MAMMOGRAPHIC FEATURES AND BREAST-CANCER RISK - EFFECTS WITH TIME, AGE, AND MENOPAUSE STATUS
MAMMOGRAPHIC FEATURES AND BREAST-CANCER RISK - EFFECTS WITH TIME, AGE, AND MENOPAUSE STATUS
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DOI：
10.1093/jnci/87.21.1622
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发表时间：
1995-11-01
期刊：
影响因子：
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通讯作者：
HAILE, R
中科院分区：
文献类型：
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作者：
BYRNE, C;SCHAIRER, C;HAILE, R
背景资料：乳腺上皮和间质组织比例高的女性的钼靶X线图像被描述为显示高密度的实质模式。大多数过去的研究指出，乳腺癌风险增加与乳腺X线摄影实质模式相关，显示高密度，1）缺乏其他乳腺癌风险因素的信息，2）太小，或3）随访时间不足，无法充分解决持续存在的疑问，即乳腺X线摄影特征是否是乳腺癌风险的“独立”指标，而不是检测伪影，目的：本研究的目的有两个：1）评估乳房X线摄影特征与其他乳腺癌风险因素之间的关联，2）通过时间、年龄和绝经状态评估乳房X线摄影特征对乳腺癌风险的影响。为了解决这些问题，我们分析了一项大型巢式病例对照研究的详细信息，该研究随访16年，这项研究使用了来自乳腺癌检测示范项目的筛查和随访阶段的信息，该项目是一项全国性的计划，从1973年到1980年为超过28万名妇女提供年度乳腺癌筛查，对1880例发病病例和2152例对照者的基线筛查乳腺X线摄影检查进行了乳腺X线摄影特征评估。对照者从与每个病例受试者相同年龄和种族的妇女中随机选择，对照受试者与病例受试者参加相同的筛查中心，并且在病例受试者的诊断日期没有乳腺癌。比值比（OR）和95%置信区间（CI）提供了乳腺癌相对风险的估计值，结果：乳腺X线特征与已知的乳腺癌危险因素相关，然而，高密度实质模式的影响与家族史、首次生育年龄、饮酒、与良性乳腺疾病相比，Wolfe两种高密度实质模式，P2（OR = 3.2; 95% CI = 2.5-4.0）和Dy（OR = 2.9; 95%CI = 2.2-3.9），主要通过测量具有致密乳房X光检查外观的乳房百分比来解释，与没有可见乳房密度的女性相比，乳腺密度大于等于75%的妇女患乳腺癌的风险增加近5倍（95%CI = 3.6-7.1），这些影响持续10年或更长时间，并且在所有年龄的绝经前和绝经后妇女中均观察到。结论：在参与者中评估的乳腺癌风险因素中，高密度乳房X线摄影实质模式（由上皮和基质组织组成的乳房面积比例测量）对乳腺癌风险的影响最大，在本研究中的乳腺癌中，28%可归因于具有50%或更高的乳腺密度。
Background: Mammographic images from women with a high proportion of epithelial and stromal breast tissues are described as showing high-density parenchymal patterns. Most past studies that noted an increase in breast cancer risk associated with mammographic parenchymal patterns showing high density either 1) lacked information on other breast cancer risk factors, 2) were too small, or 3) included insufficient follow-up time to adequately resolve persisting doubts whether mammographic features are ''independent'' measures of breast cancer risk and not a detection artifact, Purpose: The purpose of this study was twofold: 1) to evaluate the associations between mammographic features and other breast cancer risk factors and 2) to assess effects of mammographic features on breast cancer risk by time, age, and menopause status, Methods: To address these questions, we analyzed detailed information from a large, nested case-control study with 16 years of follow-up, This study used information from both screening and follow-up phases of the Breast Cancer Detection Demonstration Project, a nationwide program that offered annual breast cancer screening for more than 280 000 women from 1973 to 1980, Mammographic features were assessed from the base-line screening mammographic examination for 1880 incident case subjects and 2152 control subjects, Control subjects were randomly selected from women of the same age and race as each case subject, Control subjects attended the same screening center as the case subject and were free of breast cancer at the case subject's date of diagnosis, Odds ratios (ORs) with 95% confidence intervals (CIs) provided estimates of the relative risk of breast cancer, Results: Mammographic features were associated with known breast cancer risk factors, However, the high-density parenchymal pattern effects were independent of family history, age at first birth, alcohol consumption, and benign breast disease, The increased risk for women with Wolfe's two high-density parenchymal patterns, P2 (OR = 3.2; 95% CI = 2.5-4.0) and Dy (OR = 2.9; 95% CI = 2.2-3.9), was explained primarily by measured percent of the breast with dense mammographic appearance, Compared with women with no visible breast density, women who had a breast density of 75% or greater had an almost fivefold increased risk of breast cancer (95% CI = 3.6-7.1), These effects persisted for 10 or more years and were noted for both premenopausal and postmenopausal women of all ages. Conclusions: Of the breast cancer risk factors assessed in the participants, high-density mammographic parenchymal patterns, as measured by the proportion of breast area composed of epithelial and stromal tissue, had the greatest impact on breast cancer risk, Of the breast cancers in this study, 28% were attributable to having 50% or greater breast density.