From the Departments of Preventive Medicine (T.X.M.T., B.P.) and Health Sciences (S.K.), Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; Department of Epidemiology and Biostatistics, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea (H.S.); Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea (E.L.).
Radiology. 2023 Feb;306(2):e220291. doi: 10.1148/radiol.220291. Epub 2022 Sep 20.
Background Although Breast Imaging Reporting and Data System (BI-RADS) density classification has been used to assess future breast cancer risk, its reliability and validity are still debated in literature. Purpose To determine the association between overall longitudinal changes in mammographic breast density and breast cancer risk stratified by menopausal status. Materials and Methods In a retrospective cohort study using the Korean National Health Insurance Service database, women aged at least 40 years without a history of cancer who underwent three consecutive biennial mammographic screenings in 2009-2014 were followed up through December 2020. Participants were divided according to baseline breast density: fatty (BI-RADS categories a, b) versus dense (BI-RADS categories c, d) and then into subgroups on the basis of changes from the first to second and from second to third screenings. Women without change in breast density were used as the reference group. Main outcomes were incident breast cancer events, both invasive breast cancer and ductal carcinoma in situ. Cox proportion hazard regression was used to calculate the hazard ratio (HR) with adjustment for other covariables. Results Among 2 253 963 women (mean age, 59 years ± 9) there were 22 439 detected breast cancers. Premenopausal women with fatty breasts at the first screening had a higher risk of breast cancer as density increased in the second and third screenings (fatty-to-dense HR, 1.45 [95% CI: 1.27, 1.65]; dense-to-fatty HR, 1.53 [95% CI: 1.34, 1.74]; dense-to-dense HR, 1.93 [95% CI: 1.75, 2.13]). In premenopausal women with dense breasts at baseline, those in whom density continuously decreased had a 0.62-fold lower risk (95% CI: 0.56, 0.69). Similar results were observed in postmenopausal women, remaining significant after adjustment for baseline breast density or changes in body mass index (fatty-to-dense HR, 1.50 [95% CI: 1.39, 1.62]; dense-to-fatty HR, 1.42 [95% CI: 1.31, 1.53]; dense-to-dense HR, 1.62 [95% CI: 1.51, 1.75]). Conclusion In both premenopausal and postmenopausal women undergoing three consecutive biennial mammographic screenings, a consecutive increase in breast density augmented the future breast cancer risk whereas a continuous decrease was associated with a lower risk. © RSNA, 2022 See also the editorial by Kataoka et al in this issue.
背景 尽管乳腺成像报告和数据系统（BI-RADS）密度分类已被用于评估未来的乳腺癌风险，但在文献中其可靠性和有效性仍存在争议。目的 确定绝经状态分层后，乳腺 X 线摄影密度的总体纵向变化与乳腺癌风险之间的关联。材料与方法 本回顾性队列研究使用了韩国国家健康保险服务数据库，纳入了在 2009-2014 年期间至少接受过 3 次连续每两年一次乳腺 X 线筛查且年龄至少 40 岁的无癌症史的女性，并随访至 2020 年 12 月。参与者根据基线乳腺密度分为脂肪型（BI-RADS 类别 a、b）和致密型（BI-RADS 类别 c、d），然后根据第一次和第二次以及第二次和第三次筛查之间的变化进一步分为亚组。未改变乳腺密度的女性被用作参考组。主要结局是浸润性乳腺癌和导管原位癌的发生情况。采用 Cox 比例风险回归计算调整其他协变量后的风险比（HR）。结果 在 2253963 名女性（平均年龄 59 岁±9 岁）中，共发现 22439 例乳腺癌。在第一次筛查时乳腺为脂肪型的绝经前女性，随着第二次和第三次筛查中密度的增加，其乳腺癌风险升高（由脂肪型变为致密型 HR，1.45[95%CI：1.27，1.65]；由致密型变为脂肪型 HR，1.53[95%CI：1.34，1.74]；由致密型变为致密型 HR，1.93[95%CI：1.75，2.13]）。在基线时乳腺为致密型的绝经前女性中，密度持续下降的女性其风险降低 0.62 倍（95%CI：0.56，0.69）。在绝经后女性中也观察到了类似的结果，在调整基线乳腺密度或体重指数变化后仍然显著（由脂肪型变为致密型 HR，1.50[95%CI：1.39，1.62]；由致密型变为脂肪型 HR，1.42[95%CI：1.31，1.53]；由致密型变为致密型 HR，1.62[95%CI：1.51，1.75]）。结论 在接受 3 次连续每两年一次乳腺 X 线筛查的绝经前和绝经后女性中，乳腺密度的连续增加增加了未来的乳腺癌风险，而连续下降与较低的风险相关。 ©2022 RSNA，见本期 Kataoka 等人的社论。
