Marta Román1,2, Javier Louro1,2,3, Margarita Posso1,2, Rodrigo Alcántara4, Lupe Peñalva5, Maria Sala1,2, Javier Del Riego6, Miguel Prieto7, Carmen Vidal8, Mar Sánchez9, Xavier Bargalló10, Ignasi Tusquets11, Xavier Castells12,13. 1. Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain. 2. Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain. 3. European Higher Education Area, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona, Barcelona, Spain. 4. Department of Radiology, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 5. Breast Cancer Screening Technical Office, Private Foundation Asil Hospital, Granollers, Spain. 6. Department of Radiology, Parc Taulí University Hospital-UAB, Sabadell, Catalonia, Spain. 7. General Directorate of Public Health, Principality of Asturias Health Service, Asturias, Spain. 8. Cancer Prevention and Monitoring Program, Catalan Institute of Oncology, Barcelona, Spain. 9. General Directorate of Public Health, Government of Cantabria, Santander, Spain. 10. Department of Radiology, Hospital Clinic, Barcelona, Spain. 11. Department of Medical Oncology, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 12. Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain. xcastells@parcdesalutmar.cat. 13. Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain. xcastells@parcdesalutmar.cat.
Abstract
OBJECTIVES: Assessing the combined effect of mammographic density and benign breast disease is of utmost importance to design personalized screening strategies. METHODS: We analyzed individual-level data from 294,943 women aged 50-69 years with at least one mammographic screening participation in any of four areas of the Spanish Breast Cancer Screening Program from 1995 to 2015, and followed up until 2017. We used partly conditional Cox models to assess the association between benign breast disease, breast density, and the risk of breast cancer. RESULTS: During a median follow-up of 8.0 years, 3697 (1.25%) women had a breast cancer diagnosis and 5941 (2.01%) had a benign breast disease. More than half of screened women had scattered fibroglandular density (55.0%). The risk of breast cancer independently increased with the presence of benign breast disease and with the increase in breast density (p for interaction = 0.84). Women with benign breast disease and extremely dense breasts had a threefold elevated risk of breast cancer compared with those with scattered fibroglandular density and without benign breast disease (hazard ratio [HR] = 3.07; 95%CI = 2.01-4.68). Heterogeneous density and benign breast disease was associated with nearly a 2.5 elevated risk (HR = 2.48; 95%CI = 1.66-3.70). Those with extremely dense breast without a benign breast disease had a 2.27 increased risk (95%CI = 2.07-2.49). CONCLUSIONS: Women with benign breast disease had an elevated risk for over 15 years independently of their breast density category. Women with benign breast disease and dense breasts are at high risk for future breast cancer. KEY POINTS: • Benign breast disease and breast density were independently associated with breast cancer. • Women with benign breast disease had an elevated risk for up to 15 years independently of their mammographic density category.
OBJECTIVES: Assessing the combined effect of mammographic density and benign breast disease is of utmost importance to design personalized screening strategies. METHODS: We analyzed individual-level data from 294,943 women aged 50-69 years with at least one mammographic screening participation in any of four areas of the Spanish Breast Cancer Screening Program from 1995 to 2015, and followed up until 2017. We used partly conditional Cox models to assess the association between benign breast disease, breast density, and the risk of breast cancer. RESULTS: During a median follow-up of 8.0 years, 3697 (1.25%) women had a breast cancer diagnosis and 5941 (2.01%) had a benign breast disease. More than half of screened women had scattered fibroglandular density (55.0%). The risk of breast cancer independently increased with the presence of benign breast disease and with the increase in breast density (p for interaction = 0.84). Women with benign breast disease and extremely dense breasts had a threefold elevated risk of breast cancer compared with those with scattered fibroglandular density and without benign breast disease (hazard ratio [HR] = 3.07; 95%CI = 2.01-4.68). Heterogeneous density and benign breast disease was associated with nearly a 2.5 elevated risk (HR = 2.48; 95%CI = 1.66-3.70). Those with extremely dense breast without a benign breast disease had a 2.27 increased risk (95%CI = 2.07-2.49). CONCLUSIONS:Women with benign breast disease had an elevated risk for over 15 years independently of their breast density category. Women with benign breast disease and dense breasts are at high risk for future breast cancer. KEY POINTS: • Benign breast disease and breast density were independently associated with breast cancer. • Women with benign breast disease had an elevated risk for up to 15 years independently of their mammographic density category.
Entities:
Keywords:
Benign breast disease; Breast neoplasms; Longitudinal studies; Mammographic density; Mass screening
Authors: Marta Román; Javier Louro; Margarita Posso; Carmen Vidal; Xavier Bargalló; Ivonne Vázquez; María Jesús Quintana; Rodrigo Alcántara; Francina Saladié; Javier Del Riego; Lupe Peñalva; Maria Sala; Xavier Castells Journal: Int J Environ Res Public Health Date: 2022-02-24 Impact factor: 3.390