title: Beyond breast cancer: mammographic features and mortality risk in a population of healthy women.
abstract: BACKGROUND
  Breast fibroglandular (dense) tissue is a risk factor for breast cancer. Beyond breast cancer, little is known regarding the prognostic significance of mammographic features.
  
  
  METHODS
  We evaluated relationships between nondense (fatty) breast area and dense area with all-cause mortality in 4,245 initially healthy women from the Breast Cancer Detection Demonstration Project; 1,361 died during a mean follow-up of 28.2 years. Dense area and total breast area were assessed using planimeter measurements from screening mammograms. Percent density reflects dense area relative to breast area and nondense area was calculated as the difference between total breast area and dense area. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression.
  
  
  RESULTS
  In age-adjusted models, greater nondense and total breast area were associated with increased risk of death (HR 1.17, 95% CI 1.10-1.24 and HR 1.13, 95% CI 1.06-1.19, per SD difference) while greater dense area and percent density were associated with lower risk of death (HR 0.91, 95% CI 0.86-0.95 and HR 0.87, 95% CI 0.83-0.92, per SD difference). Associations were not attenuated with adjustment for race, education, mammogram type (x-ray or xerogram), smoking status, diabetes and heart disease. With additional adjustment for body mass index, associations were diminished for all features but remained statistically significant for dense area (HR 0.94, 95% CI 0.89-0.99, per SD difference) and percent density (HR 0.93, 95% CI 0.87-0.98, per SD difference).
  
  
  CONCLUSIONS
  These data indicate that dense area and percent density may relate to survival in healthy women and suggest the potential utility of mammograms beyond prediction of breast cancer risk.
authors.affiliation: Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, Bethesda, Maryland, United States of America.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Murphy
authors.forename: Catherine
authors.initials: C
authors.lastname: Schairer
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Gierach
authors.forename: Celia
authors.initials: C
authors.lastname: Byrne
authors.forename: Mark E
authors.initials: ME
authors.lastname: Sherman
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Register
authors.forename: Jingzhong
authors.initials: J
authors.lastname: Ding
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
mesh_terms: D000328:Adult; D001940:Breast / Q000166:cytology* / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D064368:Healthy Volunteers / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors