Arterial calcification found on breast cancer screening mammograms and cardiovascular mortality in women: The DOM Project. Doorlopend Onderzoek Morbiditeit en Mortaliteit.

Breast arterial calcification (BAC) has been associated with diabetes and hypertension. This prompted the authors to study the relation between BAC and cardiovascular mortality in a cohort of 12,239 women aged 50-68 years who participated in a population-based breast cancer screening project (DOM Project) in Utrecht, the Netherlands, during the period 1975-1977. Mortality data from 16-19 years of follow-up were available. The occurrence of outcome events was compared in terms of hazard ratios. Cardiovascular risk factors, including age, diabetes mellitus, hypertension, parity, Quetelet index, and smoking, were studied to identify possible confounders. Arterial calcification was seen in 9% of the women. The hazard ratio for overall mortality was 1.29 (95% confidence interval 1.06-1.58) in women with BAC detected on screening mammograms in comparison with women without BAC after correction for the above-mentioned factors. An excess of all-cause mortality was found in diabetic women with BAC (hazard ratio = 1.74, 95% confidence interval 1.19-2.56), which was also present in subgroups of coronary mortality. These results indicate that BAC is associated with an increased risk of subsequent cardiovascular death in women over age 50 years and in diabetic women in particular.

Mammograms may convey more than breast cancer risk: breast arterial calcification and arterio-sclerotic related diseases in women of the DOM cohort.

In a cohort of 12,239 women aged 50-69, who participated in a population-based breast cancer screening project (DOM-project) in Utrecht, The Netherlands, as well as being coded for micro-calcifications indicative of breast cancer, the mammograms were also coded for arterial calcifications. This allowed for a secondary analysis of associations between breast arterial calcification (BAC) and the occurrence of arteriosclerosis-associated morbidity (ie diabetes, hypertension, albuminuria, stroke, thrombosis and myocardial infarction). Arterial calcifications were seen on screening mammograms in 9.1% of the women. Significant relations were found between BAC and albuminuria [Relative risk (RR) 2.7; 95% CI 1.0-7.0], BAC and hypertension (RR 1.1; 95% CI 1.0-1.3), transient ischaemic attack (TIA)/stroke (RR 1.4; 95% CI 1.1-1.8), thrombosis (RR 1.5; 95% CI 1.0-2.2) and myocardial infarction (RR 1.8; 95% CI 1.1-2.9). In addition BAC were associated with diabetes in the oldest age-group (RR 1.7; 95% CI 1.2-2.4). All relations were adjusted for age, smoking, parity and Quetelet index. The results of the present study show that BAC as detected on breast cancer screening mammograms are associated with disorders related to increased or accelerated arterio-sclerosis. Where increased parity is associated with a decrease in breast cancer risk, parity increases the occurrence of BAC. The present study suggests that breast-cancer screening mammograms may allow for the early detection of enhanced cardiovascular disease risk among otherwise healthy women.

Breast arterial calcifications: association with diabetes mellitus and cardiovascular mortality. Work in progress.

PURPOSE: To determine the relationship between breast arterial calcification, diabetes mellitus, and subsequent cardiovascular and noncardiovascular mortality. MATERIALS AND METHODS: A prospective cohort study was carried out in 12,239 women aged 50-68 years who participated in a breast cancer screening program. The screening mammograms were coded for the presence of breast arterial calcification. Diabetes (n = 442) was defined as use of insulin or oral hypoglycemic agents, use of a restricted diet for diabetes, or the presence of glucosuria. Data were available from questionnaires and urine glucose tests. Hazard ratios, which were adjusted for age, smoking, parity, and obesity, were calculated from mortality data after 16-19 years of follow-up. RESULTS: Breast arterial calcification was seen in 9.0% (1,107 of 12,239) of all women and in 15.4% (68 of 442) of the diabetic women. An excess cardiovascular mortality of 40% (hazard ratio = 1.4; 95% confidence interval = 1.1, 1.8) was found for all women with breast arterial calcification. In diabetic women, the presence of breast arterial calcification was associated with a 90% (hazard ratio = 1.9; 95% confidence interval = 1.1, 3.2) increase in cardiovascular mortality. CONCLUSION: Breast arterial calcification represents an independent risk factor for cardiovascular mortality in women over 50 years of age, especially in those with diabetes.

Breast cancer induction due to mammographic screening in hereditarily affected women.

Breast cancer induction due to mammographic screening has aroused considerable controversy in the discussion of the safety of this procedure. We have attempted to shed some light on this problem by approaching it from both a theoretical and a mathematical point of view. We found that about 99% of mammographically induced breast cancers occur in the group of women who are carriers of a breast cancer gene. Our calculations suggest that in women with an inherited gene for breast cancer an extra tumour in one out of 10 women will be induced by 20 mammographical examinations. On the other hand, mammography is safe for non-gene carriers.

Breast size as a determinant of breast cancer.

OBJECTIVE: To determine whether breast size as reflected in cup size is independently associated with Wolfe's mammographic patterns. DESIGN: Univariate and multivariate associations between the waist/hip ratio (WHR), body mass index (BMI), cup size, age, parity, age at menarche menopausal status and Wolfe's mammographic parenchymal patterns were determined by (multiple) linear logistic regression. SETTING: Population based mammographic breast cancer screening project. SUBJECTS: 7819 women between 39 to 52 years of age. RESULTS: The univariate analysis demonstrated that women in the lowest tertile with respect to BMI and WHR when compared to women in the upper tertile were significantly more likely to display the high risk P2, Dy breast patterns. Cup size showed a similar inverse relation with the P2, Dy patterns. When age, WHR and BMI are entered together in the multivariate model the relation between cup size and the P2 Dy patterns is no longer significant in the upper tertile. CONCLUSION: Breast size is not a major independent determinant of the high risk P2, Dy parenchymal breast patterns when the WHR and BMI are taken into account.

Exclusion from mammographic screening of women genetically predisposed to breast cancer will probably eliminate mammographically induced breast cancer.

In this paper we present our view on the contribution of mammography examinations to breast cancer induction in patients with hereditary breast cancer predisposition. We contradict the usual reasoning that the benefits of early breast cancer detection outweigh the small number of induced breast cancers. Though this tenet is justified in the majority of women, yet in a small, readily identifiable group of hereditary effected women, radiation even in small doses may enhance oncogenesis. If this relatively small group of patients is barred from mammography and regularly screened with other means, mammography may even become a more safe procedure.

Abdominal fat predominance in women is associated with a decreased prevalence of the high risk P2, DY mammographic breast patterns.

Body fat distribution was studied in relation to mammographic breast morphology in a cross-sectional sample of 583 women aged 41-75 years participating in the DOM project, a regional breast cancer detection project in Utrecht, the Netherlands. The waist/hip ratio (WHR) was used as an indicator of body fat topography. Mammographic breast morphology was categorized according to the parenchymal breast patterns (N1, P1, P2, DY) as defined by Wolfe. Multivariate associations between the waist/hip ratio, Quetelet's index, age and parity and mammographic parenchymal patterns were tested by multiple linear logistic regression. Independently of age, parity and the degree of obesity, women with a high WHR ratio, i.e. with a predominant fat accumulation in the abdominal region, were significantly less likely to have the high risk P2, DY mammographic parenchymal pattern than women with a low WHR, i.e. with a preferential gluteal-femoral fat accumulation.