title: Mammographic breast density: Predictive value for pathological response to neoadjuvant chemotherapy in breast cancer patients.
abstract: BACKGROUND
  This study aims to evaluate the relation between mammographic breast density (BD) and pathological response to neoadjuvant chemotherapy.
  
  
  METHODS
  In this retrospective study, 241 breast cancer patients who received neoadjuvant chemotherapy were included. BD was assessed in mammograms already performed at diagnosis. Pathological complete response (pCR) and pathological stage were correlated with BD, tumour phenotype and other clinico-pathological factors.
  
  
  RESULTS
  Patients with low BD had better pCR compared to those with high density (30.5% vs 19.5% respectively, OR = 1.8, 95% CI = 0.98-3.3, p = 0.056) which was more pronounced after adjustment with body mass index (BMI) (OR = 2.4, 95% CI = 1.2-4.8, p = 0.011). HER2-positive disease (32.5% vs. 18.4%, OR = 2.2, 95% = 1.2-4.0, p = 0.01), lower BMI (OR = 1.1, 95% CI = 1.03-1.15, p = 0.004) and lower clinical stage (p = 0.002) were significant predictors of pCR in univariate analysis. In multivariate analysis, low BD (OR = 2.7, 95% CI = 1.3-5.5, p = 0.006) and lower BMI (OR = 1.1, 95% CI = 1.03-1.17, p = 0.003) were independent predictors of better pCR, while early clinical stage (I, II) was of borderline significance (OR = 2.6, 95% CI = 0.99-6.7, p = 0.052). High BD (OR = 1.8, 95% CI = 1.1-3.2, p = 0.03), advanced clinical stage (III) (OR = 1.5, 95% CI = 1.03-2.1, p = 0.03) and higher BMI (OR = 1.06, 95% CI = 1.02-1.11, p = 0.006) were significant predictors of advanced pathological stage.
  
  
  CONCLUSIONS
  Low mammographic BD, low BMI and early clinical stage were associated with improved pCR rate and lower pathological stage after neoadjuvant chemotherapy. BD had more pronounced association with response to chemotherapy after adjustment with BMI.
authors.affiliation: Oncology, King Abdullah Medical City, Makkah, Saudi Arabia; Oncology, Oncology centre, Mansoura University, Mansoura, Egypt. Electronic address: shereefmohamad@yahoo.com.
authors.forename: S
authors.initials: S
authors.lastname: Elsamany
authors.affiliation: Oncology, King Abdullah Medical City, Makkah, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Alzahrani
authors.affiliation: Medical Oncology, King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia; Clinical Oncology, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: W N
authors.initials: WN
authors.lastname: Abozeed
authors.affiliation: Oncology, King Fahd Specialist Hospital, Dammam, Saudi Arabia; Oncology, Zagazig University Hospital, Zagazig, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Rasmy
authors.affiliation: Research, King Abdullah Medical City, Makkah, Saudi Arabia.
authors.forename: M U
authors.initials: MU
authors.lastname: Farooq
authors.affiliation: Oncology, Oncology centre, Mansoura University, Mansoura, Egypt.
authors.forename: M A
authors.initials: MA
authors.lastname: Elbiomy
authors.affiliation: Radiology, King Abdullah Medical City, Makkah, Saudi Arabia.
authors.forename: E
authors.initials: E
authors.lastname: Rawah
authors.affiliation: Medical Oncology, King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia.
authors.forename: K
authors.initials: K
authors.lastname: Alsaleh
authors.affiliation: Medical Oncology, King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia; Medical Oncology, South Egypt Cancer Institute, Assuit University, Assuit, Egypt.
authors.forename: N M
authors.initials: NM
authors.lastname: Abdel-Aziz
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015992:Body Mass Index; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008327:Mammography; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D000068878:Trastuzumab / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D003520:Cyclophosphamide; D000077143:Docetaxel; D015251:Epirubicin; D005472:Fluorouracil; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D043823:Taxoids; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: Breast density; Mammogram; Neoadjuvant chemotherapy; Pathological response