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Mammographic density and the risk of breast cancer recurrence after breast-conserving surgery

  1. Tulin Cil MD1,
  2. Eve Fishell MD2,
  3. Wedad Hanna MD3,
  4. Ping Sun PhD4,
  5. Ellen Rawlinson4,
  6. Steven A. Narod MD4,†,*,
  7. David R. McCready MD1

Article first published online: 9 NOV 2009

DOI: 10.1002/cncr.24638

Issue

Cancer

Cancer

Volume 115, Issue 24, pages 5780–5787, 15 December 2009

Additional Information

How to Cite

Cil, T., Fishell, E., Hanna, W., Sun, P., Rawlinson, E., Narod, S. A. and McCready, D. R. (2009), Mammographic density and the risk of breast cancer recurrence after breast-conserving surgery. Cancer, 115: 5780–5787. doi: 10.1002/cncr.24638

Author Information

  1. 1

    Department of Surgery, University Health Network, Toronto, Ontario, Canada

  2. 2

    Department of Radiology, Women's College Hospital, Toronto, Ontario, Canada

  3. 3

    Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada

  4. 4

    Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada

  1. †

    Fax: (416) 351-3767

*Women's College Research Institute, 790 Bay Street, Seventh Floor, Toronto, Ontario, M5G 1N8 Canada

  1. †

    Fax: (416) 351-3767

Publication History

  1. Issue published online: 2 DEC 2009
  2. Article first published online: 9 NOV 2009
  3. Manuscript Accepted: 12 FEB 2009
  4. Manuscript Revised: 11 FEB 2009
  5. Manuscript Received: 5 JAN 2009

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Keywords:

  • breast cancer;
  • prognosis;
  • mammographic density;
  • local disease recurrence

Abstract

BACKGROUND:

Women with invasive breast cancer who are treated with breast-conserving surgery and radiotherapy face a cumulative risk of local disease recurrence of approximately 10% at 10 years. To the authors' knowledge, the role of mammographic density as a risk factor for the development of local recurrence has not been thoroughly evaluated to date.

METHODS:

Medical records were reviewed for 335 patients who underwent breast-conserving surgery for invasive breast cancer and for whom a pretreatment mammogram was available. Information was recorded concerning mammographic density as well as tumor features, patient characteristics, and adjuvant treatments received. Patients were categorized for mammographic density based on the Wolfe classification as either low (<25% density), intermediate (25-50% density), or high (>50% density). A multivariate survival analysis was conducted using the Cox proportional hazards model with local disease recurrence as the primary endpoint.

RESULTS:

Patients in the high mammographic density group experienced a much greater risk of local disease recurrence compared with women with the least dense breasts (10-year actuarial risks: 21% vs 5%; hazards ratio [HR], 5.7 [95% confidence interval, 1.6-20; P = .006]). The difference in the rates of disease recurrence at 10 years was pronounced for women who did not receive radiotherapy (40% vs 0% for patients with >50% density and <25% density, respectively; P < .0001).

CONCLUSIONS:

Mammographic breast density is an important risk factor for local breast cancer recurrence among women not receiving breast irradiation. Mammographic density should be taken into consideration when stratifying patients for clinical trials of partial breast radiotherapy. If confirmed, mammographic density might be used to help determine which patients might benefit from radiotherapy. Cancer 2009. © 2009 American Cancer Society.

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