Mammographic density and risk of breast cancer by age and tumor characteristics

Abstract

Introduction: Understanding whether mammographic density (MD) is associated with all breast tumor subtypes and whether the strength of association varies by age is important for utilizing MD in risk models.

Methods: Data were pooled from six studies including 3414 women with breast cancer and 7199 without who underwent screening mammography. Percent MD was assessed from digitized film-screen mammograms using a computer-assisted threshold technique. We used polytomous logistic regression to calculate breast cancer odds according to tumor type, histopathological characteristics, and receptor (estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2)) status by age (<55, 55-64, and ≥ 65 years).

Results: MD was positively associated with risk of invasive tumors across all ages, with a two-fold increased risk for high (>51%) versus average density (11-25%). Women ages <55 years with high MD had stronger increased risk of ductal carcinoma in situ (DCIS) compared to women ages 55-64 and ≥ 65 years (P(age-interaction) = 0.02). Among all ages, MD had a stronger association with large (>2.1 cm) versus small tumors and positive versus negative lymph node status (P's < 0.01). For women ages <55 years, there was a stronger association of MD with ER-negative breast cancer than ER-positive tumors compared to women ages 55-64 and ≥ 65 years (P(age-interaction) = 0.04). MD was positively associated with both HER2-negative and HER2-positive tumors within each age group.

Conclusion: MD is strongly associated with all breast cancer subtypes, but particularly tumors of large size and positive lymph nodes across all ages, and ER-negative status among women ages <55 years, suggesting high MD may play an important role in tumor aggressiveness, especially in younger women.

Figure 1

Pooled associations of categorical mammographic density for tumor type and morphological subtypes of invasive breast cancer by age. Odds ratios and 95% confidence intervals adjusted for age, body mass index, and study are shown for each category of mammographic density (MD): 1, 0 to 10% MD; 2, 11 to 25% MD (reference); 3, 26 to 50% MD; 4, 51% + MD). (A) Tumor type. (B) Histology. (C) Tumor grade. (D) Tumor size. (E) Lymph node involvement. (F) Estrogen receptor (ER) status. (G) Progesterone receptor (PR) status. (H) Human epidermal growth factor receptor 2 (HER2) status. DCIS, ductal carcinoma in situ.