MAMMOGRAPHIC PARENCHYMAL PATTERNS - A MARKER OF BREAST-CANCER RISK
MAMMOGRAPHIC PARENCHYMAL PATTERNS - A MARKER OF BREAST-CANCER RISK
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DOI：
10.1093/oxfordjournals.epirev.a036105
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发表时间：
1993-01-01
影响因子：
5.5
通讯作者：
BOYD, NF
中科院分区：
文献类型：
--
作者：
OZA, AM;BOYD, NF
现在有大量的证据表明，乳房X线摄影密度是乳腺癌风险增加的一个指标。目前还没有一种普遍认可的方法来对这些密度进行分类，尽管现有的证据表明，密度的定量描述比Wolfe分类产生更大的风险梯度，比大多数其他乳腺癌风险因素产生更大的风险梯度。似乎有可能改进的方法来定量描述密度，并可能其他方法来表征组织的变化，负责密度，将允许更大的歧视。然而，已经清楚的是，乳腺癌发生在大量没有表明风险增加的放射学变化的妇女中，并且乳房X线摄影模式或迄今为止确定的任何其他乳腺癌风险因素不太可能对选择进行乳房X线摄影筛查的妇女有用。尽管乳腺摄影密度与发生组织学变化（乳腺癌的风险因素）的风险增加相关，但与乳腺摄影密度最相关的组织学特征是间质纤维化。我们认为，基质纤维化和乳腺癌风险之间的关系可以解释的各种生长因子，被认为是在乳腺发育和癌变的一些方面发挥作用的已知行动。乳腺摄影密度与其他几个乳腺癌风险因素之间的关联表明，这些因素也可能调节乳腺组织中生长因子的活性，这可能是它们影响乳腺癌风险的方式。需要进一步的研究来确定乳腺组织中生长因子活性的差异是否与乳腺癌的放射学和其他危险因素有关。因此，现有证据表明，乳腺X线摄影实质模式至少部分符合本文引言中概述的标准。一些乳房X光表现与乳腺癌风险的大幅增加有关，并且正如对激素使用影响的观察所示，能够改变。还发现乳腺摄影密度与可能与致癌相关的生化特征相关。因此，与风险相关的表现可能是最有用的一种手段，用于调查乳腺癌的病因学和检验有关潜在预防策略的假设。
There is now a large amount of evidence showing that mammographic densities are an indicator of increased risk of breast cancer. There is as yet no generally agreed upon and recognized method of classifying these densities, although the available evidence shows that quantitative description of densities creates larger gradients of risk than Wolfe's classification and larger risk gradients than most other risk factors for breast cancer. It seems likely that improved methods of describing densities quantitatively, and possibly other methods of characterizing the tissue changes that are responsible for the densities, will allow greater discrimination. However, it is already clear that breast cancer develops in a large number of women who do not have radiologic changes indicating increased risk, and that it is unlikely that mammographic pattern, or any other risk factor for breast cancer identified to date, will be useful for the selection of women for mammographic screening. Although mammographic densities are associated with an increased risk of developing histologic changes that are risk factors for breast cancer, the histologic feature most consistently associated with mammographic densities is stromal fibrosis. We suggest that the relation between stromal fibrosis and risk of breast cancer can be explained by the known actions of a variety of growth factors that are thought to play a role in a number of aspects of breast development and carcinogenesis. The association between mammographic densities and several other risk factors for breast cancer suggests that these factors may also modulate the activity of growth factors in breast tissue, and that this may be the means by which they influence breast cancer risk. Further research is needed to determine whether differences in the activity of growth factors in breast tissue can be found in association with radiologic and other risk factors for breast cancer. The available evidence indicates, therefore, that mammographic parenchymal patterns do, at least in part, meet the criteria outlined in the introduction of this paper. Some mammographic appearances are associated with a substantial increase in the risk of breast cancer, and, as shown by observations on the effects of hormone use, are capable of change. Mammographic densities have also been found to be associated with biochemical characteristics of possible relevance to carcinogenesis. The appearances that are related to risk may, therefore, be most useful as a means of investigating the etiology of breast cancer and of testing hypotheses about potential preventive strategies.