Josefa Miranda-García

Generalitat Valenciana

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Marina Pollán

GEICAM – Spanish Breast Cancer Group

Beatriz Pérez‐Gómez

Instituto de Salud Carlos III

Carmen Sánchez‐Contador

Health Research Institute of the Balearic Islands

Pilar Moreo

Servicio Aragonés de Salud

Dolores Salas‐Trejo

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Carmen Pedraz‐Pingarrón

Junta de Castilla y León

Carmen Santamariña

Government of Spain

Rafael Llobet

Universitat Politècnica de València

Núria Aragonés

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Virginia Lope

Instituto de Salud Carlos III

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Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Instituto de Salud Carlos III

Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana

Generalitat Valenciana

Centro Nacional de Epidemiología

National Center for Epidemiology

Centre for Biomedical Network Research on Rare Diseases

Institut Català d'Oncologia

Breast Cancer Research Foundation

Health Research Institute of the Balearic Islands

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Supplementary Figure 1 from High Mammographic Density in Long-Term Night-Shift Workers: DDM-Spain/Var-DDM

Ana María Pedraza-Flechas Virginia Lope Carmen Sánchez‐Contador Carmen Santamariña Carmen Pedraz‐Pingarrón

Supplementary Figure 1. Graphic esqueme summarizing the proposed pathways of the association between night-shift work and mammographic density.

Mammographic Density

10.1158/1055-9965.22438209

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Semi-automated and fully automated mammographic density measurement and breast cancer risk prediction

Computer Methods and Programs in Biomedicine (2014)

Rafael Llobet Marina Pollán Joaquín Antón Josefa Miranda-García María Rosa Casals

Automated method

Digital Mammography

10.1016/j.cmpb.2014.01.021

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Citations (32)

Supplementary Table 1 from High Mammographic Density in Long-Term Night-Shift Workers: DDM-Spain/Var-DDM

Ana María Pedraza-Flechas Virginia Lope Carmen Sánchez‐Contador Carmen Santamariña Carmen Pedraz‐Pingarrón

Supplementary table S1. Association of current or recent (stopped NSW <1 before mammogram) Night-shift Work (NSW) and Mammographic Density in DDM-Spain/Var-DDM study.

Table (database)

10.1158/1055-9965.22438206

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Adult weight gain, fat distribution and mammographic density in Spanish pre- and post-menopausal women (DDM-Spain)

Breast Cancer Research and Treatment (2012)

Marina Pollán Virginia Lope Josefa Miranda-García Milagros García Francisco Javier Bernal Casanova

High mammographic density (MD) is a phenotype risk marker for breast cancer. Body mass index (BMI) is inversely associated with MD, with the breast being a fat storage site. We investigated the influence of abdominal fat distribution and adult weight gain on MD, taking age, BMI and other confounders into account. Because visceral adiposity and BMI are associated with breast cancer only after menopause, differences in pre- and post-menopausal women were also explored. We recruited 3,584 women aged 45-68 years within the Spanish breast cancer screening network. Demographic, reproductive, family and personal history data were collected by purpose-trained staff, who measured current weight, height, waist and hip circumferences under the same protocol and with the same tools. MD was assessed in the left craniocaudal view using Boyd's Semiquantitative Scale. Association between waist-to-hip ratio, adult weight gain (difference between current weight and self-reported weight at 18 years) and MD was quantified by ordinal logistic regression, with random center-specific intercepts. Models were adjusted for age, BMI, breast size, time since menopause, parity, family history of breast cancer and hormonal replacement therapy use. Natural splines were used to describe the shape of the relationship between these two variables and MD. Waist-to-hip ratio was inversely associated with MD, and the effect was more pronounced in pre-menopausal (OR = 0.53 per 0.1 units; 95 % CI = 0.42-0.66) than in post-menopausal women (OR = 0.73; 95 % CI = 0.65-0.82) (P of heterogeneity = 0.010). In contrast, adult weight gain displayed a positive association with MD, which was similar in both groups (OR = 1.17 per 6 kg; 95 % CI = 1.11-1.23). Women who had gained more than 24 kg displayed higher MD (OR = 2.05; 95 % CI = 1.53-2.73). MD was also evaluated using Wolfe's and Tabár's classifications, with similar results being obtained. Once BMI, fat distribution and other confounders were considered, our results showed a clear dose-response gradient between the number of kg gained during adulthood and the proportion of dense tissue in the breast.

Waist–hip ratio

10.1007/s10549-012-2108-3

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Diet quality and related factors among Spanish female participants in breast cancer screening programs

Menopause The Journal of The North American Menopause Society (2012)

Nicolás García‐Arenzana Eva María Navarrete‐Muñoz Mercé Peris Dolores Salas Nieves Ascunce

A healthy diet is particularly important during menopause, a period in which the risk of a number of health problems increases. This study analyzed diet quality as measured by two indices, namely, the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet (aMED) index, which measures adherence to a Mediterranean diet, and examined the factors associated with lower diet quality.This was a cross-sectional study covering 3,564 women aged 45 to 68 years who underwent breast cancer screening at 7 centers (Corunna, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia, and Zaragoza). Data on diet were collected using a food frequency questionnaire validated for the Spanish population. We calculated the AHEI out of a total of 80 points and the aMED out of a total of 9 points. Ordinal logistic regression models were fitted, taking diet quality (tertiles of the AHEI and the aMED) as dependent variables. The following were included in the final multivariate models as explanatory variables: sociodemographic characteristics, chronic diseases, and lifestyles that were associated with diet quality, with a P value <0.100 in an initial simple model (adjusted solely for calorie intake and screening center). Interaction between menopause status and the other explanatory variables was checked.The median score for AHEI was 40 of a maximum of 80 points. Lower diet quality was registered by the youngest women (P for trend < 0.001), premenopausal and perimenopausal women (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; and OR, 1.48; CI, 1.20-1.83, respectively), obese women (OR, 1.18; CI, 0.99-1.41), those with a diagnosis of diabetes (OR, 1.35; CI, 1.01-1.79), smokers (OR, 1.41; CI, 1.21-1.66), and women reporting lower daily physical activity (OR, 1.31; CI, 1.12-1.53). Better diet quality was shown by women with higher education (OR, 0.74; CI, 0.62-0.88) and ex-smokers (OR, 0.82; CI, 0.69-0.98). Nulliparity was associated with higher AHEI scores, but only among premenopausal women (OR, 0.50; CI, 0.32-0.78). aMED index varied between 0 and 9 (median 5). Lower scores were associated with younger age (P for trend < 0.001), low socioeconomic level (OR, 1.13; CI, 0.96-1.33), lower educational level (P for trend = 0.008), and low level of daily physical activity (OR, 1.27, CI, 1.08-1.50).The youngest women, the most sedentary women, and those who had a lower educational level and socioeconomic status registered worse diet quality. Ex-smokers and postmenopausal women obtained better scores, probably reflecting a keener concern about leading a healthy life.

Mediterranean Diet

Food frequency questionnaire

10.1097/gme.0b013e3182544925

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Supplementary Figure 1 from High Mammographic Density in Long-Term Night-Shift Workers: DDM-Spain/Var-DDM

Ana María Pedraza-Flechas Virginia Lope Carmen Sánchez‐Contador Carmen Santamariña Carmen Pedraz‐Pingarrón

Supplementary Figure 1. Graphic esqueme summarizing the proposed pathways of the association between night-shift work and mammographic density.

Mammographic Density

10.1158/1055-9965.22438209.v1

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Association analysis between breast cancer genetic variants and mammographic density in a large population-based study (Determinants of Density in Mammographies in Spain) identifies susceptibility loci in TOX3 gene

European Journal of Cancer (2012)

Pablo Fernández‐Navarro Guillermo Pita Carmen Santamariña María Pilar Moreno Carmen Vidal

Genetic Association

Genome-wide Association Study

Genetic predisposition

10.1016/j.ejca.2012.08.026

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Citations (26)

Data from High Mammographic Density in Long-Term Night-Shift Workers: DDM-Spain/Var-DDM

Ana María Pedraza-Flechas Virginia Lope Carmen Sánchez‐Contador Carmen Santamariña Carmen Pedraz‐Pingarrón

<div>AbstractBackground: Night-shift work (NSW) has been suggested as a possible cause of breast cancer, and its association with mammographic density (MD), one of the strongest risk factors for breast cancer, has been scarcely addressed. This study examined NSW and MD in Spanish women.Methods: The study covered 2,752 women aged 45–68 years recruited in 2007–2008 in 7 population-based public breast cancer screening centers, which included 243 women who had performed NSW for at least one year. Occupational data and information on potential confounders were collected by personal interview. Two trained radiologist estimated the percentage of MD assisted by a validated semiautomatic computer tool (DM-scan). Multivariable mixed linear regression models with random screening center–specific intercepts were fitted using log-transformed percentage of MD as the dependent variable and adjusting by known confounding variables.Results: Having ever worked in NSW was not associated with MD [{e^\beta }$:0.96; 95% confidence interval (CI), 0.86–1.06]. However, the adjusted geometric mean of the percentage of MD in women with NSW for more than 15 years was 25% higher than that of those without NSW history (MD>15 years:20.7% vs. MDnever:16.5%;{e^\beta }$:1.25; 95% CI,1.01–1.54). This association was mainly observed in postmenopausal participants ({e^\beta }$:1.28; 95% CI, 1.00–1.64). Among NSW-exposed women, those with ≤2 night-shifts per week had higher MD than those with 5 to 7 nightshifts per week ({e^\beta }$:1.42; 95% CI, 1.10–1.84).Conclusions: Performing NSW was associated with higher MD only in women with more than 15 years of cumulated exposure. These findings warrant replication in futures studies.Impact: Our findings suggest that MD could play a role in the pathway between long-term NSW and breast cancer. Cancer Epidemiol Biomarkers Prev; 26(6); 905–13. ©2017 AACR.</div>

10.1158/1055-9965.c.6516258.v1

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Validation of DM-Scan, a computer-assisted tool to assess mammographic density in full-field digital mammograms

SpringerPlus (2013)

Marina Pollán Rafael Llobet Josefa Miranda-García Joaquín Antón María Rosa Casals

We developed a semi-automated tool to assess mammographic density (MD), a phenotype risk marker for breast cancer (BC), in full-field digital images and evaluated its performance testing its reproducibility, comparing our MD estimates with those obtained by visual inspection and using Cumulus, verifying their association with factors that influence MD, and studying the association between MD measures and subsequent BC risk. Three radiologists assessed MD using DM-Scan, the new tool, on 655 processed images (craniocaudal view) obtained in two screening centers. Reproducibility was explored computing pair-wise concordance correlation coefficients (CCC). The agreement between DM-Scan estimates and visual assessment (semi-quantitative scale, 6 categories) was quantified computing weighted kappa statistics (quadratic weights). DM-Scan and Cumulus readings were compared using CCC. Variation of DM-Scan measures by age, body mass index (BMI) and other MD modifiers was tested in regression mixed models with mammographic device as a random-effect term. The association between DM-Scan measures and subsequent BC was estimated in a case-control study. All BC cases in screening attendants (2007-2010) at a center with full-field digital mammography were matched by age and screening year with healthy controls (127 pairs). DM-Scan was used to blindly assess MD in available mammograms (112 cases/119 controls). Unconditional logistic models were fitted, including age, menopausal status and BMI as confounders. DM-Scan estimates were very reliable (pairwise CCC: 0.921, 0.928 and 0.916). They showed a reasonable agreement with visual MD assessment (weighted kappa ranging 0.79-0.81). DM-Scan and Cumulus measures were highly concordant (CCC ranging 0.80-0.84), but ours tended to be higher (4%-5% on average). As expected, DM-Scan estimates varied with age, BMI, parity and family history of BC. Finally, DM-Scan measures were significantly associated with BC (p-trend=0.005). Taking MD<7% as reference, OR per categories of MD were: OR7%-17%=1.32 (95% CI=0.59-2.99), OR17%-28%=2.28 (95% CI=1.03-5.04) and OR>=29%=3.10 (95% CI=1.35-7.14). Our results confirm that DM-Scan is a reliable tool to assess MD in full-field digital mammograms.

Mammographic Density

Digital Mammography

Breast density

10.1186/2193-1801-2-242

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Thyroid disorders and mammographic density in Spanish women: Var-DDM study

The Breast (2017)

Ana María Pedraza-Flechas Virginia Lope Carmen Vidal Carmen Sánchez‐Contador Carmen Santamariña

Thyroid disease

10.1016/j.breast.2017.04.011

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Citations (3)