非典型增生女性的乳腺钼靶密度与乳腺癌风险：一项来自梅奥诊所良性乳腺疾病（BBD）队列的观察性队列研究。
Mammographic breast density and risk of breast cancer in women with atypical hyperplasia: an observational cohort study from the Mayo Clinic Benign Breast Disease (BBD) cohort.
作者信息
Vierkant Robert A, Degnim Amy C, Radisky Derek C, Visscher Daniel W, Heinzen Ethan P, Frank Ryan D, Winham Stacey J, Frost Marlene H, Scott Christopher G, Jensen Matthew R, Ghosh Karthik, Manduca Armando, Brandt Kathleen R, Whaley Dana H, Hartmann Lynn C, Vachon Celine M
机构信息
Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Department of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
出版信息
BMC Cancer. 2017 Jan 31;17(1):84. doi: 10.1186/s12885-017-3082-2.
BACKGROUND
Atypical hyperplasia (AH) and mammographic breast density (MBD) are established risk factors for breast cancer (BC), but their joint contributions are not well understood. We examine associations of MBD and BC by histologic impression, including AH, in a subcohort of women from the Mayo Clinic Benign Breast Disease Cohort.
METHODS
Women with a diagnosis of BBD and mammogram between 1985 and 2001 were eligible. Histologic impression was assessed via pathology review and coded as non-proliferative disease (NP), proliferative disease without atypia (PDWA) and AH. MBD was assessed clinically using parenchymal pattern (PP) or BI-RADS criteria and categorized as low, moderate or high. Percent density (PD) was also available for a subset of women. BC and clinical information were obtained by questionnaires, medical records and the Mayo Clinic Tumor Registry. Women were followed from date of benign biopsy to BC, death or last contact. Standardized incidence ratios (SIRs) compared the observed number of BCs to expected counts. Cox regression estimated multivariate-adjusted MBD hazard ratios.
RESULTS
Of the 6271 women included in the study, 1132 (18.0%) had low MBD, 2921 (46.6%) had moderate MBD, and 2218 (35.4%) had high MBD. A total of 3532 women (56.3%) had NP, 2269 (36.2%) had PDWA and 470 (7.5%) had AH. Over a median follow-up of 14.3 years, 528 BCs were observed. The association of MBD and BC risk differed by histologic impression (p-interaction = 0.03), such that there was a strong MBD and BC association among NP (p < 0.001) but non-significant associations for PDWA (p = 0.27) and AH (p = 0.96). MBD and BC associations for AH women were not significant within subsets defined by type of MBD measure (PP vs. BI-RADS), age at biopsy, number of foci of AH, type of AH (lobular vs. ductal) and body mass index, and after adjustment for potential confounding variables. Women with atypia who also had high PD (>50%) demonstrated marginal evidence of increased BC risk (SIR 4.98), but results were not statistically significant.
CONCLUSION
We found no evidence of an association between MBD and subsequent BC risk in women with AH.
背景
不典型增生（AH）和乳腺钼靶密度（MBD）是已确定的乳腺癌（BC）风险因素，但其共同作用尚不清楚。我们在梅奥诊所良性乳腺疾病队列的一个亚组中，按组织学特征（包括AH）研究MBD与BC的关联。
方法
符合条件的女性为1985年至2001年间诊断为BBD且有乳腺钼靶检查结果者。通过病理检查评估组织学特征，并编码为非增生性疾病（NP）、无异型增生的增生性疾病（PDWA）和AH。临床使用实质模式（PP）或BI-RADS标准评估MBD，并分为低、中、高三个等级。部分女性还可获得百分密度（PD）数据。通过问卷调查、病历和梅奥诊所肿瘤登记处获取BC及临床信息。女性从良性活检日期开始随访至发生BC、死亡或最后一次联系。标准化发病比（SIR）将观察到的BC病例数与预期病例数进行比较。Cox回归估计多变量调整后的MBD风险比。
结果
纳入研究的6271名女性中，1132名（18.0%）MBD低，2921名（46.6%）MBD中等，2218名（35.4%）MBD高。共有3532名女性（56.3%）为NP，2269名（36.2%）为PDWA，470名（7.5%）为AH。中位随访14.3年期间，观察到528例BC。MBD与BC风险的关联因组织学特征而异（p交互作用=0.03），即NP组中MBD与BC关联强烈（p<0.001），而PDWA组（p=0.27）和AH组（p=0.96）无显著关联。在按MBD测量类型（PP与BI-RADS）、活检年龄、AH病灶数量、AH类型（小叶型与导管型）和体重指数定义的亚组中，以及在调整潜在混杂变量后，AH女性的MBD与BC关联均不显著。有异型增生且PD>50%的女性显示出BC风险增加的边缘证据（SIR 4.98），但结果无统计学意义。
结论
我们未发现AH女性中MBD与后续BC风险之间存在关联的证据。
Zotero 插件