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Abstract：
BACKGROUND: In a previous paper, we had assumed that the risk of screen-detected breast cancer mostly reflects inherent risk, and the risk of whether a breast cancer is interval versus screen-detected mostly reflects risk of masking. We found that inherent risk was predicted by body mass index (BMI) and dense area (DA) or percent dense area (PDA), but not by non-dense area (NDA). Masking, however, was best predicted by PDA but not BMI. In this study, we aimed to investigate if these associations vary by tumor characteristics and mode of detection.
METHODS: We conducted a case-control study nested within the Melbourne Collaborative Cohort Study of 244 screen-detected cases matched to 700 controls and 148 interval cases matched to 446 controls. DA, NDA and PDA were measured using the Cumulus software. Tumor characteristics included size, grade, lymph node involvement, and ER, PR, and HER2 status. Conditional and unconditional logistic regression were applied as appropriate to estimate the Odds per Adjusted Standard Deviation (OPERA) adjusted for age and BMI, allowing the association with BMI to be a function of age at diagnosis.
RESULTS: For screen-detected cancer, both DA and PDA were associated to an increased risk of tumors of large size (OPERA ~ 1.6) and positive lymph node involvement (OPERA ~ 1.8); no association was observed for BMI and NDA. For risk of interval versus screen-detected breast cancer, the association with risk for any of the three mammographic measures did not vary by tumor characteristics; an association was observed for BMI for positive lymph nodes (OPERA ~ 0.6). No associations were observed for tumor grade and ER, PR and HER2 status of tumor.
CONCLUSIONS: Both DA and PDA were predictors of inherent risk of larger breast tumors and positive nodal status, whereas for each of the three mammographic density measures the association with risk of masking did not vary by tumor characteristics. This might raise the hypothesis that the risk of breast tumours with poorer prognosis, such as larger and node positive tumours, is intrinsically associated with increased mammographic density and not through delay of diagnosis due to masking.
METHODS: We conducted a case-control study nested within the Melbourne Collaborative Cohort Study of 244 screen-detected cases matched to 700 controls and 148 interval cases matched to 446 controls. DA, NDA and PDA were measured using the Cumulus software. Tumor characteristics included size, grade, lymph node involvement, and ER, PR, and HER2 status. Conditional and unconditional logistic regression were applied as appropriate to estimate the Odds per Adjusted Standard Deviation (OPERA) adjusted for age and BMI, allowing the association with BMI to be a function of age at diagnosis.
RESULTS: For screen-detected cancer, both DA and PDA were associated to an increased risk of tumors of large size (OPERA ~ 1.6) and positive lymph node involvement (OPERA ~ 1.8); no association was observed for BMI and NDA. For risk of interval versus screen-detected breast cancer, the association with risk for any of the three mammographic measures did not vary by tumor characteristics; an association was observed for BMI for positive lymph nodes (OPERA ~ 0.6). No associations were observed for tumor grade and ER, PR and HER2 status of tumor.
CONCLUSIONS: Both DA and PDA were predictors of inherent risk of larger breast tumors and positive nodal status, whereas for each of the three mammographic density measures the association with risk of masking did not vary by tumor characteristics. This might raise the hypothesis that the risk of breast tumours with poorer prognosis, such as larger and node positive tumours, is intrinsically associated with increased mammographic density and not through delay of diagnosis due to masking.
摘要：
背景：在之前的一篇论文中，我们假设屏幕检测到的乳腺癌的风险主要反映了固有的风险，和乳腺癌是否是间隔与屏幕检测的风险主要反映了掩蔽的风险。我们发现，固有风险是通过体重指数（BMI）和密集面积（DA）或密集面积百分比（PDA）来预测的，但不是通过非密集区域（NDA）。蒙面,然而,最好的预测是PDA，但不是BMI。在这项研究中,我们的目的是调查这些关联是否因肿瘤特征和检测模式而异.
方法：我们在墨尔本协作队列研究中进行了一项病例对照研究，该研究涉及与700个对照匹配的244个筛查检测病例和与446个对照匹配的148个间隔病例。DA,使用积云软件测量NDA和PDA。肿瘤特征包括大小，grade,淋巴结受累,ER,PR,和HER2状态。适当地应用条件和非条件逻辑回归来估计针对年龄和BMI调整后的每个调整标准偏差(OPERA)的赔率。允许与BMI的关联是诊断时年龄的函数。
结果：对于屏幕检测到的癌症，DA和PDA均与大尺寸肿瘤(OPERA~1.6)和阳性淋巴结受累(OPERA~1.8)的风险增加相关;未观察到BMI和NDA的相关性.对于间隔与屏幕检测到的乳腺癌的风险，3种乳房X线摄影方法中的任何一种与风险的相关性均不因肿瘤特征而异;观察到阳性淋巴结的BMI存在相关性(OPERA~0.6).未观察到肿瘤分级和ER的关联，肿瘤的PR和HER2状态。
结论：DA和PDA都是较大乳腺肿瘤和淋巴结状态阳性的固有风险的预测因子，而对于3种乳腺密度测量中的每一种,其与掩蔽风险的相关性并不因肿瘤特征而异.这可能会提出一个假设，即乳腺癌预后较差的风险，例如较大的和淋巴结阳性的肿瘤，本质上与增加的乳房X线摄影密度有关，而不是由于掩盖而导致诊断延迟。
方法：我们在墨尔本协作队列研究中进行了一项病例对照研究，该研究涉及与700个对照匹配的244个筛查检测病例和与446个对照匹配的148个间隔病例。DA,使用积云软件测量NDA和PDA。肿瘤特征包括大小，grade,淋巴结受累,ER,PR,和HER2状态。适当地应用条件和非条件逻辑回归来估计针对年龄和BMI调整后的每个调整标准偏差(OPERA)的赔率。允许与BMI的关联是诊断时年龄的函数。
结果：对于屏幕检测到的癌症，DA和PDA均与大尺寸肿瘤(OPERA~1.6)和阳性淋巴结受累(OPERA~1.8)的风险增加相关;未观察到BMI和NDA的相关性.对于间隔与屏幕检测到的乳腺癌的风险，3种乳房X线摄影方法中的任何一种与风险的相关性均不因肿瘤特征而异;观察到阳性淋巴结的BMI存在相关性(OPERA~0.6).未观察到肿瘤分级和ER的关联，肿瘤的PR和HER2状态。
结论：DA和PDA都是较大乳腺肿瘤和淋巴结状态阳性的固有风险的预测因子，而对于3种乳腺密度测量中的每一种,其与掩蔽风险的相关性并不因肿瘤特征而异.这可能会提出一个假设，即乳腺癌预后较差的风险，例如较大的和淋巴结阳性的肿瘤，本质上与增加的乳房X线摄影密度有关，而不是由于掩盖而导致诊断延迟。
