Longitudinal Analysis of Change in Mammographic Density in Each Breast and Its Association With Breast Cancer Risk.
Longitudinal Analysis of Change in Mammographic Density in Each Breast and Its Association With Breast Cancer Risk.
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DOI：
10.1001/jamaoncol.2023.0434
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发表时间：
2023-06-01
期刊：
影响因子：
28.4
通讯作者：
Colditz GA
中科院分区：
文献类型：
--
作者：
Jiang S;Bennett DL;Rosner BA;Colditz GA
乳腺X线摄影密度的变化是否与乳腺癌的发生有关，这种变化是否与预期的密度随年龄增长而下降的趋势不同？在这项对947名在长达10年的时间里接受乳腺筛查的妇女进行的巢式病例对照队列研究中，无论随后是否发生乳腺癌，所有妇女的乳腺密度都有所下降。密度变化的速度在后来被诊断为癌症的乳腺中明显较慢。这项研究发现，从数字乳房X光检查中评估乳房密度的纵向变化可能为评估乳腺癌风险和随后的风险降低策略提供额外的工具。虽然乳腺密度是乳腺癌的一个既定的风险因素，但乳腺密度的纵向变化尚未得到广泛研究，以确定该因素是否与乳腺癌风险相关。前瞻性评价各乳房X线摄影密度随时间变化与后续乳腺癌风险之间的相关性。这项巢式病例对照队列研究从Joanne Knight乳腺健康队列的10481名女性中抽样，从2008年11月3日至2020年10月31日观察，每1至2年进行一次常规筛查乳房X光检查，提供乳腺密度的测量。为圣刘易斯地区的不同妇女群体提供了乳腺癌筛查。共确定了289例经病理证实的乳腺癌患者，根据入组时的年龄和入组年份，对每例患者抽取约2名对照参与者，共获得658名对照者，共8710张头尾位乳腺X线照片用于分析。暴露包括筛查性乳腺X线摄影（密度体积百分比）、乳腺体积密度随时间的变化和乳腺活检病理学证实的癌症。在入组时通过问卷调查收集乳腺癌风险因素。病例组和对照组妇女乳腺体积密度随时间的纵向变化。入组时947例受试者的平均（SD）年龄为56.67（8.71）岁; 141例为黑人（14.9%），763例为白色（80.6%），20例为其他人种或种族（2.1%），23例未报告此信息（2.4%）。从最后一次乳房X线检查到随后的乳腺癌诊断日期的平均（SD）间隔为2.0（1.5）年（第10百分位数，1.0年;第90百分位数，3.9年）。乳腺密度在病例组和对照组中均随时间降低。然而，与对照组相比，发生乳腺癌的乳腺密度下降速度明显较慢（估计值= 0.027; 95%CI，0.001-0.053; P = 0.04）。这项研究发现，乳腺密度的变化率与随后患乳腺癌的风险有关。将纵向变化纳入现有模型可以优化风险分层，并指导更个性化的风险管理。这项巢式病例对照队列研究评估了每个乳房的乳房X线摄影密度随时间的变化与随后乳腺癌风险之间的关系。
Is change in mammographic breast density associated with the development of breast cancer, and does this change diverge from the expected decrease in density with age? In this nested case-control cohort study of 947 women attending breast screening during up to 10 years, a decrease in breast density was observed in all women regardless of subsequent breast cancer development. The rate of density change was significantly slower in the breast in which cancer was later diagnosed. This study found that evaluating longitudinal changes in breast density from digital mammograms may offer an additional tool for assessing risk of breast cancer and subsequent risk reduction strategies. Although breast density is an established risk factor for breast cancer, longitudinal changes in breast density have not been extensively studied to determine whether this factor is associated with breast cancer risk. To prospectively evaluate the association between change in mammographic density in each breast over time and risk of subsequent breast cancer. This nested case-control cohort study was sampled from the Joanne Knight Breast Health Cohort of 10 481 women free from cancer at entry and observed from November 3, 2008, to October 31, 2020, with routine screening mammograms every 1 to 2 years, providing a measure of breast density. Breast cancer screening was provided for a diverse population of women in the St Louis region. A total of 289 case patients with pathology-confirmed breast cancer were identified, and approximately 2 control participants were sampled for each case according to age at entry and year of enrollment, yielding 658 controls with a total number of 8710 craniocaudal-view mammograms for analysis. Exposures included screening mammograms with volumetric percentage of density, change in volumetric breast density over time, and breast biopsy pathology-confirmed cancer. Breast cancer risk factors were collected via questionnaire at enrollment. Longitudinal changes over time in each woman’s volumetric breast density by case and control status. The mean (SD) age of the 947 participants was 56.67 (8.71) years at entry; 141 were Black (14.9%), 763 were White (80.6%), 20 were of other race or ethnicity (2.1%), and 23 did not report this information (2.4%). The mean (SD) interval was 2.0 (1.5) years from last mammogram to date of subsequent breast cancer diagnosis (10th percentile, 1.0 year; 90th percentile, 3.9 years). Breast density decreased over time in both cases and controls. However, there was a significantly slower decrease in rate of decline in density in the breast that developed breast cancer compared with the decline in controls (estimate = 0.027; 95% CI, 0.001-0.053; P = .04). This study found that the rate of change in breast density was associated with the risk of subsequent breast cancer. Incorporation of longitudinal changes into existing models could optimize risk stratification and guide more personalized risk management. This nested case-control cohort study evaluates the association between change in mammographic density in each breast over time and risk of subsequent breast cancer.
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