September 5, 2006
New model emphasizes breast density as a predictor of breast cancer risk, large study shows
Seattle—Breast density is nearly as important as age in determining a woman's risk of developing breast cancer, according to a new model developed by scientists from Group Health and seven other health care organizations in the Breast Cancer Surveillance Consortium (BCSC). Presented in the September 6 issue of the Journal of the National Cancer Institute, the model is based on the largest study of this issue to-date in terms of population size and the number of risk factors examined.
The researchers collected data from more than 1 million women at the time of their screening mammograms. They then identified 11,638 who were diagnosed with breast cancer within the next year. Information on women who did and did not get breast cancer was analyzed to develop and validate risk-prediction models.
Breast density is a measure of how well tissue can be seen on mammogram. Some tissue, such as the milk gland, is dense and appears white on an x-ray. This density makes it hard for doctors to see tumors, which also appear white. Fatty tissue is less dense and appears clear on the x-ray, allowing better tumor detection.
"Although breast cancer is harder to detect in women with dense breasts, our research showed that women with dense breasts are more likely to develop breast cancer," said William E. Barlow, PhD, a researcher with Group Health and the lead author of the article. After adjustment for age, the risk for breast cancer was almost four times greater for women with extremely dense breasts than for a woman with breasts that are almost entirely fat.
The scientists found that several risk factors influenced breast cancer diagnosis. In pre-menopausal women, risk factors included age, breast density, family history of breast cancer, and a prior breast procedure. In postmenopausal women, risk factors included ethnicity, greater body mass index, natural menopause, use of hormone therapy, a prior false-positive mammogram, as well as the risk factors found in pre-menopausal women.
In an accompanying article, Jinbo Chen, PhD, and Mitchell Gail, MD, PhD, of the National Cancer Institute (NCI), presents an updated version of the "Gail model," a breast cancer risk assessment tool that's been widely used since the 1980s. The updated version now includes breast density as well.
The new models may eventually help doctors identify women at high risk for breast cancer who might benefit from preventive interventions or more intensive screening, the researchers concluded. However, they cautioned that more research is needed before doctors can predict the development of cancer in individual women.
The study was funded by the National Cancer Institute (NCI).
About the Breast Cancer Surveillance Consortium (BCSC)
The BCSC was established in 1994 by NCI to assess community mammography practice and outcomes, collect risk factors prospectively at the time of each screening mammogram, and ascertain cancer outcomes for all women. The seven BCSC mammography registries that participated in this study included Group Health's Breast Cancer Surveillance Project, Carolina Mammography Registry, Colorado Mammography Project, New Hampshire Mammography Network, New Mexico mammography Project, San Francisco Mammography Registry, and the Vermont Breast Cancer Surveillance System. More information can be found at: www.breastscreening.cancer.gov.
Group Health Center for Health Studies
Group Health Research Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.