Mullooly Maeve, Nyante Sarah J, Pfeiffer Ruth M, Cora Renata, Butcher Donna, Sternberg Lawrence, Aiello Bowles Erin J, Fan Shaoqi, Figueroa Jonine D, Weinmann Sheila, Hoover Robert N, Brinton Louise A, Berrington de Gonzalez Amy, Glass Andrew, Sherman Mark E, Gierach Gretchen L
Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.
J Clin Med. 2019 Nov 4;8(11):1868. doi: 10.3390/jcm8111868.
Mammographic breast density (MD) reflects breast fibroglandular content. Its decline following adjuvant tamoxifen treated, estrogen receptor (ER)-positive breast cancer has been associated with improved outcomes. Breast cancers arise from structures termed lobules, and lower MD is associated with increased age-related lobule involution. We assessed whether pre-treatment involution influenced associations between MD decline and risk of breast cancer-specific death. ER-positive tamoxifen treated patients diagnosed at Kaiser Permanente Northwest (1990-2008) were defined as cases who died of breast cancer ( = 54) and matched controls (remained alive over similar follow-up; = 180). Lobule involution was assessed by examining terminal duct lobular units (TDLUs) in benign tissues surrounding cancers as TDLU count/mm, median span and acini count/TDLU. MD (%) was measured in the unaffected breast at baseline (median 6-months before) and follow-up (median 12-months after tamoxifen initiation). TDLU measures and baseline MD were positively associated among controls ( < 0.05). In multivariable regression models, MD decline (≥10%) was associated with reduced risk of breast cancer-specific death before (odds ratio (OR): 0.41, 95% CI: 0.18-0.92) and after (OR: 0.41, 95% CI: 0.18-0.94) adjustment for TDLU count/mm, TDLU span (OR: 0.34, 95% CI: 0.14-0.84), and acini count/TDLU (OR: 0.33, 95% CI: 0.13-0.81). MD decline following adjuvant tamoxifen is associated with reduced risk of breast cancer-specific death, irrespective of pre-treatment lobule involution.
乳腺钼靶密度（MD）反映了乳腺纤维腺体量。在接受辅助他莫昔芬治疗的雌激素受体（ER）阳性乳腺癌患者中，其下降与预后改善相关。乳腺癌起源于称为小叶的结构，而较低的MD与年龄相关的小叶退化增加有关。我们评估了治疗前的退化是否会影响MD下降与乳腺癌特异性死亡风险之间的关联。在西北凯撒医疗集团（1990 - 2008年）被诊断为ER阳性且接受他莫昔芬治疗的患者被定义为死于乳腺癌的病例（n = 54）以及匹配的对照组（在相似的随访期内仍存活；n = 180）。通过检查癌周围良性组织中的终末导管小叶单位（TDLUs）来评估小叶退化情况，以TDLU计数/mm、中位跨度和每个TDLU的腺泡计数来表示。在基线（中位时间为前6个月）和随访（中位时间为他莫昔芬开始治疗后12个月）时，对未受影响的乳房测量MD（%）。在对照组中，TDLU测量值与基线MD呈正相关（P < 0.05）。在多变量回归模型中，在对TDLU计数/mm、TDLU跨度（比值比（OR）：0.34，95%置信区间：0.14 - 0.84）和每个TDLU的腺泡计数（OR：0.33，95%置信区间：0.13 - 0.81）进行调整之前（OR：0.41，95%置信区间：0.18 - 0.92）和之后（OR：0.41，95%置信区间：0.18 - 0.94），MD下降（≥10%）与乳腺癌特异性死亡风险降低相关。辅助他莫昔芬治疗后MD下降与乳腺癌特异性死亡风险降低相关，与治疗前小叶退化情况无关。
