Beyond breast cancer: mammographic features and mortality risk in a population of healthy women

• Published in: PloS one Vol. 8; no. 10; p. e78722
• Main Authors: Murphy, Rachel A, Schairer, Catherine, Gierach, Gretchen L, Byrne, Celia, Sherman, Mark E, Register, Thomas C, Ding, Jingzhong, Kritchevsky, Stephen B, Harris, Tamara B
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.10.2013; Public Library of Science (PLoS)
• Subjects: Adult; Aging; Body mass; Body mass index; Body size; Breast - cytology; Breast - pathology; Breast cancer; Breast Neoplasms - diagnostic imaging; Breasts; Cancer; Confidence intervals; Coronary artery disease; Density; Diabetes; Diabetes mellitus; Disease; Epidemiology; Female; Gender differences; Genetics; Geriatrics; Gerontology; Hazards; Health care; Health risk assessment; Health risks; Healthy Volunteers - statistics & numerical data; Heart diseases; Humans; Laboratories; Mammography; Medical imaging; Medical screening; Middle Aged; Mortality; Musculoskeletal system; Obesity; Older people; Population; Prognosis; Proportional Hazards Models; Regression analysis; Risk Factors; Smoking; Statistical analysis; Studies; Systematic review; Womens health; North Carolina; United States > US; Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0078722

Breast fibroglandular (dense) tissue is a risk factor for breast cancer. Beyond breast cancer, little is known regarding the prognostic significance of mammographic features. We evaluated relationships between nondense (fatty) breast area and dense area with all-cause mortality in 4,245 initially healthy women from the Breast Cancer Detection Demonstration Project; 1,361 died during a mean follow-up of 28.2 years. Dense area and total breast area were assessed using planimeter measurements from screening mammograms. Percent density reflects dense area relative to breast area and nondense area was calculated as the difference between total breast area and dense area. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression. In age-adjusted models, greater nondense and total breast area were associated with increased risk of death (HR 1.17, 95% CI 1.10-1.24 and HR 1.13, 95% CI 1.06-1.19, per SD difference) while greater dense area and percent density were associated with lower risk of death (HR 0.91, 95% CI 0.86-0.95 and HR 0.87, 95% CI 0.83-0.92, per SD difference). Associations were not attenuated with adjustment for race, education, mammogram type (x-ray or xerogram), smoking status, diabetes and heart disease. With additional adjustment for body mass index, associations were diminished for all features but remained statistically significant for dense area (HR 0.94, 95% CI 0.89-0.99, per SD difference) and percent density (HR 0.93, 95% CI 0.87-0.98, per SD difference). These data indicate that dense area and percent density may relate to survival in healthy women and suggest the potential utility of mammograms beyond prediction of breast cancer risk.