Abstract
Mammographic density reveals information about the hormonal environment along with
the heritability in which breast cancer develops. This is made possible by the widespread
use of population screening by mammography. Increasingly this is an important observation
not just for population studies, which reveal disease determinants, but also for the
individual. Density reveals the effect of the intrinsic hormonal environment and its
background genetics, and also the effect of pharmaceuticals—agents used for disease
control and prevention and hormone replacement therapy (HRT) used for well-being around
the menopause. Increasingly this focus on the individual will need methods of measurement
of density that can be monitored with greater accuracy than the widely used BI-RADS
4 categories. For this purpose studies are under way to measure volume of dense tissue
as a continuous variable. In due course, measurement of density will be used as a
biomarker of risk, employed in risk models and to monitor interventions. Before this
can happen more knowledge will be needed of the change occurring naturally through
the menopause and the differences between individuals. This will need specific study
backed up with detailed information about the patient on large numbers of women and
their mammograms. Currently the widespread use of HRT has increased the prevalence
of the dense patterns and potentially may adversely affect the effectiveness of mammographic
screening programmes. There is a large literature recording this from which we see
that combined continuous preparations of oestrogen progestin are more likely to cause
increased density than oestrogen alone or tibolone. Breast density, measured more
accurately, has the potential to be an important adjunct to risk estimation and to
monitor interventions for breast cancer prevention with pharmaceuticals (such as SERMS)
and by change in lifestyle behaviours.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Breast patterns as an index of risk for developing breast cancer.Am. J. Roentgenol. 1976; 126: 1130-1137
- Use of the American College of Radiology BI-RADS guidelines by community radiologists: concordance of assessments and recommendations assigned to screening mammograms.AJR Am. J. Roentgenol. 2002; 179: 15-20
- Effects of mammographic density and benign breast disease on breast cancer risk.Cancer Causes Control. 2001; 12: 103-110
- Breast cancer and hormone-replacement therapy in the Million Women Study.Lancet. 2003; 362: 419-427
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial.JAMA. 2002; 288: 321-333
- Hormone replacement therapy and the sensitivity and specificity of breast cancer screening: a review.J. Med. Screen. 2001; 8: 29-34
- Can the stroma provider the clue to mammographic density.Breast Cancer Res. 2003; 5: 225-227
- Mammographic densities and breast cancer risk.Cancer Epidemiol. Biomark. Prev. 1998; 7: 1133-1144
- Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States).Cancer Causes Control. 2000; 11: 653-662
- High-risk mammographic parenchymal patterns and anthropometric measures: a case-control study.Br. J. Cancer. 1999; 81: 1257-1261
- Mammographic tissue, breast cancer risk, serial image analysis, and digital mammography..Acad. Radiol. 2002; 9: 317-335
- Mammographic tissue, breast cancer risk, serial image analysis, and digital mammography..Acad. Radiol. 2002; 9: 298-316
- Heritability of mammographic density, a risk factor for breast cancer.N. Engl. J. Med. 2002; 347: 886-894
- Relationship between mammographic and histological risk factors for breast cancer.J. Natl. Cancer Inst. 1992; 84: 1170-1179
- Automated analysis of mammographic densities.Phys. Med. Biol. 1996; 41: 909-923
- A volumetric method for estimation of breast density on digitized screen-film mammograms.Med. Phys. 2003; 30: 352-364
- New biology of the oestrogen receptor.Lancet. 2003; 362: 260-262
- High-risk mammographic parenchymal patterns and hormone replacement therapy: a case-control study.Int. J. Epidemiol. 2000; 29: 629-636
- Mammographic patterns as a predictive biomarker of breast cancer risk: effect of tamoxifen [in process citation].Cancer Epidemiol. Biomark. Prev. 1999; 8: 863-866
- Variation in mammographic breast density by time in menstrual cycle among women aged 40–49 years.J. Natl. Cancer Inst. 1998; 90: 906-910
- Effects of a short-term suspension of hormone replacement therapy on mammographic density.Fertil. Steril. 2001; 76: 451-455
- Mammographic breast density as a biomarker of effects of isoflavones on the female breast.Breast Cancer Res. 2002; 4: 1-4
- Effects at two years of a low-fat, high-carbohydrate diet on radiologic features of the breast: results from a randomized trial. Canadian Diet and Breast Cancer Prevention Study Group.J. Natl. Cancer Inst. 1997; 89: 488-496
- Mammographic density changes in perimenopausal and postmenopausal women: is effect of hormone replacement therapy predictable?.Breast Cancer Res. Treat. 2000; 59: 125-132
- A pilot study of hormone replacement therapy with tibolone in women with mastopathic breasts.Maturitas. 2001; 40: 165-171
- Effect of mammographic breast density on breast cancer screening performance: a study in Nijmegen, The Netherlands.J. Epidemiol. Commun. Health. 1998; 52: 267-271
- Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial.JAMA. 2003; 289: 3243-3253
- Hormone replacement therapy and high incidence of breast cancer between mammographic screens.Lancet. 1997; 349: 1103-1104
- Screening mammography: sensitivity and specificity in relation to hormone replacement therapy.Radiology. 1997; 203: 339-341
- The effect of hormone replacement therapy on the sensitivity of screening mammograms.Clin. Radiol. 1999; 54: 285-288
- Hormone replacement therapy and screening mammography: analysis of the results in the Bouches du Rhone programme.J. Med. Screen. 1999; 6: 99-102
- The effect of hormone replacement therapy on recall rate in the National Health Service Breast Screening Programme.Clin. Radiol. 1997; 52: 276-279
- The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up.Radiol. Clin. North Am. 2000; 38: 625-651
- Effect of hormone replacement therapy on cancer detection by mammography.Lancet. 1997; 349: 1624
- Serum oestradiol and breast cancer risk.Endocr. Relat. Cancer. 1999; 6: 175-180
- Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women.J. Natl. Cancer Inst. 2003; 95: 1218-1226
- The association of breast mitogens with mammographic densities.Br. J. Cancer. 2002; 87: 876-882
- Plasma insulin-like growth factor (IGF) I, IGF-binding protein 3, and mammographic density.Cancer Res. 2000; 60: 3744-3748
- Breast cancer risk associated with genotype polymorphism of the estrogen-metabolizing genes CYP17, CYP1A1, and COMT: a multigenic study on cancer susceptibility.Cancer Res. 1999; 59: 4870-4875
- Genetic determinants of mammographic density.Breast Cancer Res. 2002; 4: R5
- Impact of menstrual phase on false-negative mammograms in the Canadian National Breast Screening Study.Cancer. 1997; 80: 720-724
- Mammographic density changes during the menstrual cycle.Prev. Cancer Epidemiol. Biomark. 2001; 10: 141-142
- Menstrual cycle variation in mammographic breast density: so who cares?.J. Natl. Cancer Inst. 1998; 90: 875-876
- Estimation of breast volume and its variation during the menstrual cycle using MRI and stereology.Br. J. Radiol. 1999; 72: 236-245
- Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density.Am. J. Obstet. Gynecol. 2002; 186: 717-722
- Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy.JAMA. 2001; 285: 171-176
- Effect of postmenopausal hormonal replacement therapy on mammographic density and parenchymal pattern.Radiology. 1995; 196: 433-437
- Is a dense mammographic parenchymal pattern a contraindication to hormonal replacement therapy?.Acta Oncol. 2000; 39: 969-972
- Smoking and high-risk mammographic parenchymal patterns: a case-control study.Breast Cancer Res. 2000; 2: 59-63
- European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics.Pub. Health Nutr. 2002; 5: 1125-1145
- Gene-environment interactions—the BioBank UK study.Pharmacogenom. J. 2002; 2: 75-82
- Tamoxifen and mammographic breast densities.Cancer Epidemiol. Biomark. Prev. 2000; 9: 911-915
- Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial.Lancet. 2002; 359: 2131-2139
- Anti-oestrogenic prevention of breast cancer—the make or break point.Nat. Rev. Cancer. 2002; 2: 787-794
- Tamoxifen and breast density in women at increased risk of breast cancer.J. Natl. Cancer Inst. 2004; 96: 621-628
- Breast cancer chemoprevention: current challenges and a look toward the future.Clin. Breast Cancer. 2002; 3: 113-124
- Digitized mammography: a clinical trial of postmenopausal women randomly assigned to receive raloxifene, estrogen, or placebo.J. Natl. Cancer Inst. 2001; 93: 51-56
- Isoflavones and women’s health.Breast Cancer Res. 2004; 6: 140-142
- Mammographic densities in a one-year isoflavone intervention.Eur. J. Cancer Prev. 2003; 12: 165-169
- The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trial.Am. J. Clin. Nutr. 2004; 79: 326-333
- Mammographic densities as a criterion for entry to a clinical trial of breast cancer prevention.Br. J. Cancer. 1995; 72: 476-479
- Mammographic densities as a marker of human breast cancer risk and their use in chemoprevention.Curr. Oncol. Rep. 2001; 3: 314-321
- Hormone replacement therapy and the risk of breast cancer Nested case-control study in a cohort of Swedish women attending mammography screening.Int. J. Cancer. 1997; 72: 758-761
- Mammographic changes in postmenopausal women on hormonal replacement therapy.Eur. Radiol. 1997; 7: 749-755
- Mammographic changes in women receiving tibolone therapy.Fertil. Steril. 1998; 69: 870-875
- Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183,134 screening mammograms in Albuquerque.New Mexico Radiol. 1998; 209: 511-518
- Mammographic changes after hormone replacement therapy in patients who have undergone breast irradiation.AJR Am. J. Roentgenol. 1999; 172: 147-150
- Effects of estrogen and estrogen-progestin on mammographic parenchymal density. Postmenopausal Estrogen/Progestin Interventions (PEPI) Investigators.Ann. Intern. Med. 1999; 130: 262-269
- Mammographic and ultrasonographic study of changes in the breast related to HRT.Int. J. Gynaecol. Obstet. 1999; 67: 23-32
- Mammographic breast density during hormone replacement therapy: differences according to treatment.Am. J. Obstet. Gynecol. 1999; 181: 348-352
- Reproductive and hormonal factors associated with mammographic breast density by age (United States).Cancer Causes Control. 2000; 11: 955-963
- Mammographic density changes during different postmenopausal hormone replacement therapies.Fertil. Steril. 2001; 76: 445-450
- Mammographic breast density during hormone replacement therapy: effects of continuous combination, unopposed transdermal and low-potency estrogen regimens.Climacteric. 2001; 4: 42-48
- Mammographic density increase in women receiving different hormone replacement regimens.Maturitas. 2001; 40: 151-157
- Effects of hormone replacement therapy on mammographic findings.Arch. Gynecol. Obstet. 2003; 268: 5-8
- Case-control study of increased mammographic breast density response to hormone replacement therapy.Cancer Epidemiol. Biomark. Prev. 2002; 11: 1382-1388
- Effect of long-term continuous combined hormone replacement therapy with estradiol valerate and either dienogest or norethisterone acetate on mammographic density in postmenopausal women.Medscape Womens Health. 2002; 7: 1
- Mammographic changes associated with raloxifene and tibolone therapy in postmenopausal women: a prospective study.Menopause. 2002; 9: 110-116
- Postmenopausal hormone therapy and change in mammographic density.J. Natl. Cancer Inst. 2003; 95: 30-37
- Correlates of mammogram density in southwestern Native-American women.Cancer Epidemiol. Biomark. Prev. 2003; 12: 552-558
- Comparison of the effect of raloxifene and continuous-combined hormone therapy on mammographic breast density and breast tenderness in postmenopausal women.Am. J. Obstet. Gynecol. 2003; 188: 389-394
- The effect of various regimens of hormone replacement therapy on mammographic breast density.Maturitas. 2003; 45: 109-118
- Red-clover-derived isoflavones and mammographic breast density: a double-blind, randomized placebo-controlled trial [ISRCTN 42940165].Breast Cancer Res. 2004; 6: R170-R179
Article info
Publication history
Accepted:
June 10,
2004
Received in revised form:
April 25,
2004
Received:
December 16,
2003
Identification
Copyright
© 2004 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
