Maskarinec Gertraud, Pagano Ian, Lurie Galina, Wilkens Lynne R, Kolonel Laurence N
Cancer Etiology Program, Cancer Research Center of Hawaii, Honolulu, HI 96813, USA.
Am J Epidemiol. 2005 Oct 15;162(8):743-52. doi: 10.1093/aje/kwi270. Epub 2005 Sep 8.
In a nested case-control study (2001-2004), the authors investigated the association between mammographic density and breast cancer risk among women of Caucasian, Japanese, and Native Hawaiian ancestry in the Hawaii component of the Multiethnic Cohort Study. The authors retrieved several prediagnostic mammograms for breast cancer cases and for controls frequency-matched to cases by age and ethnicity. A reader who was blinded to case status and year of mammogram performed computer-assisted density assessment. Suitable mammographic readings were obtained for 607 cases and 667 controls. The authors used unconditional logistic regression to estimate odds ratios and 95% confidence intervals while adjusting for confounders. Mean percent density and mean dense area were significantly greater for cases than for controls: 39.6% vs. 29.7% and 37.3 cm2 vs. 28.4 cm2, respectively. For the earliest mammogram taken, the overall odds ratio for a 10% increase in breast density was 1.22 (95% confidence interval: 1.14, 1.30), and the overall odds ratio for a 10-cm2 increase in dense area was 1.17 (95% confidence interval: 1.11, 1.24). The similar sizes of the areas under the receiver operating characteristic curve (0.66) confirmed that percent density and dense area predicted breast cancer equally well. Because the risk estimates appeared higher for Caucasians and Native Hawaiians than for Japanese women, ethnicity-specific models may be necessary to predict risk from breast density in different ethnic groups.
在一项巢式病例对照研究（2001 - 2004年）中，作者在多民族队列研究的夏威夷部分，调查了白种人、日本人以及夏威夷原住民血统女性的乳腺X线密度与乳腺癌风险之间的关联。作者检索了乳腺癌病例以及按年龄和种族与病例进行频率匹配的对照的几份诊断前乳腺X线照片。一位对病例状态和乳腺X线照片年份不知情的阅片者进行了计算机辅助密度评估。为607例病例和667名对照获得了合适的乳腺X线阅片结果。作者使用无条件逻辑回归来估计比值比和95%置信区间，同时对混杂因素进行了调整。病例组的平均密度百分比和平均致密面积显著高于对照组，分别为39.6%对29.7%以及37.3平方厘米对28.4平方厘米。对于所拍摄的最早的乳腺X线照片，乳腺密度增加10%时的总体比值比为1.22（95%置信区间：1.14, 1.30），致密面积增加10平方厘米时的总体比值比为1.17（95%置信区间：1.11, 1.24）。受试者工作特征曲线下面积大小相似（0.66），证实密度百分比和致密面积对乳腺癌的预测效果相当。由于白种人和夏威夷原住民的风险估计值似乎高于日本女性，可能需要采用特定种族模型来根据不同种族的乳腺密度预测风险。
