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

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 & 34 others Rose Ndumia, Sudhir Vinayak, Soo Hwang Teo, Shivaani Mariapun, Farhana Fadzli, Beata Peplonska, Agnieszka Bukowska, Chisato Nagata, Jennifer Stone, John Hopper, Graham G. 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

Research output: Contribution to journalArticle

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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.

LanguageEnglish
Article numbere1002335
JournalPLoS Medicine
Volume14
Issue number6
DOIs
StatePublished - 1 Jun 2017

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Cross-Sectional Studies
Aging of materials
Mammography
Breast Neoplasms
Linear regression
Population Groups
Linear Models
Breast
Breast Density
Risk Reduction Behavior
Meta-Analysis
Life Style
Body Mass Index

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Burton, A., Maskarinec, G., Perez-Gomez, B., Vachon, C., Miao, H., Lajous, M., ... McCormack, V. (2017). Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide. PLoS Medicine, 14(6), [e1002335]. DOI: 10.1371/journal.pmed.1002335
Burton, Anya ; Maskarinec, Gertraud ; Perez-Gomez, Beatriz ; Vachon, Celine ; Miao, Hui ; Lajous, Martín ; López-Ridaura, Ruy ; Rice, Megan ; Pereira, Ana ; Garmendia, Maria Luisa ; Tamimi, Rulla M. ; Bertrand, Kimberly ; Kwong, Ava ; Ursin, Giske ; Lee, Eunjung ; Qureshi, Samera A. ; Ma, Huiyan ; Vinnicombe, Sarah ; Moss, Sue ; Allen, Steve ; Ndumia, Rose ; Vinayak, Sudhir ; Teo, Soo Hwang ; Mariapun, Shivaani ; Fadzli, Farhana ; Peplonska, Beata ; Bukowska, Agnieszka ; Nagata, Chisato ; Stone, Jennifer ; Hopper, John ; Giles, Graham G. ; Ozmen, Vahit ; Aribal, Mustafa Erkin ; Schüz, Joachim ; Van Gils, Carla H. ; Wanders, Johanna O.P. ; Sirous, Reza ; Sirous, Mehri ; Hipwell, John ; Kim, Jisun ; Lee, Jong Won ; Dickens, Caroline ; Hartman, Mikael ; Chia, Kee Seng ; Scott, Christopher ; Chiarelli, Anna M. ; Linton, Linda ; Pollan, Marina ; Flugelman, Anath Arzee ; Salem, Dorria ; Kamal, Rasha ; Boyd, Norman ; Dos-Santos-Silva, Isabel ; McCormack, Valerie. / Mammographic density and ageing : A collaborative pooled analysis of cross-sectional data from 22 countries worldwide. In: PLoS Medicine. 2017 ; Vol. 14, No. 6.
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title = "Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide",
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.",
author = "Anya Burton and Gertraud Maskarinec and Beatriz Perez-Gomez and Celine Vachon and Hui Miao and Mart{\'i}n Lajous and Ruy L{\'o}pez-Ridaura and Megan Rice and Ana Pereira and Garmendia, {Maria Luisa} and Tamimi, {Rulla M.} and Kimberly Bertrand and Ava Kwong and Giske Ursin and Eunjung Lee and Qureshi, {Samera A.} and Huiyan Ma and Sarah Vinnicombe and Sue Moss and Steve Allen and Rose Ndumia and Sudhir Vinayak and Teo, {Soo Hwang} and Shivaani Mariapun and Farhana Fadzli and Beata Peplonska and Agnieszka Bukowska and Chisato Nagata and Jennifer Stone and John Hopper and Giles, {Graham G.} and Vahit Ozmen and Aribal, {Mustafa Erkin} and Joachim Sch{\"u}z and {Van Gils}, {Carla H.} and Wanders, {Johanna O.P.} and Reza Sirous and Mehri Sirous and John Hipwell and Jisun Kim and Lee, {Jong Won} and Caroline Dickens and Mikael Hartman and Chia, {Kee Seng} and Christopher Scott and Chiarelli, {Anna M.} and Linda Linton and Marina Pollan and Flugelman, {Anath Arzee} and Dorria Salem and Rasha Kamal and Norman Boyd and Isabel Dos-Santos-Silva and Valerie McCormack",
year = "2017",
month = "6",
day = "1",
doi = "10.1371/journal.pmed.1002335",
language = "English",
volume = "14",
journal = "PLoS Medicine",
issn = "1549-1277",
publisher = "Public Library of Science (PLoS)",
number = "6",

}

Burton, A, Maskarinec, G, Perez-Gomez, B, Vachon, C, Miao, H, Lajous, M, López-Ridaura, R, Rice, M, Pereira, A, Garmendia, ML, Tamimi, RM, Bertrand, K, Kwong, A, Ursin, G, Lee, E, Qureshi, SA, Ma, H, Vinnicombe, S, Moss, S, Allen, S, Ndumia, R, Vinayak, S, Teo, SH, Mariapun, S, Fadzli, F, Peplonska, B, Bukowska, A, Nagata, C, Stone, J, Hopper, J, Giles, GG, Ozmen, V, Aribal, ME, Schüz, J, Van Gils, CH, Wanders, JOP, Sirous, R, Sirous, M, Hipwell, J, Kim, J, Lee, JW, Dickens, C, Hartman, M, Chia, KS, Scott, C, Chiarelli, AM, Linton, L, Pollan, M, Flugelman, AA, Salem, D, Kamal, R, Boyd, N, Dos-Santos-Silva, I & McCormack, V 2017, 'Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide' PLoS Medicine, vol 14, no. 6, e1002335. DOI: 10.1371/journal.pmed.1002335

Mammographic density and ageing : A collaborative pooled analysis of cross-sectional data from 22 countries worldwide. / Burton, Anya; Maskarinec, Gertraud; Perez-Gomez, Beatriz; Vachon, Celine; Miao, Hui; Lajous, Martín; López-Ridaura, Ruy; Rice, Megan; Pereira, Ana; Garmendia, Maria Luisa; Tamimi, Rulla M.; Bertrand, Kimberly; Kwong, Ava; Ursin, Giske; Lee, Eunjung; Qureshi, Samera A.; Ma, Huiyan; Vinnicombe, Sarah; Moss, Sue; Allen, Steve; Ndumia, Rose; Vinayak, Sudhir; Teo, Soo Hwang; Mariapun, Shivaani; Fadzli, Farhana; Peplonska, Beata; Bukowska, Agnieszka; Nagata, Chisato; Stone, Jennifer; Hopper, John; Giles, Graham G.; Ozmen, Vahit; Aribal, Mustafa Erkin; Schüz, Joachim; Van Gils, Carla H.; Wanders, Johanna O.P.; Sirous, Reza; Sirous, Mehri; Hipwell, John; Kim, Jisun; Lee, Jong Won; Dickens, Caroline; Hartman, Mikael; Chia, Kee Seng; Scott, Christopher; Chiarelli, Anna M.; Linton, Linda; Pollan, Marina; Flugelman, Anath Arzee; Salem, Dorria; Kamal, Rasha; Boyd, Norman; Dos-Santos-Silva, Isabel; McCormack, Valerie.

In: PLoS Medicine, Vol. 14, No. 6, e1002335, 01.06.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mammographic density and ageing

T2 - PLoS Medicine

AU - Burton,Anya

AU - Maskarinec,Gertraud

AU - Perez-Gomez,Beatriz

AU - Vachon,Celine

AU - Miao,Hui

AU - Lajous,Martín

AU - López-Ridaura,Ruy

AU - Rice,Megan

AU - Pereira,Ana

AU - Garmendia,Maria Luisa

AU - Tamimi,Rulla M.

AU - Bertrand,Kimberly

AU - Kwong,Ava

AU - Ursin,Giske

AU - Lee,Eunjung

AU - Qureshi,Samera A.

AU - Ma,Huiyan

AU - Vinnicombe,Sarah

AU - Moss,Sue

AU - Allen,Steve

AU - Ndumia,Rose

AU - Vinayak,Sudhir

AU - Teo,Soo Hwang

AU - Mariapun,Shivaani

AU - Fadzli,Farhana

AU - Peplonska,Beata

AU - Bukowska,Agnieszka

AU - Nagata,Chisato

AU - Stone,Jennifer

AU - Hopper,John

AU - Giles,Graham G.

AU - Ozmen,Vahit

AU - Aribal,Mustafa Erkin

AU - Schüz,Joachim

AU - Van Gils,Carla H.

AU - Wanders,Johanna O.P.

AU - Sirous,Reza

AU - Sirous,Mehri

AU - Hipwell,John

AU - Kim,Jisun

AU - Lee,Jong Won

AU - Dickens,Caroline

AU - Hartman,Mikael

AU - Chia,Kee Seng

AU - Scott,Christopher

AU - Chiarelli,Anna M.

AU - Linton,Linda

AU - Pollan,Marina

AU - Flugelman,Anath Arzee

AU - Salem,Dorria

AU - Kamal,Rasha

AU - Boyd,Norman

AU - Dos-Santos-Silva,Isabel

AU - McCormack,Valerie

PY - 2017/6/1

Y1 - 2017/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85021821442&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1002335

DO - 10.1371/journal.pmed.1002335

M3 - Article

VL - 14

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 6

M1 - e1002335

ER -

Burton A, Maskarinec G, Perez-Gomez B, Vachon C, Miao H, Lajous M et al. Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide. PLoS Medicine. 2017 Jun 1;14(6). e1002335. Available from, DOI: 10.1371/journal.pmed.1002335