Is There a Difference in the Association between Percent Mammographic Density and Subtypes of Breast Cancer? Luminal A and Triple-Negative Breast Cancer

Background: Mammographic density is a potentially modifiable risk factor for breast cancer. To what extent mammographic density is a predictor for both hormone receptor-positive and hormone receptor-negative tumors is unclear. Even less is known about whether mammographic density predicts subtypes of breast cancer defined by expression status of the three receptors: estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2). Methods: We estimated the association of percent mammographic density with subtypes of invasive breast cancer among 479 population-based female breast cancer patients and 376 control subjects ages 35 to 64 years. The expression status of ER, PR, and HER-2 was assessed using immunohistochemistry methods in a single laboratory. We considered ER+ or PR+ plus HER-2- tumors as luminal A breast cancer and ER-/PR-/HER-2-tumors as triple-negative breast cancer. We used unconditional logistic regression methods to estimate odd ratios (95% confidence intervals) for both case-control and case-case comparisons. Results: Mammographic density was associated with increased risk of both invasive breast cancer subtypes, luminal A and triple-negative, in the case-control analysis. Results from case-case comparisons yielded no differences between the two subtypes among all women combined or in analyses done separately by race (White versus African American women) or menopausal status (premenopausal versus postmenopausal women; all P values > 0.05). Conclusions: Our results suggest that percent mammographic density is positively associated with both luminal A and triple-negative breast cancer. (Cancer Epidemiol Biomarkers Prev 2009;18(2):479-85)