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Open AccessCommentary

Going Beyond Conventional Mammographic Density to Discover Novel Mammogram-Based Predictors of Breast Cancer Risk

Centre for Epidemiology & Biostatistics/Melbourne School of Population & Global Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Victoria 3010, Australia
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J. Clin. Med. 2020, 9(3), 627; https://doi.org/10.3390/jcm9030627
Received: 31 January 2020 / Revised: 15 February 2020 / Accepted: 17 February 2020 / Published: 26 February 2020
(This article belongs to the Special Issue Mammographic Density: Biology and Clinical Applications)
This commentary is about predicting a woman’s breast cancer risk from her mammogram, building on the work of Wolfe, Boyd and Yaffe on mammographic density. We summarise our efforts at finding new mammogram-based risk predictors, and how they combine with the conventional mammographic density, in predicting risk for interval cancers and screen-detected breast cancers across different ages at diagnosis and for both Caucasian and Asian women. Using the OPERA (odds ratio per adjusted standard deviation) concept, in which the risk gradient is measured on an appropriate scale that takes into account other factors adjusted for by design or analysis, we show that our new mammogram-based measures are the strongest of all currently known breast cancer risk factors in terms of risk discrimination on a population-basis. We summarise our findings graphically using a path diagram in which conventional mammographic density predicts interval cancer due to its role in masking, while the new mammogram-based risk measures could have a causal effect on both interval and screen-detected breast cancer. We discuss attempts by others to pursue this line of investigation, the measurement challenge that allows different measures to be compared in an open and transparent manner on the same datasets, as well as the biological and public health consequences. View Full-Text
Keywords: breast cancer; cumulus; cirrocumulus; cirrus; mammogram-based risk; mammographic density; OPERA breast cancer; cumulus; cirrocumulus; cirrus; mammogram-based risk; mammographic density; OPERA
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Hopper, J.L.; Nguyen, T.L.; Schmidt, D.F.; Makalic, E.; Song, Y.-M.; Sung, J.; Dite, G.S.; Dowty, J.G.; Li, S. Going Beyond Conventional Mammographic Density to Discover Novel Mammogram-Based Predictors of Breast Cancer Risk. J. Clin. Med. 2020, 9, 627.

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