Dense and nondense Mammographic area and risk of breast cancer by age and tumor characteristics

Background: Mammographic density (MD) is a strong breast cancer risk factor. We previously reported associations of percent mammographic density (PMD) with larger and node-positive tumors across all ages, and estrogen receptor (ER)-negative status among women ages <55 years. To provide insight into these associations, we examined the components of PMD [dense area (DA) and nondense area (NDA)] with breast cancer subtypes. Methods: Data were pooled from six studies including 4,095 breast cancers and 8,558 controls. DA and NDA were assessed from digitized film-screen mammograms and standardized across studies. Breast cancer odds by density phenotypes and age according to histopathologic characteristics and receptor status were calculated using polytomous logistic regression. Results: DA was associated with increased breast cancer risk [OR for quartiles: 0.65, 1.00 (Ref), 1.22, 1.55; P_trend<0.001] and NDA was associated with decreased risk [ORs for quartiles: 1.39, 1.00 (Ref), 0.88, 0.72; P_trend<0.001] across all ages and invasive tumor characteristics. There were significant trends in the magnitude of associations of both DA and NDA with breast cancer by increasing tumor size (P_trend< 0.001) but no differences by nodal status. Among women <55 years, DA was more strongly associated with increased risk of ER⁺ versus ER^- tumors (P_het= 0.02), while NDA was more strongly associated with decreased risk of ER^- versus ER⁺ tumors (Phet = 0.03). Conclusions: DA and NDA have differential associations with ER⁺ versus ER^- tumors that vary by age. Impact: DA and NDA are important to consider when developing age- and subtype-specific risk models.