Mammographic density and histopathologic characteristics of screen-detected tumors in the Norwegian Breast Cancer Screening Program
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Original versionMoshina, N., Ursin, G., Hoff, S. R., Akslen, L. A., Roman, M., Sebuødegård, S., & Hofvind, S. (2015). Mammographic density and histopathologic characteristics of screen-detected tumors in the Norwegian Breast Cancer Screening Program. Acta radiologica open, 4(9), 2058460115604340. http://dx.doi.org/10.1177/2058460115604340
Background:High mammographic density might mask breast tumors, resulting in delayed diagnosis or missed cancers.Purpose:To investigate the association between mammographic density and histopathologic tumor characteristics(histologic type, size, grade, and lymph node status) among women screened in the Norwegian Breast CancerScreening Program.Material and Methods:Information about 1760 screen-detected ductal carcinoma in situ (DCIS) and 7366 invasivebreast cancers diagnosed among women aged 50–69 years, 1996–2010, was analyzed. The screening mammograms wereclassified subjectively according to the amount of fibroglandular tissue into fatty, medium dense, and dense by breastradiologists. Chi-square test was used to compare the distribution of tumor characteristics by mammographic density.Odds ratio (OR) of tumor characteristics by density was estimated by means of logistic regression, adjusting forscreening mode (screen-film and full-field digital mammography), and age.Results:Mean and median tumor size of invasive breast cancers was 13.8 and 12 mm, respectively, for women with fattybreasts, and 16.2 and 14 mm for those with dense breasts. Lymph node positive tumors were identified among 20.6% ofwomen with fatty breasts compared with 27.2% of those with dense breasts (P<0.001). The proportion of DCIS wassignificantly lower for women with fatty (15.8%) compared with dense breasts (22.0%). Women with dense breasts hadan increased risk of large (OR, 1.44; 95% CI, 1.18–1.73) and lymph node positive tumors (OR, 1.26; 95% CI, 1.05–1.51)compared with women with fatty and medium dense breasts.Conclusion:High mammographic density was positively associated with tumor size and lymph node positive tumors.