Mammographic Density and the Risk and Detection of Breast Cancer
Norman F. Boyd, M.D., D.Sc., Helen Guo, M.Sc., Lisa J. Martin, Ph.D., Limei Sun, M.Sc., Jennifer Stone, M.Sc., Eve Fishell, M.D., F.R.C.P.C., Roberta A. Jong, M.D., F.R.C.P.C., Greg Hislop, M.D., F.R.C.P.C., Anna Chiarelli, Ph.D., Salomon Minkin, Ph.D., and Martin J. Yaffe, Ph.D.
Background Extensive mammographic density is associated withan increased risk of breast cancer and makes the detection ofcancer by mammography difficult, but the influence of densityon risk according to method of cancer detection is unknown.
Methods We carried out three nested case–control studiesin screened populations with 1112 matched case–controlpairs. We examined the association of the measured percentageof density in the baseline mammogram with risk of breast cancer,according to method of cancer detection, time since the initiationof screening, and age.
Results As compared with women with density in less than 10%of the mammogram, women with density in 75% or more had an increasedrisk of breast cancer (odds ratio, 4.7; 95% confidence interval[CI], 3.0 to 7.4), whether detected by screening (odds ratio,3.5; 95% CI, 2.0 to 6.2) or less than 12 months after a negativescreening examination (odds ratio, 17.8; 95% CI, 4.8 to 65.9).Increased risk of breast cancer, whether detected by screeningor other means, persisted for at least 8 years after study entryand was greater in younger than in older women. For women youngerthan the median age of 56 years, 26% of all breast cancers and50% of cancers detected less than 12 months after a negativescreening test were attributable to density in 50% or more ofthe mammogram.
Conclusions Extensive mammographic density is strongly associatedwith the risk of breast cancer detected by screening or betweenscreening tests. A substantial fraction of breast cancers canbe attributed to this risk factor.
Source Information
From the Campbell Family Institute for Breast Cancer Research (N.F.B., H.G., L.J.M., L.S.); the Ontario Cancer Institute (N.F.B, H.G., L.J.M., L.S., J.S., S.M.); the Departments of Radiology and Imaging Research, Women's College Hospital (E.F.) and Sunnybrook Health Sciences Centre (R.A.J., M.J.Y.); and the Ontario Breast Screening Program, Cancer Care Ontario (A.C.) — all in Toronto; and the British Columbia Cancer Agency, Vancouver (G.H.) — all in Canada.
Address reprint requests to Dr. Boyd at Ontario Cancer Institute, 610 University Ave., Room 10-415, Toronto, ON M5G 2M9, Canada, or at boyd{at}uhnres.utoronto.ca.
Mammographic Breast Density
Dandolu V., Hernandez E., Kopans D. B., Cuzick J., van Netten J. P., van Netten-Thomas C. J., Fletcher C. L., Boyd N., Minkin S., Yaffe M.
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N Engl J Med 2007;
356:1885-1887, May 3, 2007.
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