Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis

ObjectivesMammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.MethodsMedline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I² statistic, stratified and sensitivity analyses.ResultsNine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84–2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52–2.21) increased. Both results were statistically significant and homogenous.ConclusionsMammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.     

Mammographic density and prognosis in primary breast cancer patients

PurposeMammographic density (MD) is one of the strongest risk factors for breast cancer (BC). However, the influence of MD on the BC prognosis is unclear. The objective of this study was therefore to investigate whether percentage MD (PMD) is associated with a difference in disease-free or overall survival in primary BC patients.MethodsA total of 2525 patients with primary, metastasis-free BC were followed up retrospectively for this analysis. For all patients, PMD was evaluated by two readers using a semi-automated method. The association between PMD and prognosis was evaluated using Cox regression models with disease-free survival (DFS) and overall survival (OS) as the outcome, and the following adjustments: age at diagnosis, year of diagnosis, body mass index, tumor stage, grading, lymph node status, hormone receptor and HER2 status.ResultsAfter median observation periods of 9.5 and 10.0 years, no influence of PMD on DFS (p = 0.46, likelihood ratio test (LRT)) or OS (p = 0.22, LRT), respectively, was found. In the initial unadjusted analysis higher PMD was associated with longer DFS and OS. The effect of PMD on DFS and OS disappeared after adjustment for age and was caused by the underlying age effect.ConclusionsAlthough MD is one of the strongest independent risk factors for BC, in our collective PMD is not associated with disease-free and overall survival in patients with BC.     

A Simple Way to Choose the Right Implant Volume in Breast Augmentation

In planning a breast augmentation, the choice of an appropriate breast implant volume is sometimes a problem, particularly for unskilled surgeons. The authors have used a little trick to make the choice easier for both the surgeon and the patient.     

应用解剖型假体隆乳治疗轻中度乳房下垂

目的探讨应用解剖型假体隆乳术治疗小乳症伴轻中度乳房下垂的方法及效果。方法对15例患小乳症伴乳房轻中度下垂者应用解剖型ST-410假体行乳腺下隆乳术，根据术后患者满意度判断手术治疗效果。结果15例乳房轻中度下垂者通过此方法均获得很大改善，患者均感满意。结论应用解剖型假体行乳腺下隆乳术可明显改善轻中度乳腺下垂。     

Potential immune response to breast implants after immunization with COVID-19 vaccines

Besides reports of alarming potential side effects after COVID-19 vaccinations there have been rare observations of rather benign reactions to foreign materials such as cosmetic hyaluronic acid filler injections after a COVID-19 immunization. Likewise to dermal fillers any foreign material may cause a reaction when the immune system is triggered. In the recent weeks we observed four noteworthy potential reactions in association with breast implants between one and three days after COVID-19 vaccinations. We release these information at the earliest to educate colleagues and draw attention to possible reactions between the COVID-19 vaccines and foreign bodies such as breast implants.     

Predictability in breast augmentation

Plastic surgery literature does not teach us much about the size of breast prostheses required to get the cup size the patient wants in breast augmentation. The purpose of this study is to allow predictability of the increase in cup size using a series of measurements and to correlate them with volume changes and the required volume of implants to achieve the desired change in bra cup size.     

Assessment of mammographic breast density after sleeve gastrectomy

Background

Mammographic breast density (BD) is an independent risk factor for breast cancer. The effects of bariatric surgery on BD are unknown.

Family history of breast cancer,mammographic breast density and breast cancer risk: Findings from a cohort study of Korean women

BackgroundThis study investigated whether the association between family history of breast cancer in first-degree relatives and breast cancer risk varies by breast density.MethodsWomen aged 40 years and older who underwent screening between 2009 and 2010 were followed up until 2020. Family history was assessed using a self-reported questionnaire. Using Breast Imaging Reporting and Data System (BI-RADS), breast density was categorized into dense breast (heterogeneously or extremely dense) and non-dense breast (almost entirely fatty or scattered areas of fibro-glandular). Cox regression model was used to assess the association between family history and breast cancer risk.ResultsOf the 4,835,507 women, 79,153 (1.6%) reported having a family history of breast cancer and 77,238 women developed breast cancer. Family history led to an increase in the 5-year cumulative incidence in women with dense- and non-dense breasts. Results from the regression model with and without adjustment for breast density yielded similar HRs in all age groups, suggesting that breast density did not modify the association between family history and breast cancer. After adjusting for breast density and other factors, family history of breast cancer was associated with an increased risk of breast cancer in all three age groups (age 40–49 years: aHR 1.96, 95% confidence interval [CI] 1.85–2.08; age 50–64 years: aHR 1.70, 95% CI 1.58–1.82, and age ≥65 years: aHR 1.95, 95% CI 1.78–2.14).ConclusionFamily history of breast cancer and breast density are independently associated with breast cancer. Both factors should be carefully considered in future risk prediction models of breast cancer.     

A Nomogram for Predicting the Degree of Breast Augmentation According to Implant Size

Choosing the right implant size for a specific patient is a challenging aspect of breast augmentation. Bust circumference is obtained by measuring the chest circumference at the level of the nipple-areola complex. Pre- and postoperative bust circumference measurements obtained from 147 patients who underwent primary bilateral breast augmentation using round, textured, gel-filled implants were evaluated, and a practical reference list for future operations was developed. According to the results, each additional 100 ml in implant size yielded an approximate 2-cm increase in bust circumference. The authors believe these results gathered from systematic measurements may serve as a useful guide for choosing the right size implant for a satisfactory augmentation procedure.     

应用三维扫描技术测量分析假体隆乳术后乳房形态变化的研究

目的 应用三维扫描技术准确客观地测量并分析隆乳术后乳房三维形态的变化。方法 双侧隆乳者18例（36只乳房）,均为圆形硅凝胶假体,采用胸肌下平面置入。假体体积平均为232．2ml,高度平均为3．46cm,其中低突型12只（h〈3．0cm）,中突型16只（3．0≤h＜4．0cm）,高突型8只（h≥4．0cm）。应用三维扫描仪采集术前及手术后1个月后的乳房三维图像,并用Geomagicl0．0软件测量乳房体积、突度、对称性等参数。结果 获得隆乳前后36只乳房的体积、突度等参数。术后乳房增加的体积与假体体积基本相当（P〉0．05）,乳房突度的增加值小于假体高度,术后乳房突度比预期突度（术前突度＋假体高度）减少12．9％,其中低型、中突型、高突型分别为5．2％、15．1％、20．2％。结论 三维扫描技术能在临床上简便、快捷、准确、非接触性地测量乳房的三维形态,为术前设计及术后评估提供科学性的指导,是理想的乳房形态测量工具。     

Mammography: interobserver variability in breast density assessment

Our objective was to determine the interobserver variability of breast density assessment according to the Breast Imaging Reporting and Data System (BI-RADS) and to examine potential associations between breast density and risk factors for breast cancer. Four experienced breast radiologists received instructions regarding the use of BI-RADS and they assessed 57 mammograms into BI-RADS density categories of 1-4. The weighted kappa values for breast density between pairs of observers were 0.84 (A, B) (almost perfect agreement); 0.75 (A, C), 0.74 (A, D), 0.71 (B, C), 0.77 (B, D), 0.65 (C, D) (substantial agreement). The weighted overall kappa, measured by the intraclass correlation coefficient (ICC), was 0.77 (95% CI: 0.69-0.85). Body mass index was inversely associated with high breast density. In conclusion, overall interobserver agreement in mammographic interpretation of breast density is substantial and therefore, the BI-RADS classification for breast density is useful for standardization in a multicentre study.     

Mammographic density changes during neoadjuvant breast cancer treatment: NeoDense,a prospective study in Sweden

ObjectivesTo assess if mammographic density (MD) changes during neoadjuvant breast cancer treatment and is predictive of a pathological complete response (pCR).MethodsWe prospectively included 200 breast cancer patients assigned to neoadjuvant chemotherapy (NACT) in the NeoDense study (2014–2019). Raw data mammograms were used to assess MD with a fully automated volumetric method and radiologists categorized MD using the Breast Imaging-Reporting and Data System (BI-RADS), 5th Edition. Logistic regression was used to calculate odds ratios (OR) for pCR comparing BI-RADS categories c vs. a, b, and d as well as with a 0.5% change in percent dense volume adjusting for baseline characteristics.ResultsThe overall median age was 53.1 years, and 48% of study participants were premenopausal pre-NACT. A total of 23% (N = 45) of the patients accomplished pCR following NACT. Patients with very dense breasts (BI-RADS d) were more likely to have a positive axillary lymph node status at diagnosis: 89% of the patients with very dense breasts compared to 72% in the entire cohort. A total of 74% of patients decreased their absolute dense volume during NACT. The likelihood of accomplishing pCR following NACT was independent of volumetric MD at diagnosis and change in volumetric MD during treatment. No trend was observed between decreasing density according to BI-RADS and the likelihood of accomplishing pCR following NACT.ConclusionsThe majority of patients decreased their MD during NACT. We found no evidence of MD as a predictive marker of pCR in the neoadjuvant setting.     

乳晕切口法解剖型假体隆乳术治疗轻度乳房下垂

目的探讨应用解剖型假体(又称泪滴型假体)隆乳术矫正轻度乳房下垂的可行性及临床效果。方法术前依据原乳房三维形态,测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据,以确定所需采用的假体类型、容量及下垂乳房下皱襞距离,选用乳晕切口对36例轻度乳房下垂者应用麦格410解剖型假体行隆乳术。结果全部隆乳者术后乳房挺拔,下垂基本得到矫正,受术者均表满意。结论应用解剖型假体的隆乳术是目前矫正有增大乳房容积愿望的轻度乳房下垂者的最佳选择之一。     

自体脂肪颗粒少量多次注射移植隆乳术脂肪吸收率的超声评价

目的通过超声技术评估自体脂肪颗粒注射移植隆乳术后脂肪的吸收率。方法超声测量自体脂肪颗粒少量多次注射移植隆乳术者33例,每例接受1～5次注射,每侧每次注入脂肪颗粒50～60ml,通过超声测量乳房不同位点的腺体后移植脂肪各时期厚度的变化,评价脂肪的吸收率。结果共测量乳房264个位点,其中224个位点脂肪颗粒位于腺体后层;32个位点脂肪颗粒位于胸大肌层;8个位点脂肪颗粒位于腺体层内。腺体后脂肪平均厚度由术前0．2cm增加到第5次注射后的1．0cm,隆乳术1个月后腺体后脂肪厚度的平均吸收率为34％～66％。结论自体脂肪颗粒少量多次注射移植隆乳术是一种有效的方式,超声技术是一种有效的诊断监测方法。     

改进剥离范围在提高隆乳外形美中的应用

目的探讨改善隆乳外形效果的方法。方法提出扩大胸大肌后间隙内、下方剥离范围的改进措施。1995年10月～1996年10月,用于隆乳术28例56侧。结果 1例因间隙内侧方剥离过度致双侧乳房距离过近有欠自然外,其余效果满意。结论认为腋部切口径路,胸大肌的肋胸骨处附着点剥离不充分以及术后胸大肌收缩致假体过度上移是以往隆乳乳房外形不佳的两个主要因素,而改进剥离范围则是消除上述不良因素的有效措施。     

Dosimetric impact of breast density in breast tomosynthesis: A comparative study

A radiation dose survey has been undertaken involving 256 patients to investigate the dosimetric impact of breast tomosynthesis screening by employing different breast densities estimated by the Dance model, 50‐50 breast model, and patient‐specific density software: Volpara. Mean glandular dose (MGD) based on the Dance model provided the most realistic dose estimate with an average difference of ?3.3 ± 4.8% from the patient‐specific estimation. Average differences of ?8.2 ± 6.5% and ?7.3 ± 4.7% were observed for the 50‐50 breast model and console MGD, respectively. We conclude that the Dance model should be used for dose calculations in radiation dose surveys and establishing diagnostic reference levels (DRL).     

改进剥离范围在提高隆乳外形美中的应用

目的探讨改善隆乳外形效果的方法。方法提出扩大胸大肌后间隙内、下方剥离范围的改进措施。１９９５年１０月～１９９６年１０月，用于隆乳术２８例５６侧。结果１例因间隙内侧方剥离过度致双侧乳房距离过近有欠自然外，其余效果满意。结论认为腋部切口径路，胸大肌的肋胸骨处附着点剥离不充分以及术后胸大肌收缩致假体过度上移是以往隆乳乳房外形不佳的两个主要因素，而改进剥离范围则是消除上述不良因素的有效措施。     

筋膜下隆乳术与乳腺后间隙隆乳术的临床效果和并发症比较

目的 比较筋膜下隆乳术与乳腺后间隙隆乳术的临床效果和并发症的发生情况,以探讨筋膜下隆乳术的临床优势.方法 2009年9月至2012年5月,临床完成25例筋膜下隆乳术和31例乳腺后间隙隆乳术.观察比较术后出现的可见的假体边缘或皱褶、乳房上极外形呈凸状和远期继发下移现象,以及血肿、感染和包膜挛缩3种常见并发症的发生率.结果 所有病例获术后2～26个月的随访.筋膜下隆乳组和乳腺后间隙隆乳组出现可见的假体边缘或皱褶的发生率分别为4.0％ (1/25)和29.0％ (9/31),组间比较差异有统计学意义(P＜0.05);乳房上极呈凸状的发生率分别为8.0％(2/25)和35.5％(11/31),组间比较差异有统计学意义(P＜0.05);2组均尚未见远期继发下移的现象.2组血肿的发生率分别为4.0％(1/25)和6.5％(2/31);2组均未见感染的表现;2组包膜挛缩的发生率分别为8.0％(2/25)和12.9％(4/31),组间比较差异无统计学意义(P＞0.05).结论 筋膜下隆乳术与乳腺后间隙隆乳术相比,在临床效果方面有一定的优势,但在发生包膜挛缩等常见的并发症方面尚未见明显的差别.