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Abstract：
BACKGROUND: Benign breast disease (BBD) and high mammographic breast density (MBD) are prevalent and independent risk factors for invasive breast cancer. It has been suggested that temporal changes in MBD may impact future invasive breast cancer risk, but this has not been studied among women with BBD.
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.
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.
摘要：
背景：良性乳腺疾病（BBD）和高乳腺密度（MBD）是浸润性乳腺癌的流行和独立危险因素。有人认为，MBD的时间变化可能会影响未来的浸润性乳腺癌风险。但尚未在BBD女性中进行研究。
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。
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。
