库的回顾性队列研究中，年龄在40岁以上、无癌症病史的女性在2009-2014年连续三次接受两年一次的乳房x光检查，随访至2020年12月。参与者根据基线乳腺密度分为：脂肪（BI-RADS分类a， b）和致密（BI-RADS分类c， d），然后根据从第一次到第二次和从第二次到第三次筛查的变化分为亚组。乳腺密度无变化的妇女作为参照组。主要结局是乳腺癌事件，包括浸润性乳腺癌和导管原位癌。采用Cox比例风险回归计算校正其他协变量后的风险比（HR）。结果：2 253 963例女性（平均年龄59岁±9岁）中，22 439例检测出乳腺癌。在第一次筛查时患有脂肪性乳房的绝经前妇女，随着第二次和第三次筛查时密度的增加，患乳腺癌的风险更高（脂肪-密度比，1.45 [95% CI: 1.27, 1.65]；密度-脂肪比，1.53 [95% CI: 1.34, 1.74]；密度-密度比，1.93 [95% CI: 1.75, 2.13]）。在基线时乳房致密的绝经前妇女中，密度持续下降的妇女的风险降低了0.62倍（95% CI: 0.56, 0.69）。在绝经后妇女中观察到类似的结果，在调整基线乳腺密度或体重指数变化后仍然显著（脂肪-密度比，1.50 [95% CI: 1.39, 1.62]；密度-脂肪比，1.42 [95% CI: 1.31, 1.53]；密度-密度比，1.62 [95% CI: 1.51, 1.75]）。结论：绝经前和绝经后妇女连续两年进行三次乳房x光检查，乳房密度的连续增加增加了未来患乳腺癌的风险，而连续减少则与风险降低相关。
Background: Although Breast Imaging Reporting and Data System (BI-RADS) density classification has been used to assess future breast cancer risk, its reliability and validity are still debated in literature. Purpose: To determine the association between overall longitudinal changes in mammographic breast density and breast cancer risk stratified by menopausal status.Materials and Methods: In a retrospective cohort study using the Korean National Health Insurance Service database, women aged at least 40 years without a history of cancer who underwent three consecutive biennial mammographic screenings in 2009-2014 were followed up through December 2020. Participants were divided according to baseline breast density: fatty (BI-RADS categories a, b) versus dense (BI-RADS categories c, d) and then into subgroups on the basis of changes from the first to second and from second to third screenings. Women without change in breast density were used as the reference group. Main outcomes were incident breast cancer events, both invasive breast cancer and ductal carcinoma in situ. Cox proportion hazard regression was used to calculate the hazard ratio (HR) with adjustment for other covariables.Results: Among 2 253 963 women (mean age, 59 years +/- 9) there were 22 439 detected breast cancers. Premenopausal women with fatty breasts at the first screening had a higher risk of breast cancer as density increased in the second and third screenings (fatty-to -dense HR, 1.45 [95% CI: 1.27, 1.65]; dense-to-fatty HR, 1.53 [95% CI: 1.34, 1.74]; dense-to-dense HR, 1.93 [95% CI: 1.75, 2.13]). In premenopausal women with dense breasts at baseline, those in whom density continuously decreased had a 0.62-fold lower risk (95% CI: 0.56, 0.69). Similar results were observed in postmenopausal women, remaining significant after adjustment for baseline breast density or changes in body mass index (fatty-to-dense HR, 1.50 [95% CI: 1.39, 1.62]; dense-to-fatty HR, 1.42 [95% CI: 1.31, 1.53]; dense-to-dense HR, 1.62 [95% CI: 1.51, 1.75]).Conclusion: In both premenopausal and postmenopausal women undergoing three consecutive biennial mammographic screenings, a consecutive increase in breast density augmented the future breast cancer risk whereas a continuous decrease was associated with a lower risk.