title: Risk factors and tumor characteristics of interval cancers by mammographic density.
abstract: OBJECTIVE
  To compare tumor characteristics and risk factors of interval breast cancers and screen-detected breast cancers, taking mammographic density into account.
  
  
  METHODS
  Women diagnosed with invasive breast cancer from 2001 to 2008 in Stockholm, Sweden, with data on tumor characteristics (n = 4,091), risk factors, and mammographic density (n = 1,957) were included. Logistic regression was used to compare interval breast cancers with screen-detected breast cancers, overall and by highest and lowest quartiles of percent mammographic density.
  
  
  RESULTS
  Compared with screen-detected breast cancers, interval breast cancers in nondense breasts (≤ 20% mammographic density) were significantly more likely to exhibit lymph node involvement (odds ratio [OR], 3.55; 95% CI, 1.74 to 7.13) and to be estrogen receptor negative (OR, 4.05; 95% CI, 2.24 to 7.25), human epidermal growth factor receptor 2 positive (OR, 5.17; 95% CI, 1.64 to 17.01), progesterone receptor negative (OR, 2.63; 95% CI, 1.58 to 4.38), and triple negative (OR, 5.33; 95% CI, 1.21 to 22.46). In contrast, interval breast cancers in dense breasts (> 40.9% mammographic density) were less aggressive than interval breast cancers in nondense breasts (overall difference, P = .008) and were phenotypically more similar to screen-detected breast cancers. Risk factors differentially associated with interval breast cancer relative to screen-detected breast cancer after adjusting for age and mammographic density were family history of breast cancer (OR, 1.32; 95% CI, 1.02 to 1.70), current use of hormone replacement therapy (HRT; OR, 1.84; 95% CI, 1.38 to 2.44), and body mass index more than 25 kg/m(2) (OR, 0.49; 95% CI, 0.29 to 0.82).
  
  
  CONCLUSIONS
  Interval breast cancers in women with low mammographic density have the most aggressive phenotype. The effect of HRT on interval breast cancer risk is not fully explained by mammographic density. Family history is associated with interval breast cancers, possibly indicating disparate genetic background of screen-detected breast cancers and interval breast cancers.
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore. Johanna.holm@ki.se.
authors: Johanna
authors: J
authors: Holm
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Keith
authors: K
authors: Humphreys
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Jingmei
authors: J
authors: Li
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Alexander
authors: A
authors: Ploner
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Abbas
authors: A
authors: Cheddad
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Mikael
authors: M
authors: Eriksson
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Sven
authors: S
authors: Törnberg
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Per
authors: P
authors: Hall
authors: Johanna Holm, Keith Humphreys, Jingmei Li, Alexander Ploner, Abbas Cheddad, Mikael Eriksson, Per Hall, and Kamila Czene, Karolinska Institutet; Sven Törnberg, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden; and Jingmei Li, Genome Institute of Singapore, Singapore, Singapore.
authors: Kamila
authors: K
authors: Czene
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology; D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D016015:Logistic Models; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D010641:Phenotype; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism; D012042:Registries; D012307:Risk Factors; D013548:Sweden
chemical_list: D011960:Receptors, Estrogen