Predictors of mammographic microcalcifications

Abstract

We examined the association between established risk factors for breast cancer and microcalcification clusters and their asymmetry. A cohort study of 53 273 Swedish women aged 30 to 80 years, with comprehensive information on breast cancer risk factors and mammograms, was conducted. Total number of microcalcification clusters and the average mammographic density area were measured using a Computer Aided Detection system and the STRATUS method, respectively. A polygenic risk score for breast cancer, including 313 single nucleotide polymorphisms, was calculated for those women genotyped (N = 7387). Odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for potential confounders, were estimated. Age was strongly associated with microcalcification clusters. Both high mammographic density (>40 cm² ), and high polygenic risk score (80-100 percentile) were associated with microcalcification clusters, OR = 2.08 (95% CI = 1.93-2.25) and OR = 1.22 (95% CI = 1.06-1.48), respectively. Among reproductive risk factors, life-time breastfeeding duration >1 year was associated with microcalcification clusters OR = 1.22 (95% CI = 1.03-1.46). The association was confined to postmenopausal women. Among lifestyle risk factors, women with a body mass index ≥30 kg/m² had the lowest risk of microcalcification clusters OR = 0.79 (95% CI = 0.73-0.85) and the association was stronger among premenopausal women. Our results suggest that age, mammographic density, genetic predictors of breast cancer, having more than two children, longer duration of breast-feeding are significantly associated with increased risk of microcalcification clusters. However, most lifestyle risk factors for breast cancer seem to protect against presence of microcalcification clusters. More research is needed to study biological mechanisms behind microcalcifications formation.

Keywords: cohort study; mammographic feature; mammographic microcalcifications.

FIGURE 1

Flow chart describing the exclusion criteria for 70 874 women in KARMA cohort [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Illustration of suspicious microcalcification clusters using iCAD software on cranio‐caudal views of a 74 years old woman with a lump in the right breast. iCAD software identified microcalcification clusters with suspicious morphology (iCAD Inc. Mammography: benefits of computer aided detection. Clinical case study; 2016. Accessed August 13, 2020. https://www.icadmed.com/assets/dmm223_mammography_benefit_of_computer‐aided_detection_reva_01.pdf)