The association of mammographic density with risk of contralateral breast cancer and change in density with treatment in the WECARE study

Julia A Knight; Kristina M Blackmore; Jing Fan; Kathleen E Malone; Esther M John; Charles F Lynch; Celine M Vachon; Leslie Bernstein; Jennifer D Brooks; Anne S Reiner; Xiaolin Liang; Meghan Woods; Jonine L Bernstein; WECARE Study Collaborative Group

doi:10.1186/s13058-018-0948-4

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The association of mammographic density with risk of contralateral breast cancer and change in density with treatment in the WECARE study

Journal article

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Peer reviewed

The association of mammographic density with risk of contralateral breast cancer and change in density with treatment in the WECARE study

Julia A Knight, Kristina M Blackmore, Jing Fan, Kathleen E Malone, Esther M John, Charles F Lynch, Celine M Vachon, Leslie Bernstein, Jennifer D Brooks, Anne S Reiner, …

Breast cancer research : BCR, Vol.20(1), pp.23-23

03/22/2018

DOI: 10.1186/s13058-018-0948-4

PMCID: PMC5863854

PMID: 29566728

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Abstract

Mammographic density (MD) is an established predictor of risk of a first breast cancer, but the relationship of MD to contralateral breast cancer (CBC) risk is not clear, including the roles of age, mammogram timing, and change with treatment. Multivariable prediction models for CBC risk are needed and MD could contribute to these. We conducted a case-control study of MD and CBC risk in phase II of the WECARE study where cases had a CBC diagnosed ≥ 2 years after first diagnosis at age <55 years and controls had unilateral breast cancer (UBC) with similar follow-up time. We retrieved film mammograms of the unaffected breast from two time points, prior to/at the time of the first diagnosis (253 CBC cases, 269 UBC controls) and ≥ 6 months up to 48 months following the first diagnosis (333 CBC cases, 377 UBC controls). Mammograms were digitized and percent MD (%MD) was measured using the thresholding program Cumulus. Odds ratios (OR) and 95% confidence intervals (CI) for association between %MD and CBC, adjusted for age, treatment, and other factors related to CBC, were estimated using logistic regression. Linear regression was used to estimate the association between treatment modality and change in %MD in 467 women with mammograms at both time points. For %MD assessed following diagnosis, there was a statistically significant trend of increasing CBC with increasing %MD (p = 0.03). Lower density (<25%) was associated with reduced risk of CBC compared to 25 to < 50% density (OR 0.69, 95% CI 0.49, 0.98). Similar, but weaker, associations were noted for %MD measurements prior to/at diagnosis. The relationship appeared strongest in women aged < 45 years and non-existent in women aged 50 to 54 years. A decrease of ≥ 10% in %MD between first and second mammogram was associated marginally with reduced risk of CBC (OR 0.63, 95% CI 0.40, 1.01) compared to change of <10%. Both tamoxifen and chemotherapy were associated with statistically significant 3% decreases in %MD (p < 0.01). Post-diagnosis measures of %MD may be useful to include in CBC risk prediction models with consideration of age at diagnosis. Chemotherapy is associated with reductions in %MD, similar to tamoxifen.

Humans

Middle Aged

Risk Factors

Breast - diagnostic imaging

Logistic Models

Mammography

Breast Neoplasms - drug therapy

Neoplasms, Second Primary - diagnosis

Breast Neoplasms - pathology

Tamoxifen - therapeutic use

Female

Aged

Breast Density

Breast Neoplasms - diagnosis

Neoplasms, Second Primary - diagnostic imaging

Breast Neoplasms - diagnostic imaging

Neoplasms, Second Primary - drug therapy

Breast - pathology

Neoplasms, Second Primary - pathology

Details

Title: Subtitle: The association of mammographic density with risk of contralateral breast cancer and change in density with treatment in the WECARE study
Creators: Julia A Knight - Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. knight@lunenfeld.ca
Kristina M Blackmore - Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
Jing Fan - Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 60 Murray Street Box 18, Toronto, ON, M6P 2G3, Canada
Kathleen E Malone - Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Esther M John - Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
Charles F Lynch - University of Iowa, Iowa City, IA, USA
Celine M Vachon - Mayo Clinic, Rochester, MN, USA
Leslie Bernstein - Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
Jennifer D Brooks - Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Anne S Reiner - Memorial Sloan Kettering Cancer Center, New York, NY, USA
Xiaolin Liang - Memorial Sloan Kettering Cancer Center, New York, NY, USA
Meghan Woods - Memorial Sloan Kettering Cancer Center, New York, NY, USA
Jonine L Bernstein - Memorial Sloan Kettering Cancer Center, New York, NY, USA
WECARE Study Collaborative Group
Resource Type: Journal article
Publication Details: Breast cancer research : BCR, Vol.20(1), pp.23-23
DOI: 10.1186/s13058-018-0948-4
PMID: 29566728
PMCID: PMC5863854
NLM abbreviation: Breast Cancer Res
ISSN: 1465-5411
eISSN: 1465-542X
Publisher: England
Grant note: R01 CA129639 / NCI NIH HHS P30 ES005605 / NIEHS NIH HHS R01 CA129639 / NIH HHS U01 CA083178 / NCI NIH HHS P30 CA008748 / NIH HHS R01 CA168339 / NIH HHS P30 CA008748 / NCI NIH HHS P30 CA086862 / NCI NIH HHS R01 CA114236 / NCI NIH HHS R01 CA168339 / NCI NIH HHS R01 CA97397 / NIH HHS R01 CA097397 / NCI NIH HHS R01 CA114236 / NIH HHS U01 CA83178 / NIH HHS
Language: English
Date published: 03/22/2018
Academic Unit: Epidemiology
Record Identifier: 9983996060502771

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