Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.

<h4>Background</h4>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.<h4>Methods and findings</h4>...

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Main Authors: Anya Burton, Gertraud Maskarinec, Beatriz Perez-Gomez, Celine Vachon, Hui Miao, Martín Lajous, Ruy López-Ridaura, Megan Rice, Ana Pereira, Maria Luisa Garmendia, Rulla M Tamimi, Kimberly Bertrand, Ava Kwong, Giske Ursin, Eunjung Lee, Samera A Qureshi, Huiyan Ma, Sarah Vinnicombe, Sue Moss, Steve Allen, Rose Ndumia, Sudhir Vinayak, Soo-Hwang Teo, Shivaani Mariapun, Farhana Fadzli, Beata Peplonska, Agnieszka Bukowska, Chisato Nagata, Jennifer Stone, John Hopper, Graham Giles, Vahit Ozmen, Mustafa Erkin Aribal, Joachim Schüz, Carla H Van Gils, Johanna O P Wanders, Reza Sirous, Mehri Sirous, John Hipwell, Jisun Kim, Jong Won Lee, Caroline Dickens, Mikael Hartman, Kee-Seng Chia, Christopher Scott, Anna M Chiarelli, Linda Linton, Marina Pollan, Anath Arzee Flugelman, Dorria Salem, Rasha Kamal, Norman Boyd, Isabel Dos-Santos-Silva, Valerie McCormack
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2017-06-01
Series:PLoS Medicine
Online Access:https://doi.org/10.1371/journal.pmed.1002335
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author Anya Burton
Gertraud Maskarinec
Beatriz Perez-Gomez
Celine Vachon
Hui Miao
Martín Lajous
Ruy López-Ridaura
Megan Rice
Ana Pereira
Maria Luisa Garmendia
Rulla M Tamimi
Kimberly Bertrand
Ava Kwong
Giske Ursin
Eunjung Lee
Samera A Qureshi
Huiyan Ma
Sarah Vinnicombe
Sue Moss
Steve Allen
Rose Ndumia
Sudhir Vinayak
Soo-Hwang Teo
Shivaani Mariapun
Farhana Fadzli
Beata Peplonska
Agnieszka Bukowska
Chisato Nagata
Jennifer Stone
John Hopper
Graham Giles
Vahit Ozmen
Mustafa Erkin Aribal
Joachim Schüz
Carla H Van Gils
Johanna O P Wanders
Reza Sirous
Mehri Sirous
John Hipwell
Jisun Kim
Jong Won Lee
Caroline Dickens
Mikael Hartman
Kee-Seng Chia
Christopher Scott
Anna M Chiarelli
Linda Linton
Marina Pollan
Anath Arzee Flugelman
Dorria Salem
Rasha Kamal
Norman Boyd
Isabel Dos-Santos-Silva
Valerie McCormack
author_facet Anya Burton
Gertraud Maskarinec
Beatriz Perez-Gomez
Celine Vachon
Hui Miao
Martín Lajous
Ruy López-Ridaura
Megan Rice
Ana Pereira
Maria Luisa Garmendia
Rulla M Tamimi
Kimberly Bertrand
Ava Kwong
Giske Ursin
Eunjung Lee
Samera A Qureshi
Huiyan Ma
Sarah Vinnicombe
Sue Moss
Steve Allen
Rose Ndumia
Sudhir Vinayak
Soo-Hwang Teo
Shivaani Mariapun
Farhana Fadzli
Beata Peplonska
Agnieszka Bukowska
Chisato Nagata
Jennifer Stone
John Hopper
Graham Giles
Vahit Ozmen
Mustafa Erkin Aribal
Joachim Schüz
Carla H Van Gils
Johanna O P Wanders
Reza Sirous
Mehri Sirous
John Hipwell
Jisun Kim
Jong Won Lee
Caroline Dickens
Mikael Hartman
Kee-Seng Chia
Christopher Scott
Anna M Chiarelli
Linda Linton
Marina Pollan
Anath Arzee Flugelman
Dorria Salem
Rasha Kamal
Norman Boyd
Isabel Dos-Santos-Silva
Valerie McCormack
author_sort Anya Burton
collection DOAJ
description <h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.
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spelling doaj-art-09ec9150a21844fe90bce8f94d3958ca2025-08-20T02:22:06ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762017-06-01146e100233510.1371/journal.pmed.1002335Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.Anya BurtonGertraud MaskarinecBeatriz Perez-GomezCeline VachonHui MiaoMartín LajousRuy López-RidauraMegan RiceAna PereiraMaria Luisa GarmendiaRulla M TamimiKimberly BertrandAva KwongGiske UrsinEunjung LeeSamera A QureshiHuiyan MaSarah VinnicombeSue MossSteve AllenRose NdumiaSudhir VinayakSoo-Hwang TeoShivaani MariapunFarhana FadzliBeata PeplonskaAgnieszka BukowskaChisato NagataJennifer StoneJohn HopperGraham GilesVahit OzmenMustafa Erkin AribalJoachim SchüzCarla H Van GilsJohanna O P WandersReza SirousMehri SirousJohn HipwellJisun KimJong Won LeeCaroline DickensMikael HartmanKee-Seng ChiaChristopher ScottAnna M ChiarelliLinda LintonMarina PollanAnath Arzee FlugelmanDorria SalemRasha KamalNorman BoydIsabel Dos-Santos-SilvaValerie McCormack<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pmed.1002335
spellingShingle Anya Burton
Gertraud Maskarinec
Beatriz Perez-Gomez
Celine Vachon
Hui Miao
Martín Lajous
Ruy López-Ridaura
Megan Rice
Ana Pereira
Maria Luisa Garmendia
Rulla M Tamimi
Kimberly Bertrand
Ava Kwong
Giske Ursin
Eunjung Lee
Samera A Qureshi
Huiyan Ma
Sarah Vinnicombe
Sue Moss
Steve Allen
Rose Ndumia
Sudhir Vinayak
Soo-Hwang Teo
Shivaani Mariapun
Farhana Fadzli
Beata Peplonska
Agnieszka Bukowska
Chisato Nagata
Jennifer Stone
John Hopper
Graham Giles
Vahit Ozmen
Mustafa Erkin Aribal
Joachim Schüz
Carla H Van Gils
Johanna O P Wanders
Reza Sirous
Mehri Sirous
John Hipwell
Jisun Kim
Jong Won Lee
Caroline Dickens
Mikael Hartman
Kee-Seng Chia
Christopher Scott
Anna M Chiarelli
Linda Linton
Marina Pollan
Anath Arzee Flugelman
Dorria Salem
Rasha Kamal
Norman Boyd
Isabel Dos-Santos-Silva
Valerie McCormack
Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.
PLoS Medicine
title Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.
title_full Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.
title_fullStr Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.
title_full_unstemmed Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.
title_short Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.
title_sort mammographic density and ageing a collaborative pooled analysis of cross sectional data from 22 countries worldwide
url https://doi.org/10.1371/journal.pmed.1002335
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