Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands.
Department of Radiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands.
Breast. 2022 Dec;66:62-68. doi: 10.1016/j.breast.2022.09.007. Epub 2022 Sep 26.
Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.
Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I statistic, stratified and sensitivity analyses.
Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84-2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52-2.21) increased. Both results were statistically significant and homogenous.
Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.
乳腺密度是乳腺癌的一个明确的危险因素，乳腺组织极度致密与乳腺癌风险增加 1 至 6 倍相关。然而，人们质疑这种风险增加的估计是否适用于当前的乳腺密度分类方法。因此，本研究的目的是进一步根据现有文献调查和阐明乳腺密度与乳腺癌风险之间的关系。
系统检索了 Medline、Embase 和 Web of Science 上自 2013 年以来发表的文章，这些文章使用了 BI-RADS 词汇表第 5 版，并纳入了数字乳腺摄影数据。使用随机效应模型，以比值比（OR）汇总了未经调整和最大混杂因素调整的数据。使用 I 统计量、分层和敏感性分析来研究乳腺癌风险的异质性。
纳入了 9 项观察性研究。与散在致密乳腺组织（BI-RADS 密度 B）相比，乳腺组织极度致密（BI-RADS 密度 D）导致乳腺癌风险增加 2.11 倍（95% CI 1.84-2.42）。敏感性分析显示，仅使用调整年龄和 BMI 的数据时，乳腺癌风险增加 1.83 倍（95% CI 1.52-2.21）。这两个结果均具有统计学意义且同质。
在一般人群女性中，与 BI-RADS 密度 B 相比，乳腺 X 线摄影乳腺密度 BI-RADS D 与乳腺癌风险增加约两倍相关。与之前报道的相比，这是一个新的且风险较低的估计，这可能是由于使用了数字乳腺摄影和 BI-RADS 词汇表第 5 版。
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