Breast Carcinoma In-Situ: Mammographic Risk Factors

描述（由申请人提供）：随着使用乳房x光检查筛查女性的努力增加，被诊断为原位乳腺癌（BCIS）的女性数量也在增加。明确乳腺x线摄影特征，如乳腺密度（MBD）与BCIS风险的作用是很重要的，因为1)多达20%的筛查乳腺癌患者被诊断为这种病变，2)MBD增加与浸润性乳腺癌风险增加2-6倍相关。本项目将通过收集和回顾迄今为止最大规模的基于人群的BCIS病例/对照研究中的乳房x光片，首次研究这种相关性。样本包括1994年9月15日至1998年3月14日在康涅狄格州居民中诊断的所有年龄在20至79岁之间的女性BCIS病例，以及一系列年龄匹配的随机数字拨号对照；这些女性（875例导管原位癌，123例小叶原位癌和999例对照）作为BCIS结果研究的一部分进行了随访。已收集的信息包括：1)癌症家族史、妊娠期月经史、外源性激素使用以及癌症筛查史的问卷调查数据；2)生活方式和医疗结果的随访访谈数据；对于病例，3)石蜡包埋肿瘤块用于ER、PR、p53和HER-2/neu受体的免疫组织化学检测；4)血液样本用于BRCA1/BRCA2突变检测。我们将研究是否1)MBD增加或MBD改变与BCIS风险相关，以及2)临床变量、乳房x线摄影特征和结果之间是否存在相关性。这些信息将用于3)完善我们的乳腺癌风险模型，4)检查乳房x光检查是否可以区分高风险和低风险的结果。在已有的流行病学队列中增加乳房x光检查，以其独特的受试者组成、高参与率、集中的病理审查和多学科数据收集而闻名，是一个具有成本效益和科学价值的机会。

DESCRIPTION (provided by applicant): As efforts to screen women using mammography have increased, so has the number of women diagnosed with breast carcinoma in-situ (BCIS). Clarification of the role of mammographic characteristics, such as mammographic breast density (MBD), with BCIS risk is important as 1) Up to 20% of screened breast cancer patients are diagnosed with this lesion and 2) increased MBD is associated with a 2-6 fold increase in the risk of invasive breast cancer. This project will study this association for the first time by collecting and reviewing mammograms in the largest population-based, case/control study of BCIS to date. The sample includes all cases of female BCIS aged 20 to 79 years diagnosed among residents of Connecticut from 9/15/94-3/14/98 as well as a series of age-matched random-digit-dial controls; these women (875 ductal carcinoma in-situ cases, 123 Iobular in-situ cases and 999 controls) are followed as part of our BCIS outcomes study. Information already collected includes 1) questionnaire data on family history of cancer, pregnancy menstrual history, exogenous hormone use, as well as cancer screening history, 2) follow-up interview data on lifestyle and medical outcomes, and, for cases, 3) paraffin embedded tumor blocks for immunohistochemical testing of ER, PR, p53 and HER-2/neu receptors, as well as 4) blood-samples for testing of mutations in BRCA1/BRCA2. We will examine whether 1) increased MBD or change in MBD is associated with BCIS risk, and 2) whether any correlation exists between clinical variables, mammographic characteristics, and outcome. This information will be used to 3) refine our models of breast cancer risk and to 4) examine whether mammograms can be characterized with respect to high and low risk outcomes. The addition of mammograms to a pre-existing epidemiologic cohort notable for its unique subject compositition, high participation rates, centralized pathology review and multi-disciplinary data collection, is a cost-efficient and scientifically valuable opportunity.