title: Prognostic value of mammographic breast density in patients with metastatic breast cancer.
abstract: Breast density is a modifiable trait linked with breast cancer predisposition. However, the relation between mammographic breast density and survival outcome is not yet clarified. The present study aims to study the prognostic value of mammographic density in patients diagnosed with metastatic breast cancer. In this observational study, breast cancer patients with metastatic disease at diagnosis were enrolled. Two-view mammograms were performed at diagnosis, and breast density was quantitatively assessed. Progression-free survival (PFS) was correlated with breast density and other prognostic variables in univariate and multivariate analyses. PFS, stratified by different prognostic factors, was assessed in low compared to high density patients to check for possible differential survival outcome in patients' subgroups. Among the sixty enrolled patients, median PFS in low density patients was significantly better than those with high density (18.4 months, 95 % CI 14.88-22.15 vs. 9.3 months, 95 % CI 8.51-13.60, respectively, p = 0.002). Significant correlation of breast density with PFS persisted after adjustment by body mass index (p = 0.003) and after multivariate analysis incorporating other prognostic variables (HR 6.16, 95 % CI (2.17-17.48), p = 0.001). PFS was better in low density patients older than 40 years at diagnosis (p = 0.001), with HER2-negative disease (p = 0.015), hormonal receptor-positive phenotype (p = 0.020), patients with single site of metastasis (p = 0.006), and patients with bone-only metastases (p = 0.042). Breast density assessed at the time of diagnosis was significantly correlated with PFS of metastatic breast cancer patients. Survival outcome is improved in certain patients' subgroups with low breast density.
authors.affiliation: Oncology, King Abdullah Medical City, Makkah, Saudi Arabia, samanyshereef@yahoo.com.
authors.forename: Shereef
authors.initials: S
authors.lastname: Elsamany
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alzahrani
authors.forename: Seham Abd
authors.initials: SA
authors.lastname: Elkhalik
authors.forename: Omaima
authors.initials: O
authors.lastname: Elemam
authors.forename: Elham
authors.initials: E
authors.lastname: Rawah
authors.forename: Mian U
authors.initials: MU
authors.lastname: Farooq
authors.forename: Musab
authors.initials: M
authors.lastname: H Almatrafi
authors.forename: Feras
authors.initials: F
authors.lastname: K Olayan
mesh_terms: D000328:Adult; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011859:Radiography; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human