Sprague Brian L, Gangnon Ronald E, Burt Veronica, Trentham-Dietz Amy, Hampton John M, Wellman Robert D, Kerlikowske Karla, Miglioretti Diana L
Department of Surgery, Office of Health Promotion Research and Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Health Sciences, University of Wisconsin, Madison, WI (REG, VB, ATD); University of Wisconsin Carbone Cancer Center, Madison, WI (REG, ATD, JMH); Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI (REG); Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (RDW, DLM).
J Natl Cancer Inst. 2014 Sep 12;106(10). doi: 10.1093/jnci/dju255. Print 2014 Oct.
National legislation is under consideration that would require women with mammographically dense breasts to be informed of their breast density and encouraged to discuss supplemental breast cancer screening with their health care providers. The number of US women potentially affected by this legislation is unknown.
We determined the mammographic breast density distribution by age and body mass index (BMI) using data from 1518 599 mammograms conducted from 2007 through 2010 at mammography facilities in the Breast Cancer Surveillance Consortium (BCSC). We applied these breast density distributions to age- and BMI-specific counts of the US female population derived from the 2010 US Census and the National Health and Nutrition Examination Survey (NHANES) to estimate the number of US women with dense breasts.
Overall, 43.3% (95% confidence interval [CI] = 43.1% to 43.4%) of women 40 to 74 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age and BMI. Based on the age and BMI distribution of US women, we estimated that 27.6 million women (95% CI = 27.5 to 27.7 million) aged 40 to 74 years in the United States have heterogeneously or extremely dense breasts. Women aged 40 to 49 years (N = 12.3 million) accounted for 44.3% of this group.
The prevalence of dense breasts among US women of common breast cancer screening ages exceeds 25 million. Policymakers and healthcare providers should consider this large prevalence when debating breast density notification legislation and designing strategies to ensure that women who are notified have opportunities to evaluate breast cancer risk and discuss and pursue supplemental screening options if deemed appropriate.
国家立法正在审议中，该立法将要求乳房钼靶检查显示乳房密度高的女性了解其乳房密度，并鼓励她们与医疗服务提供者讨论补充性乳腺癌筛查。受该立法潜在影响的美国女性人数尚不清楚。
我们利用2007年至2010年在乳腺癌监测联盟（BCSC）的乳房钼靶检查机构进行的1518599例乳房钼靶检查数据，按年龄和体重指数（BMI）确定乳房钼靶密度分布。我们将这些乳房密度分布应用于从2010年美国人口普查和国家健康与营养检查调查（NHANES）得出的美国女性人口按年龄和BMI分类的计数中，以估计美国乳房密度高的女性人数。
总体而言，40至74岁的女性中有43.3%（95%置信区间[CI]=43.1%至43.4%）的乳房为不均匀致密或极度致密，这一比例与年龄和BMI呈负相关。根据美国女性的年龄和BMI分布，我们估计美国有2760万40至74岁的女性乳房为不均匀致密或极度致密（95%CI=2750万至2770万）。40至49岁的女性（N=1230万）占该群体的44.3%。
在乳腺癌常见筛查年龄的美国女性中，致密乳房的患病率超过2500万。政策制定者和医疗服务提供者在辩论乳房密度告知立法和设计策略以确保被告知的女性有机会评估乳腺癌风险并在认为适当时讨论和寻求补充筛查选项时，应考虑到这一高患病率。
