METHODS: We undertook a nested case-control study within a cohort of 15,395 women with BBD in Kaiser Permanente Northwest (KPNW; 1970-2012, followed through mid-2015). Cases (n = 261) developed invasive breast cancer > 1 year after BBD diagnosis, whereas controls (n = 249) did not have breast cancer by the case diagnosis date. Cases and controls were individually matched on BBD diagnosis age and plan membership duration. Standardized %MBD change (per 2 years), categorized as stable/any increase (≥ 0%), minimal decrease of less than 5% or a decrease greater than or equal to 5%, was determined from baseline and follow-up mammograms. Associations between MBD change and breast cancer risk were examined using adjusted unconditional logistic regression.
RESULTS: Overall, 64.5% (n = 329) of BBD patients had non-proliferative and 35.5% (n = 181) had proliferative disease with/without atypia. Women with an MBD decrease (≤ - 5%) were less likely to develop breast cancer (Odds Ratio (OR) 0.64; 95% Confidence Interval (CI) 0.38, 1.07) compared with women with minimal decreases. Associations were stronger among women ≥ 50 years at BBD diagnosis (OR 0.48; 95% CI 0.25, 0.92) and with proliferative BBD (OR 0.32; 95% CI 0.11, 0.99).
CONCLUSIONS: Assessment of temporal MBD changes may inform risk monitoring among women with BBD, and strategies to actively reduce MBD may help decrease future breast cancer risk.
方法:我们在西北KaiserPermanente的15,395名BBD女性队列中进行了一项巢式病例对照研究(KPNW;1970-2012,随后至2015年中)。病例(n=261)在BBD诊断后>1年发展为浸润性乳腺癌,而对照组(n=249)在病例诊断日期之前没有乳腺癌。病例和对照在BBD诊断年龄和计划成员资格持续时间上进行单独匹配。标准化%MBD变化(每2年),分类为稳定/任何增加(≥0%),最小降幅小于5%或降幅大于或等于5%,从基线和随访乳房X线照片确定。MBD改变与乳腺癌风险之间的关联使用调整的无条件逻辑回归进行检查。
结果:总体而言,64.5%(n=329)的BBD患者具有非增生性,而35.5%(n=181)的增生性疾病伴/不伴异型性。与MBD降低(≤-5%)的女性相比,MBD降低(赔率比(OR)0.64;95%置信区间(CI)0.38,1.07)的女性患乳腺癌的可能性较小。在诊断为BBD的≥50岁女性(OR0.48;95%CI0.25,0.92)和增殖性BBD(OR0.32;95%CI0.11,0.99)之间的关联更强。
结论:对时态MBD变化的评估可以为BBD女性的风险监测提供依据,积极降低MBD的策略可能有助于降低未来乳腺癌的风险。