Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.
Int J Cancer. 2022 Oct 15;151(8):1304-1309. doi: 10.1002/ijc.34001. Epub 2022 Apr 4.
Mammographic dense area (MDA) is an established predictor of future breast cancer risk. Recent studies have found that risk prediction might be improved by redefining MDA in effect at higher-than-conventional intensity thresholds. We assessed whether such higher-intensity MDA measures gave stronger prediction of subsequent contralateral breast cancer (CBC) risk using the Women's Environment, Cancer, and Radiation Epidemiology (WECARE) Study, a population-based CBC case-control study of ≥1 year survivors of unilateral breast cancer diagnosed between 1990 and 2008. Three measures of MDA for the unaffected contralateral breast were made at the conventional intensity threshold ("Cumulus") and at two sequentially higher-intensity thresholds ("Altocumulus" and "Cirrocumulus") using the CUMULUS software and mammograms taken up to 3 years prior to the first breast cancer diagnosis. The measures were fitted separately and together in multivariable-adjusted logistic regression models of CBC (252 CBC cases and 271 unilateral breast cancer controls). The strongest association with CBC was MDA defined using the highest intensity threshold, Cirrocumulus (odds ratio per adjusted SD [OPERA] 1.40, 95% CI 1.13-1.73); and the weakest association was MDA defined at the conventional threshold, Cumulus (1.32, 95% CI 1.05-1.66). In a model fitting the three measures together, the association of CBC with Cirrocumulus was unchanged (1.40, 95% CI 0.97-2.05), and the lower brightness measures did not contribute to the CBC model fit. These results suggest that MDA defined at a high-intensity threshold is a better predictor of CBC risk and has the potential to improve CBC risk stratification beyond conventional MDA measures.
乳腺密度区域（MDA）是未来乳腺癌风险的既定预测指标。最近的研究发现，通过在高于常规强度阈值的情况下重新定义 MDA，可以改善风险预测。我们使用妇女环境、癌症和辐射流行病学（WECARE）研究评估了这种更高强度 MDA 测量方法是否可以通过单侧乳腺癌确诊后至少 1 年的生存者的基于人群的对侧乳腺癌（CBC）病例对照研究，更好地预测随后的对侧乳腺癌（CBC）风险。在使用 CUMULUS 软件和在首次乳腺癌诊断前最多 3 年拍摄的乳房 X 光片中，对未受影响的对侧乳房进行了三种 MDA 测量，分别在常规强度阈值（“Cumulus”）和两个连续的高强度阈值（“Altocumulus”和“Cirrocumulus”）下进行。使用多变量调整后的逻辑回归模型分别和一起对 CBC（252 例 CBC 病例和 271 例单侧乳腺癌对照）进行 MDA 测量。与 CBC 最强相关的是使用最高强度阈值定义的 MDA，Cirrocumulus（调整后每标准差的优势比 [OPERA] 1.40，95%CI 1.13-1.73）；与 CBC 最弱相关的是在常规阈值定义的 MDA，Cumulus（1.32，95%CI 1.05-1.66）。在拟合三个测量值的模型中，CBC 与 Cirrocumulus 的关联保持不变（1.40，95%CI 0.97-2.05），而较低的亮度测量值对 CBC 模型拟合没有贡献。这些结果表明，在高强度阈值下定义的 MDA 是 CBC 风险的更好预测指标，并且有可能改善常规 MDA 测量方法之外的 CBC 风险分层。
