Relationship Between Mammographic Density and Breast Cancer Death in the Breast Cancer Surveillance Consortium
Relationship Between Mammographic Density and Breast Cancer Death in the Breast Cancer Surveillance Consortium
复制标题
DOI：
10.1093/jnci/djs327
复制
发表时间：
2012-08-01
期刊：
影响因子：
--
通讯作者：
Sherman, Mark E.
中科院分区：
文献类型：
--
作者：
Gierach, Gretchen L.;Ichikawa, Laura;Sherman, Mark E.
乳腺摄影密度升高的妇女患乳腺癌的风险增加。然而，在被诊断为乳腺癌的女性中，尚不清楚较高的密度是否预示着独立于其他因素的生存率降低，我们评估了乳腺X线摄影密度与乳腺癌死亡风险之间的关系，以及美国乳腺癌监测联盟中的所有原因。我们研究了1996 - 2005年间9232名诊断为原发性浸润性乳腺癌的女性，平均随访6.6年。使用乳腺成像报告和数据系统（BI-RADS）密度分类评估乳腺摄影密度。通过考克斯比例风险回归估计风险比（HR）和95%置信区间（CI）;具有分散纤维腺体密度（BI-RADS 2）的女性为参照组。所有的统计检验都是双向的，共有1795名妇女死亡，其中889人死于乳腺癌。在多变量分析中（根据部位、诊断时的年龄和年份、美国癌症联合委员会分期、体重指数、检测方式、治疗和收入进行调整），高密度（BI-RADS 4）与乳腺癌死亡风险无关（HR = 0.92，95% CI = 0.71 - 1.19）或全因死亡（HR = 0.83，95% CI = 0.68 - 1.02）。按分期和其他预后因素分层的分析得出了类似的结果，除了低密度的妇女乳腺癌死亡风险增加（BI-RADS 1）肥胖者（HR = 2.02，95% CI = 1.37 - 2.97）或肿瘤至少2.0 cm（HR = 1.55，95% CI = 1.14至2.09）在考虑了其他患者和肿瘤后，高乳腺密度与乳腺癌死亡或任何原因死亡的风险无关。特色因此，乳腺癌发展的风险因素可能不一定与影响乳腺癌发展后死亡风险的因素相同。
Women with elevated mammographic density have an increased risk of developing breast cancer. However, among women diagnosed with breast cancer, it is unclear whether higher density portends reduced survival, independent of other factors.We evaluated relationships between mammographic density and risk of death from breast cancer and all causes within the US Breast Cancer Surveillance Consortium. We studied 9232 women diagnosed with primary invasive breast carcinoma during 19962005, with a mean follow-up of 6.6 years. Mammographic density was assessed using the Breast Imaging Reporting and Data System (BI-RADS) density classification. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression; women with scattered fibroglandular densities (BI-RADS 2) were the referent group. All statistical tests were two-sided.A total of 1795 women died, of whom 889 died of breast cancer. In multivariable analyses (adjusted for site, age at and year of diagnosis, American Joint Committee on Cancer stage, body mass index, mode of detection, treatment, and income), high density (BI-RADS 4) was not related to risk of death from breast cancer (HR = 0.92, 95% CI = 0.71 to 1.19) or death from all causes (HR = 0.83, 95% CI = 0.68 to 1.02). Analyses stratified by stage and other prognostic factors yielded similar results, except for an increased risk of breast cancer death among women with low density (BI-RADS 1) who were either obese (HR = 2.02, 95% CI = 1.37 to 2.97) or had tumors of at least 2.0cm (HR = 1.55, 95% CI = 1.14 to 2.09).High mammographic breast density was not associated with risk of death from breast cancer or death from any cause after accounting for other patient and tumor characteristics. Thus, risk factors for the development of breast cancer may not necessarily be the same as factors influencing the risk of death after breast cancer has developed.