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Mammographic Density and Ageing: A Collaborative Pooled Analysis of Cross-Sectional Data From 22 Countries Worldwide Publisher Pubmed



Burton A1 ; Maskarinec G2 ; Perezgomez B3, 4 ; Vachon C5 ; Miao H6 ; Lajous M7 ; Lopezridaura R7 ; Rice M8 ; Pereira A9 ; Garmendia ML9 ; Tamimi RM10 ; Bertrand K11 ; Kwong A12, 13, 14 ; Ursin G15, 16, 17 Show All Authors
Authors
  1. Burton A1
  2. Maskarinec G2
  3. Perezgomez B3, 4
  4. Vachon C5
  5. Miao H6
  6. Lajous M7
  7. Lopezridaura R7
  8. Rice M8
  9. Pereira A9
  10. Garmendia ML9
  11. Tamimi RM10
  12. Bertrand K11
  13. Kwong A12, 13, 14
  14. Ursin G15, 16, 17
  15. Lee E17
  16. Qureshi SA18
  17. Ma H19
  18. Vinnicombe S20
  19. Moss S21
  20. Allen S22
  21. Ndumia R23
  22. Vinayak S23
  23. Teo SH24, 25
  24. Mariapun S25
  25. Fadzli F26, 27
  26. Peplonska B28
  27. Bukowska A28
  28. Nagata C29
  29. Stone J30
  30. Hopper J31
  31. Giles G31, 32
  32. Ozmen V33
  33. Aribal ME34
  34. Schuz J1
  35. Van Gils CH35
  36. Wanders JOP35
  37. Sirous R36, 48
  38. Sirous M37
  39. Hipwell J38
  40. Kim J39
  41. Lee JW39
  42. Dickens C40
  43. Hartman M5, 41
  44. Chia KS42
  45. Scott C5
  46. Chiarelli AM43
  47. Linton L44
  48. Pollan M3, 4
  49. Flugelman AA45
  50. Salem D46
  51. Kamal R46
  52. Boyd N44
  53. Dossantossilva I47
  54. Mccormack V1
Show Affiliations
Authors Affiliations
  1. 1. Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
  2. 2. University of Hawaii Cancer Center, Honolulu, HI, United States
  3. 3. Instituto de Salud Carlos III, Madrid, Spain
  4. 4. CIBERESP, Madrid, Spain
  5. 5. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
  6. 6. Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  7. 7. Instituto Nacional de Salud Publica, Cuernavaca, Mexico
  8. 8. Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
  9. 9. Instituto de Nutricion y Tecnologia de los Alimentos, Universidad de Chile, Santiago, Chile
  10. 10. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
  11. 11. Slone Epidemiology Center, Boston University, Boston, MA, United States
  12. 12. Division of Breast Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, China
  13. 13. Department of Surgery and Cancer Genetics Center, Hong Kong Sanatorium and Hospital, China
  14. 14. Hong Kong Hereditary Breast Cancer Family Registry, China
  15. 15. Cancer Registry of Norway, Oslo, Norway
  16. 16. Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
  17. 17. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States
  18. 18. Norwegian Centre for Migrant and Minority Health (NAKMI), Oslo, Norway
  19. 19. Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
  20. 20. Division of Cancer Research, Ninewells Hospital and Medical School, Dundee, United Kingdom
  21. 21. Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
  22. 22. Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
  23. 23. Aga Khan University Hospital, Nairobi, Kenya
  24. 24. Breast Cancer Research Group, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
  25. 25. Cancer Research Malaysia, Subang Jaya, Malaysia
  26. 26. Breast Cancer Research Unit, Faculty of Medicine, University of Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
  27. 27. Biomedical Imaging Department, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
  28. 28. Nofer Institute of Occupational Medicine, Lodz, Poland
  29. 29. Department of Epidemiology & Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
  30. 30. Centre for Genetic Origins of Health and Disease, University of Western Australia, Crawley, WA, Australia
  31. 31. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  32. 32. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
  33. 33. Faculty of Medicine, Istanbul University, Istanbul, Turkey
  34. 34. Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
  35. 35. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
  36. 36. Isfahan University of Medical Sciences, Isfahan, Iran
  37. 37. Radiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
  38. 38. Centre for Medical Image Computing, University College London, London, United Kingdom
  39. 39. Asan Medical Center, Seoul, South Korea
  40. 40. Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  41. 41. Department of Surgery, Yong Loo Lin School of Medicine, Singapore
  42. 42. Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
  43. 43. Ontario Breast Screening Program, Cancer Care Ontario, Toronto, ON, Canada
  44. 44. Princess Margaret Cancer Centre, Toronto, ON, Canada
  45. 45. National Cancer Control Center, Lady Davis Carmel Medical Center, Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
  46. 46. Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt
  47. 47. Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
  48. 48. Jackson State University, Jackson, MS, United States

Source: PLoS Medicine Published:2017


Abstract

Background: Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known. Methods and findings: We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35–85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of pooled data, adjusted for body mass index, reproductive factors, mammogram view, image type, and reader. In all, 4,534 women were premenopausal, and 6,481 postmenopausal, at the time of mammography. A large age-adjusted difference in percent MD (PD) between post- and premenopausal women was apparent (–0.46 cm [95% CI: −0.53, −0.39]) and appeared greater in women with lower breast cancer risk profiles; variation across population groups due to heterogeneity (I2) was 16.5%. Among premenopausal women, the √PD difference per 10-year increase in age was −0.24 cm (95% CI: −0.34, −0.14; I2= 30%), reflecting a compositional change (lower dense area and higher non-dense area, with no difference in breast area). In postmenopausal women, the corresponding difference in √PD (−0.38 cm [95% CI: −0.44, −0.33]; I2= 30%) was additionally driven by increasing breast area. The study is limited by different mammography systems and its cross-sectional rather than longitudinal nature. Conclusions: Declines in MD with increasing age are present premenopausally, continue postmenopausally, and are most pronounced over the menopausal transition. These effects were highly consistent across diverse groups of women worldwide, suggesting that they result from an intrinsic biological, likely hormonal, mechanism common to women. If cumulative breast density is a key determinant of breast cancer risk, younger ages may be the more critical periods for lifestyle modifications aimed at breast density and breast cancer risk reduction. © 2017 Burton et al.
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