Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide
Identifieur interne : 004A57 ( Ncbi/Checkpoint ); précédent : 004A56; suivant : 004A58Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide
Auteurs : Anya Burton [France] ; Gertraud Maskarinec [États-Unis] ; Beatriz Perez-Gomez [Espagne] ; Celine Vachon [États-Unis] ; Hui Miao [Singapour] ; Martín Lajous [Mexique] ; Ruy L Pez-Ridaura [Mexique] ; Megan Rice [États-Unis] ; Ana Pereira [Chili] ; Maria Luisa Garmendia [Chili] ; Rulla M. Tamimi [États-Unis] ; Kimberly Bertrand [États-Unis] ; Ava Kwong [République populaire de Chine] ; Giske Ursin [Norvège, États-Unis] ; Eunjung Lee [États-Unis] ; Samera A. Qureshi [Norvège] ; Huiyan Ma [États-Unis] ; Sarah Vinnicombe [Royaume-Uni] ; Sue Moss [Royaume-Uni] ; Steve Allen [Royaume-Uni] ; Rose Ndumia [Kenya] ; Sudhir Vinayak [Kenya] ; Soo-Hwang Teo [Malaisie] ; Shivaani Mariapun [Malaisie] ; Farhana Fadzli [Malaisie] ; Beata Peplonska [Pologne] ; Agnieszka Bukowska [Pologne] ; Chisato Nagata [Japon] ; Jennifer Stone [Australie] ; John Hopper [Australie] ; Graham Giles [Australie] ; Vahit Ozmen [Turquie] ; Mustafa Erkin Aribal [Turquie] ; Joachim Schüz [France] ; Carla H. Van Gils [Pays-Bas] ; Johanna O. P. Wanders [Pays-Bas] ; Reza Sirous [Iran] ; Mehri Sirous [Iran] ; John Hipwell [Royaume-Uni] ; Jisun Kim [Corée du Sud] ; Jong Won Lee [Corée du Sud] ; Caroline Dickens [Afrique du Sud] ; Mikael Hartman [États-Unis, Singapour] ; Kee-Seng Chia [Singapour] ; Christopher Scott [États-Unis] ; Anna M. Chiarelli [Canada] ; Linda Linton [Canada] ; Marina Pollan [Espagne] ; Anath Arzee Flugelman [Israël] ; Dorria Salem [Égypte] ; Rasha Kamal [Égypte] ; Norman Boyd [Canada] ; Isabel Dos-Santos-Silva [Royaume-Uni] ; Valerie Mccormack [France]Source :
- PLoS Medicine [ 1549-1277 ] ; 2017.
Descripteurs français
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English descriptors
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Abstract
Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known.
We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35–85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of pooled data, adjusted for body mass index, reproductive factors, mammogram view, image type, and reader. In all, 4,534 women were premenopausal, and 6,481 postmenopausal, at the time of mammography. A large age-adjusted difference in percent MD (PD) between post- and premenopausal women was apparent (–0.46 cm [95% CI: −0.53, −0.39]) and appeared greater in women with lower breast cancer risk profiles; variation across population groups due to heterogeneity (
Declines in MD with increasing age are present premenopausally, continue postmenopausally, and are most pronounced over the menopausal transition. These effects were highly consistent across diverse groups of women worldwide, suggesting that they result from an intrinsic biological, likely hormonal, mechanism common to women. If cumulative breast density is a key determinant of breast cancer risk, younger ages may be the more critical periods for lifestyle modifications aimed at breast density and breast cancer risk reduction.
Url:
DOI: 10.1371/journal.pmed.1002335
PubMed: 28666001
PubMed Central: 5493289
Affiliations:
- Afrique du Sud, Australie, Canada, Chili, Corée du Sud, Espagne, France, Iran, Israël, Japon, Kenya, Malaisie, Mexique, Norvège, Pays-Bas, Pologne, Royaume-Uni, République populaire de Chine, Singapour, Turquie, Égypte, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, Californie, Communauté de Madrid, Gauteng, Grand Londres, Hawaï, Massachusetts, Minnesota, Préfecture de Gifu, Rhône-Alpes, Région capitale de Séoul, Région du Chūbu, Utrecht (province), Victoria (État), Østlandet
- Gifu (ville), Johannesbourg, Londres, Los Angeles, Lyon, Madrid, Melbourne, Oslo, Séoul, Utrecht
- University College de Londres, Université de Californie du Sud, Université de Gifu, Université de Londres, Université de Melbourne, Université du Witwatersrand, Université nationale de Singapour
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PMC:5493289Le document en format XML
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<author><name sortKey="Miao, Hui" sort="Miao, Hui" uniqKey="Miao H" first="Hui" last="Miao">Hui Miao</name>
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<author><name sortKey="Ma, Huiyan" sort="Ma, Huiyan" uniqKey="Ma H" first="Huiyan" last="Ma">Huiyan Ma</name>
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<author><name sortKey="Vinnicombe, Sarah" sort="Vinnicombe, Sarah" uniqKey="Vinnicombe S" first="Sarah" last="Vinnicombe">Sarah Vinnicombe</name>
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<author><name sortKey="Allen, Steve" sort="Allen, Steve" uniqKey="Allen S" first="Steve" last="Allen">Steve Allen</name>
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<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, London</wicri:regionArea>
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<author><name sortKey="Ndumia, Rose" sort="Ndumia, Rose" uniqKey="Ndumia R" first="Rose" last="Ndumia">Rose Ndumia</name>
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<author><name sortKey="Teo, Soo Hwang" sort="Teo, Soo Hwang" uniqKey="Teo S" first="Soo-Hwang" last="Teo">Soo-Hwang Teo</name>
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<affiliation wicri:level="1"><nlm:aff id="aff025"><addr-line>Cancer Research Malaysia, Subang Jaya, Malaysia</addr-line>
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<author><name sortKey="Mariapun, Shivaani" sort="Mariapun, Shivaani" uniqKey="Mariapun S" first="Shivaani" last="Mariapun">Shivaani Mariapun</name>
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<author><name sortKey="Fadzli, Farhana" sort="Fadzli, Farhana" uniqKey="Fadzli F" first="Farhana" last="Fadzli">Farhana Fadzli</name>
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<affiliation wicri:level="1"><nlm:aff id="aff027"><addr-line>Biomedical Imaging Department, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia</addr-line>
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<author><name sortKey="Peplonska, Beata" sort="Peplonska, Beata" uniqKey="Peplonska B" first="Beata" last="Peplonska">Beata Peplonska</name>
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<author><name sortKey="Bukowska, Agnieszka" sort="Bukowska, Agnieszka" uniqKey="Bukowska A" first="Agnieszka" last="Bukowska">Agnieszka Bukowska</name>
<affiliation wicri:level="1"><nlm:aff id="aff028"><addr-line>Nofer Institute of Occupational Medicine, Łódź, Poland</addr-line>
</nlm:aff>
<country xml:lang="fr">Pologne</country>
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<author><name sortKey="Nagata, Chisato" sort="Nagata, Chisato" uniqKey="Nagata C" first="Chisato" last="Nagata">Chisato Nagata</name>
<affiliation wicri:level="4"><nlm:aff id="aff029"><addr-line>Department of Epidemiology & Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan</addr-line>
</nlm:aff>
<country xml:lang="fr">Japon</country>
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</nlm:aff>
<country xml:lang="fr">Australie</country>
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<author><name sortKey="Hopper, John" sort="Hopper, John" uniqKey="Hopper J" first="John" last="Hopper">John Hopper</name>
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</nlm:aff>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Giles, Graham" sort="Giles, Graham" uniqKey="Giles G" first="Graham" last="Giles">Graham Giles</name>
<affiliation wicri:level="4"><nlm:aff id="aff031"><addr-line>Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria</wicri:regionArea>
<orgName type="university">Université de Melbourne</orgName>
<placeName><settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff032"><addr-line>Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria</wicri:regionArea>
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</author>
<author><name sortKey="Ozmen, Vahit" sort="Ozmen, Vahit" uniqKey="Ozmen V" first="Vahit" last="Ozmen">Vahit Ozmen</name>
<affiliation wicri:level="1"><nlm:aff id="aff033"><addr-line>Faculty of Medicine, Istanbul University, Istanbul, Turkey</addr-line>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Faculty of Medicine, Istanbul University, Istanbul</wicri:regionArea>
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</affiliation>
</author>
<author><name sortKey="Aribal, Mustafa Erkin" sort="Aribal, Mustafa Erkin" uniqKey="Aribal M" first="Mustafa Erkin" last="Aribal">Mustafa Erkin Aribal</name>
<affiliation wicri:level="1"><nlm:aff id="aff034"><addr-line>Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey</addr-line>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Department of Radiology, School of Medicine, Marmara University, Istanbul</wicri:regionArea>
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</affiliation>
</author>
<author><name sortKey="Schuz, Joachim" sort="Schuz, Joachim" uniqKey="Schuz J" first="Joachim" last="Schüz">Joachim Schüz</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Section of Environment and Radiation, International Agency for Research on Cancer, Lyon</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Lyon</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Van Gils, Carla H" sort="Van Gils, Carla H" uniqKey="Van Gils C" first="Carla H." last="Van Gils">Carla H. Van Gils</name>
<affiliation wicri:level="3"><nlm:aff id="aff035"><addr-line>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands</addr-line>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht</wicri:regionArea>
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<region nuts="2" type="province">Utrecht (province)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Wanders, Johanna O P" sort="Wanders, Johanna O P" uniqKey="Wanders J" first="Johanna O. P." last="Wanders">Johanna O. P. Wanders</name>
<affiliation wicri:level="3"><nlm:aff id="aff035"><addr-line>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands</addr-line>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht</wicri:regionArea>
<placeName><settlement type="city">Utrecht</settlement>
<region nuts="2" type="province">Utrecht (province)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Sirous, Reza" sort="Sirous, Reza" uniqKey="Sirous R" first="Reza" last="Sirous">Reza Sirous</name>
<affiliation wicri:level="1"><nlm:aff id="aff036"><addr-line>Isfahan University of Medical Sciences, Isfahan, Iran</addr-line>
</nlm:aff>
<country xml:lang="fr">Iran</country>
<wicri:regionArea>Isfahan University of Medical Sciences, Isfahan</wicri:regionArea>
<wicri:noRegion>Isfahan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Sirous, Mehri" sort="Sirous, Mehri" uniqKey="Sirous M" first="Mehri" last="Sirous">Mehri Sirous</name>
<affiliation wicri:level="1"><nlm:aff id="aff037"><addr-line>Radiology Department, Isfahan University of Medical Sciences, Isfahan, Iran</addr-line>
</nlm:aff>
<country xml:lang="fr">Iran</country>
<wicri:regionArea>Radiology Department, Isfahan University of Medical Sciences, Isfahan</wicri:regionArea>
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</affiliation>
</author>
<author><name sortKey="Hipwell, John" sort="Hipwell, John" uniqKey="Hipwell J" first="John" last="Hipwell">John Hipwell</name>
<affiliation wicri:level="4"><nlm:aff id="aff038"><addr-line>Centre for Medical Image Computing, University College London, London, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Medical Image Computing, University College London, London</wicri:regionArea>
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<region type="région" nuts="1">Grand Londres</region>
<settlement type="city">Londres</settlement>
</placeName>
<orgName type="university">University College de Londres</orgName>
</affiliation>
</author>
<author><name sortKey="Kim, Jisun" sort="Kim, Jisun" uniqKey="Kim J" first="Jisun" last="Kim">Jisun Kim</name>
<affiliation wicri:level="3"><nlm:aff id="aff039"><addr-line>Asan Medical Center, Seoul, Republic of Korea</addr-line>
</nlm:aff>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>Asan Medical Center, Seoul</wicri:regionArea>
<placeName><settlement type="city">Séoul</settlement>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Lee, Jong Won" sort="Lee, Jong Won" uniqKey="Lee J" first="Jong Won" last="Lee">Jong Won Lee</name>
<affiliation wicri:level="3"><nlm:aff id="aff039"><addr-line>Asan Medical Center, Seoul, Republic of Korea</addr-line>
</nlm:aff>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>Asan Medical Center, Seoul</wicri:regionArea>
<placeName><settlement type="city">Séoul</settlement>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Dickens, Caroline" sort="Dickens, Caroline" uniqKey="Dickens C" first="Caroline" last="Dickens">Caroline Dickens</name>
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</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
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<orgName type="university">Université du Witwatersrand</orgName>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Hartman, Mikael" sort="Hartman, Mikael" uniqKey="Hartman M" first="Mikael" last="Hartman">Mikael Hartman</name>
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</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota</wicri:regionArea>
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</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff041"><addr-line>Department of Surgery, Yong Loo Lin School of Medicine, Singapore</addr-line>
</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Department of Surgery, Yong Loo Lin School of Medicine</wicri:regionArea>
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</affiliation>
</author>
<author><name sortKey="Chia, Kee Seng" sort="Chia, Kee Seng" uniqKey="Chia K" first="Kee-Seng" last="Chia">Kee-Seng Chia</name>
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</nlm:aff>
<country xml:lang="fr">Singapour</country>
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</affiliation>
</author>
<author><name sortKey="Scott, Christopher" sort="Scott, Christopher" uniqKey="Scott C" first="Christopher" last="Scott">Christopher Scott</name>
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</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Chiarelli, Anna M" sort="Chiarelli, Anna M" uniqKey="Chiarelli A" first="Anna M." last="Chiarelli">Anna M. Chiarelli</name>
<affiliation wicri:level="1"><nlm:aff id="aff043"><addr-line>Ontario Breast Screening Program, Cancer Care Ontario, Toronto, Ontario, Canada</addr-line>
</nlm:aff>
<country xml:lang="fr">Canada</country>
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</affiliation>
</author>
<author><name sortKey="Linton, Linda" sort="Linton, Linda" uniqKey="Linton L" first="Linda" last="Linton">Linda Linton</name>
<affiliation wicri:level="1"><nlm:aff id="aff044"><addr-line>Princess Margaret Cancer Centre, Toronto, Ontario, Canada</addr-line>
</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Princess Margaret Cancer Centre, Toronto, Ontario</wicri:regionArea>
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</affiliation>
</author>
<author><name sortKey="Pollan, Marina" sort="Pollan, Marina" uniqKey="Pollan M" first="Marina" last="Pollan">Marina Pollan</name>
<affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Instituto de Salud Carlos III, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
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</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>CIBERESP, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBERESP, Madrid</wicri:regionArea>
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<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Flugelman, Anath Arzee" sort="Flugelman, Anath Arzee" uniqKey="Flugelman A" first="Anath Arzee" last="Flugelman">Anath Arzee Flugelman</name>
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</nlm:aff>
<country xml:lang="fr">Israël</country>
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</affiliation>
</author>
<author><name sortKey="Salem, Dorria" sort="Salem, Dorria" uniqKey="Salem D" first="Dorria" last="Salem">Dorria Salem</name>
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</nlm:aff>
<country xml:lang="fr">Égypte</country>
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<author><name sortKey="Kamal, Rasha" sort="Kamal, Rasha" uniqKey="Kamal R" first="Rasha" last="Kamal">Rasha Kamal</name>
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</nlm:aff>
<country xml:lang="fr">Égypte</country>
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<author><name sortKey="Boyd, Norman" sort="Boyd, Norman" uniqKey="Boyd N" first="Norman" last="Boyd">Norman Boyd</name>
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</nlm:aff>
<country xml:lang="fr">Canada</country>
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</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
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</placeName>
</affiliation>
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<author><name sortKey="Mccormack, Valerie" sort="Mccormack, Valerie" uniqKey="Mccormack V" first="Valerie" last="Mccormack">Valerie Mccormack</name>
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</nlm:aff>
<country xml:lang="fr">France</country>
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<author><name sortKey="Burton, Anya" sort="Burton, Anya" uniqKey="Burton A" first="Anya" last="Burton">Anya Burton</name>
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</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Section of Environment and Radiation, International Agency for Research on Cancer, Lyon</wicri:regionArea>
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<author><name sortKey="Maskarinec, Gertraud" sort="Maskarinec, Gertraud" uniqKey="Maskarinec G" first="Gertraud" last="Maskarinec">Gertraud Maskarinec</name>
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</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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<placeName><region type="state">Hawaï</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Perez Gomez, Beatriz" sort="Perez Gomez, Beatriz" uniqKey="Perez Gomez B" first="Beatriz" last="Perez-Gomez">Beatriz Perez-Gomez</name>
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</nlm:aff>
<country xml:lang="fr">Espagne</country>
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</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>CIBERESP, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBERESP, Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Vachon, Celine" sort="Vachon, Celine" uniqKey="Vachon C" first="Celine" last="Vachon">Celine Vachon</name>
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</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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</placeName>
</affiliation>
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<author><name sortKey="Miao, Hui" sort="Miao, Hui" uniqKey="Miao H" first="Hui" last="Miao">Hui Miao</name>
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</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Saw Swee Hock School of Public Health, National University of Singapore</wicri:regionArea>
<orgName type="university">Université nationale de Singapour</orgName>
</affiliation>
</author>
<author><name sortKey="Lajous, Martin" sort="Lajous, Martin" uniqKey="Lajous M" first="Martín" last="Lajous">Martín Lajous</name>
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</nlm:aff>
<country xml:lang="fr">Mexique</country>
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<author><name sortKey="L Pez Ridaura, Ruy" sort="L Pez Ridaura, Ruy" uniqKey="L Pez Ridaura R" first="Ruy" last="L Pez-Ridaura">Ruy L Pez-Ridaura</name>
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<country xml:lang="fr">Mexique</country>
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<author><name sortKey="Rice, Megan" sort="Rice, Megan" uniqKey="Rice M" first="Megan" last="Rice">Megan Rice</name>
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</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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</affiliation>
</author>
<author><name sortKey="Pereira, Ana" sort="Pereira, Ana" uniqKey="Pereira A" first="Ana" last="Pereira">Ana Pereira</name>
<affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile</addr-line>
</nlm:aff>
<country xml:lang="fr">Chili</country>
<wicri:regionArea>Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago</wicri:regionArea>
<wicri:noRegion>Santiago</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Garmendia, Maria Luisa" sort="Garmendia, Maria Luisa" uniqKey="Garmendia M" first="Maria Luisa" last="Garmendia">Maria Luisa Garmendia</name>
<affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile</addr-line>
</nlm:aff>
<country xml:lang="fr">Chili</country>
<wicri:regionArea>Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago</wicri:regionArea>
<wicri:noRegion>Santiago</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Tamimi, Rulla M" sort="Tamimi, Rulla M" uniqKey="Tamimi R" first="Rulla M." last="Tamimi">Rulla M. Tamimi</name>
<affiliation wicri:level="2"><nlm:aff id="aff010"><addr-line>Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Bertrand, Kimberly" sort="Bertrand, Kimberly" uniqKey="Bertrand K" first="Kimberly" last="Bertrand">Kimberly Bertrand</name>
<affiliation wicri:level="2"><nlm:aff id="aff011"><addr-line>Slone Epidemiology Center, Boston University, Boston, Massachusetts, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Slone Epidemiology Center, Boston University, Boston, Massachusetts</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Kwong, Ava" sort="Kwong, Ava" uniqKey="Kwong A" first="Ava" last="Kwong">Ava Kwong</name>
<affiliation wicri:level="1"><nlm:aff id="aff012"><addr-line>Division of Breast Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China</addr-line>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Division of Breast Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong</wicri:regionArea>
<wicri:noRegion>Hong Kong</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff013"><addr-line>Department of Surgery and Cancer Genetics Center, Hong Kong Sanatorium and Hospital, Hong Kong, China</addr-line>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Department of Surgery and Cancer Genetics Center, Hong Kong Sanatorium and Hospital, Hong Kong</wicri:regionArea>
<wicri:noRegion>Hong Kong</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff014"><addr-line>Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong, China</addr-line>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong</wicri:regionArea>
<wicri:noRegion>Hong Kong</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ursin, Giske" sort="Ursin, Giske" uniqKey="Ursin G" first="Giske" last="Ursin">Giske Ursin</name>
<affiliation wicri:level="3"><nlm:aff id="aff015"><addr-line>Cancer Registry of Norway, Oslo, Norway</addr-line>
</nlm:aff>
<country xml:lang="fr">Norvège</country>
<wicri:regionArea>Cancer Registry of Norway, Oslo</wicri:regionArea>
<placeName><settlement type="city">Oslo</settlement>
<region nuts="2">Østlandet</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff016"><addr-line>Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway</addr-line>
</nlm:aff>
<country xml:lang="fr">Norvège</country>
<wicri:regionArea>Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo</wicri:regionArea>
<placeName><settlement type="city">Oslo</settlement>
<region nuts="2">Østlandet</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="aff017"><addr-line>Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles</wicri:regionArea>
<placeName><settlement type="city">Los Angeles</settlement>
<region type="state">Californie</region>
<settlement type="city">Los Angeles</settlement>
</placeName>
<orgName type="university">Université de Californie du Sud</orgName>
</affiliation>
</author>
<author><name sortKey="Lee, Eunjung" sort="Lee, Eunjung" uniqKey="Lee E" first="Eunjung" last="Lee">Eunjung Lee</name>
<affiliation wicri:level="4"><nlm:aff id="aff017"><addr-line>Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles</wicri:regionArea>
<placeName><settlement type="city">Los Angeles</settlement>
<region type="state">Californie</region>
<settlement type="city">Los Angeles</settlement>
</placeName>
<orgName type="university">Université de Californie du Sud</orgName>
</affiliation>
</author>
<author><name sortKey="Qureshi, Samera A" sort="Qureshi, Samera A" uniqKey="Qureshi S" first="Samera A." last="Qureshi">Samera A. Qureshi</name>
<affiliation wicri:level="3"><nlm:aff id="aff018"><addr-line>Norwegian Centre for Migrant and Minority Health (NAKMI), Oslo, Norway</addr-line>
</nlm:aff>
<country xml:lang="fr">Norvège</country>
<wicri:regionArea>Norwegian Centre for Migrant and Minority Health (NAKMI), Oslo</wicri:regionArea>
<placeName><settlement type="city">Oslo</settlement>
<region nuts="2">Østlandet</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ma, Huiyan" sort="Ma, Huiyan" uniqKey="Ma H" first="Huiyan" last="Ma">Huiyan Ma</name>
<affiliation wicri:level="2"><nlm:aff id="aff019"><addr-line>Department of Population Sciences, City of Hope National Medical Center, Duarte, California, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Population Sciences, City of Hope National Medical Center, Duarte, California</wicri:regionArea>
<placeName><region type="state">Californie</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Vinnicombe, Sarah" sort="Vinnicombe, Sarah" uniqKey="Vinnicombe S" first="Sarah" last="Vinnicombe">Sarah Vinnicombe</name>
<affiliation wicri:level="1"><nlm:aff id="aff020"><addr-line>Division of Cancer Research, Ninewells Hospital and Medical School, Dundee, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Division of Cancer Research, Ninewells Hospital and Medical School, Dundee</wicri:regionArea>
<wicri:noRegion>Dundee</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Moss, Sue" sort="Moss, Sue" uniqKey="Moss S" first="Sue" last="Moss">Sue Moss</name>
<affiliation wicri:level="4"><nlm:aff id="aff021"><addr-line>Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Wolfson Institute of Preventive Medicine, Queen Mary University of London, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
<settlement type="city">Londres</settlement>
</placeName>
<orgName type="university">Université de Londres</orgName>
</affiliation>
</author>
<author><name sortKey="Allen, Steve" sort="Allen, Steve" uniqKey="Allen S" first="Steve" last="Allen">Steve Allen</name>
<affiliation wicri:level="3"><nlm:aff id="aff022"><addr-line>Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ndumia, Rose" sort="Ndumia, Rose" uniqKey="Ndumia R" first="Rose" last="Ndumia">Rose Ndumia</name>
<affiliation wicri:level="1"><nlm:aff id="aff023"><addr-line>Aga Khan University Hospital, Nairobi, Kenya</addr-line>
</nlm:aff>
<country xml:lang="fr">Kenya</country>
<wicri:regionArea>Aga Khan University Hospital, Nairobi</wicri:regionArea>
<wicri:noRegion>Nairobi</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Vinayak, Sudhir" sort="Vinayak, Sudhir" uniqKey="Vinayak S" first="Sudhir" last="Vinayak">Sudhir Vinayak</name>
<affiliation wicri:level="1"><nlm:aff id="aff023"><addr-line>Aga Khan University Hospital, Nairobi, Kenya</addr-line>
</nlm:aff>
<country xml:lang="fr">Kenya</country>
<wicri:regionArea>Aga Khan University Hospital, Nairobi</wicri:regionArea>
<wicri:noRegion>Nairobi</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Teo, Soo Hwang" sort="Teo, Soo Hwang" uniqKey="Teo S" first="Soo-Hwang" last="Teo">Soo-Hwang Teo</name>
<affiliation wicri:level="1"><nlm:aff id="aff024"><addr-line>Breast Cancer Research Group, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia</addr-line>
</nlm:aff>
<country xml:lang="fr">Malaisie</country>
<wicri:regionArea>Breast Cancer Research Group, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur</wicri:regionArea>
<wicri:noRegion>Kuala Lumpur</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff025"><addr-line>Cancer Research Malaysia, Subang Jaya, Malaysia</addr-line>
</nlm:aff>
<country xml:lang="fr">Malaisie</country>
<wicri:regionArea>Cancer Research Malaysia, Subang Jaya</wicri:regionArea>
<wicri:noRegion>Subang Jaya</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Mariapun, Shivaani" sort="Mariapun, Shivaani" uniqKey="Mariapun S" first="Shivaani" last="Mariapun">Shivaani Mariapun</name>
<affiliation wicri:level="1"><nlm:aff id="aff025"><addr-line>Cancer Research Malaysia, Subang Jaya, Malaysia</addr-line>
</nlm:aff>
<country xml:lang="fr">Malaisie</country>
<wicri:regionArea>Cancer Research Malaysia, Subang Jaya</wicri:regionArea>
<wicri:noRegion>Subang Jaya</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Fadzli, Farhana" sort="Fadzli, Farhana" uniqKey="Fadzli F" first="Farhana" last="Fadzli">Farhana Fadzli</name>
<affiliation wicri:level="1"><nlm:aff id="aff026"><addr-line>Breast Cancer Research Unit, Faculty of Medicine, University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia</addr-line>
</nlm:aff>
<country xml:lang="fr">Malaisie</country>
<wicri:regionArea>Breast Cancer Research Unit, Faculty of Medicine, University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur</wicri:regionArea>
<wicri:noRegion>Kuala Lumpur</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff027"><addr-line>Biomedical Imaging Department, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia</addr-line>
</nlm:aff>
<country xml:lang="fr">Malaisie</country>
<wicri:regionArea>Biomedical Imaging Department, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur</wicri:regionArea>
<wicri:noRegion>Kuala Lumpur</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Peplonska, Beata" sort="Peplonska, Beata" uniqKey="Peplonska B" first="Beata" last="Peplonska">Beata Peplonska</name>
<affiliation wicri:level="1"><nlm:aff id="aff028"><addr-line>Nofer Institute of Occupational Medicine, Łódź, Poland</addr-line>
</nlm:aff>
<country xml:lang="fr">Pologne</country>
<wicri:regionArea>Nofer Institute of Occupational Medicine, Łódź</wicri:regionArea>
<wicri:noRegion>Łódź</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bukowska, Agnieszka" sort="Bukowska, Agnieszka" uniqKey="Bukowska A" first="Agnieszka" last="Bukowska">Agnieszka Bukowska</name>
<affiliation wicri:level="1"><nlm:aff id="aff028"><addr-line>Nofer Institute of Occupational Medicine, Łódź, Poland</addr-line>
</nlm:aff>
<country xml:lang="fr">Pologne</country>
<wicri:regionArea>Nofer Institute of Occupational Medicine, Łódź</wicri:regionArea>
<wicri:noRegion>Łódź</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Nagata, Chisato" sort="Nagata, Chisato" uniqKey="Nagata C" first="Chisato" last="Nagata">Chisato Nagata</name>
<affiliation wicri:level="4"><nlm:aff id="aff029"><addr-line>Department of Epidemiology & Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan</addr-line>
</nlm:aff>
<country xml:lang="fr">Japon</country>
<wicri:regionArea>Department of Epidemiology & Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu</wicri:regionArea>
<orgName type="university">Université de Gifu</orgName>
<placeName><settlement type="city">Gifu (ville)</settlement>
<region type="province">Région du Chūbu</region>
<region type="prefecture">Préfecture de Gifu</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Stone, Jennifer" sort="Stone, Jennifer" uniqKey="Stone J" first="Jennifer" last="Stone">Jennifer Stone</name>
<affiliation wicri:level="1"><nlm:aff id="aff030"><addr-line>Centre for Genetic Origins of Health and Disease, University of Western Australia, Crawley, Western Australia, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Centre for Genetic Origins of Health and Disease, University of Western Australia, Crawley, Western Australia</wicri:regionArea>
<wicri:noRegion>Western Australia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hopper, John" sort="Hopper, John" uniqKey="Hopper J" first="John" last="Hopper">John Hopper</name>
<affiliation wicri:level="4"><nlm:aff id="aff031"><addr-line>Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria</wicri:regionArea>
<orgName type="university">Université de Melbourne</orgName>
<placeName><settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Giles, Graham" sort="Giles, Graham" uniqKey="Giles G" first="Graham" last="Giles">Graham Giles</name>
<affiliation wicri:level="4"><nlm:aff id="aff031"><addr-line>Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria</wicri:regionArea>
<orgName type="university">Université de Melbourne</orgName>
<placeName><settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff032"><addr-line>Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria</wicri:regionArea>
<wicri:noRegion>Victoria</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ozmen, Vahit" sort="Ozmen, Vahit" uniqKey="Ozmen V" first="Vahit" last="Ozmen">Vahit Ozmen</name>
<affiliation wicri:level="1"><nlm:aff id="aff033"><addr-line>Faculty of Medicine, Istanbul University, Istanbul, Turkey</addr-line>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Faculty of Medicine, Istanbul University, Istanbul</wicri:regionArea>
<wicri:noRegion>Istanbul</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Aribal, Mustafa Erkin" sort="Aribal, Mustafa Erkin" uniqKey="Aribal M" first="Mustafa Erkin" last="Aribal">Mustafa Erkin Aribal</name>
<affiliation wicri:level="1"><nlm:aff id="aff034"><addr-line>Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey</addr-line>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Department of Radiology, School of Medicine, Marmara University, Istanbul</wicri:regionArea>
<wicri:noRegion>Istanbul</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Schuz, Joachim" sort="Schuz, Joachim" uniqKey="Schuz J" first="Joachim" last="Schüz">Joachim Schüz</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Section of Environment and Radiation, International Agency for Research on Cancer, Lyon</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Lyon</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Van Gils, Carla H" sort="Van Gils, Carla H" uniqKey="Van Gils C" first="Carla H." last="Van Gils">Carla H. Van Gils</name>
<affiliation wicri:level="3"><nlm:aff id="aff035"><addr-line>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands</addr-line>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht</wicri:regionArea>
<placeName><settlement type="city">Utrecht</settlement>
<region nuts="2" type="province">Utrecht (province)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Wanders, Johanna O P" sort="Wanders, Johanna O P" uniqKey="Wanders J" first="Johanna O. P." last="Wanders">Johanna O. P. Wanders</name>
<affiliation wicri:level="3"><nlm:aff id="aff035"><addr-line>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands</addr-line>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht</wicri:regionArea>
<placeName><settlement type="city">Utrecht</settlement>
<region nuts="2" type="province">Utrecht (province)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Sirous, Reza" sort="Sirous, Reza" uniqKey="Sirous R" first="Reza" last="Sirous">Reza Sirous</name>
<affiliation wicri:level="1"><nlm:aff id="aff036"><addr-line>Isfahan University of Medical Sciences, Isfahan, Iran</addr-line>
</nlm:aff>
<country xml:lang="fr">Iran</country>
<wicri:regionArea>Isfahan University of Medical Sciences, Isfahan</wicri:regionArea>
<wicri:noRegion>Isfahan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Sirous, Mehri" sort="Sirous, Mehri" uniqKey="Sirous M" first="Mehri" last="Sirous">Mehri Sirous</name>
<affiliation wicri:level="1"><nlm:aff id="aff037"><addr-line>Radiology Department, Isfahan University of Medical Sciences, Isfahan, Iran</addr-line>
</nlm:aff>
<country xml:lang="fr">Iran</country>
<wicri:regionArea>Radiology Department, Isfahan University of Medical Sciences, Isfahan</wicri:regionArea>
<wicri:noRegion>Isfahan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hipwell, John" sort="Hipwell, John" uniqKey="Hipwell J" first="John" last="Hipwell">John Hipwell</name>
<affiliation wicri:level="4"><nlm:aff id="aff038"><addr-line>Centre for Medical Image Computing, University College London, London, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Medical Image Computing, University College London, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
<settlement type="city">Londres</settlement>
</placeName>
<orgName type="university">University College de Londres</orgName>
</affiliation>
</author>
<author><name sortKey="Kim, Jisun" sort="Kim, Jisun" uniqKey="Kim J" first="Jisun" last="Kim">Jisun Kim</name>
<affiliation wicri:level="3"><nlm:aff id="aff039"><addr-line>Asan Medical Center, Seoul, Republic of Korea</addr-line>
</nlm:aff>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>Asan Medical Center, Seoul</wicri:regionArea>
<placeName><settlement type="city">Séoul</settlement>
<region type="capital">Région capitale de Séoul</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lee, Jong Won" sort="Lee, Jong Won" uniqKey="Lee J" first="Jong Won" last="Lee">Jong Won Lee</name>
<affiliation wicri:level="3"><nlm:aff id="aff039"><addr-line>Asan Medical Center, Seoul, Republic of Korea</addr-line>
</nlm:aff>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>Asan Medical Center, Seoul</wicri:regionArea>
<placeName><settlement type="city">Séoul</settlement>
<region type="capital">Région capitale de Séoul</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Dickens, Caroline" sort="Dickens, Caroline" uniqKey="Dickens C" first="Caroline" last="Dickens">Caroline Dickens</name>
<affiliation wicri:level="4"><nlm:aff id="aff040"><addr-line>Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</addr-line>
</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea>
<orgName type="university">Université du Witwatersrand</orgName>
<placeName><settlement type="city">Johannesbourg</settlement>
<region type="region" nuts="2">Gauteng</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Hartman, Mikael" sort="Hartman, Mikael" uniqKey="Hartman M" first="Mikael" last="Hartman">Mikael Hartman</name>
<affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota</wicri:regionArea>
<placeName><region type="state">Minnesota</region>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff041"><addr-line>Department of Surgery, Yong Loo Lin School of Medicine, Singapore</addr-line>
</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Department of Surgery, Yong Loo Lin School of Medicine</wicri:regionArea>
<wicri:noRegion>Yong Loo Lin School of Medicine</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Chia, Kee Seng" sort="Chia, Kee Seng" uniqKey="Chia K" first="Kee-Seng" last="Chia">Kee-Seng Chia</name>
<affiliation wicri:level="4"><nlm:aff id="aff042"><addr-line>Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore</addr-line>
</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Graduate School for Integrative Sciences and Engineering, National University of Singapore</wicri:regionArea>
<orgName type="university">Université nationale de Singapour</orgName>
</affiliation>
</author>
<author><name sortKey="Scott, Christopher" sort="Scott, Christopher" uniqKey="Scott C" first="Christopher" last="Scott">Christopher Scott</name>
<affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota</wicri:regionArea>
<placeName><region type="state">Minnesota</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Chiarelli, Anna M" sort="Chiarelli, Anna M" uniqKey="Chiarelli A" first="Anna M." last="Chiarelli">Anna M. Chiarelli</name>
<affiliation wicri:level="1"><nlm:aff id="aff043"><addr-line>Ontario Breast Screening Program, Cancer Care Ontario, Toronto, Ontario, Canada</addr-line>
</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Ontario Breast Screening Program, Cancer Care Ontario, Toronto, Ontario</wicri:regionArea>
<wicri:noRegion>Ontario</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Linton, Linda" sort="Linton, Linda" uniqKey="Linton L" first="Linda" last="Linton">Linda Linton</name>
<affiliation wicri:level="1"><nlm:aff id="aff044"><addr-line>Princess Margaret Cancer Centre, Toronto, Ontario, Canada</addr-line>
</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Princess Margaret Cancer Centre, Toronto, Ontario</wicri:regionArea>
<wicri:noRegion>Ontario</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Pollan, Marina" sort="Pollan, Marina" uniqKey="Pollan M" first="Marina" last="Pollan">Marina Pollan</name>
<affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Instituto de Salud Carlos III, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Instituto de Salud Carlos III, Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>CIBERESP, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBERESP, Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Flugelman, Anath Arzee" sort="Flugelman, Anath Arzee" uniqKey="Flugelman A" first="Anath Arzee" last="Flugelman">Anath Arzee Flugelman</name>
<affiliation wicri:level="1"><nlm:aff id="aff045"><addr-line>National Cancer Control Center, Lady Davis Carmel Medical Center, Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel</addr-line>
</nlm:aff>
<country xml:lang="fr">Israël</country>
<wicri:regionArea>National Cancer Control Center, Lady Davis Carmel Medical Center, Faculty of Medicine, Technion–Israel Institute of Technology, Haifa</wicri:regionArea>
<wicri:noRegion>Haifa</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Salem, Dorria" sort="Salem, Dorria" uniqKey="Salem D" first="Dorria" last="Salem">Dorria Salem</name>
<affiliation wicri:level="1"><nlm:aff id="aff046"><addr-line>Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt</addr-line>
</nlm:aff>
<country xml:lang="fr">Égypte</country>
<wicri:regionArea>Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo</wicri:regionArea>
<wicri:noRegion>Cairo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kamal, Rasha" sort="Kamal, Rasha" uniqKey="Kamal R" first="Rasha" last="Kamal">Rasha Kamal</name>
<affiliation wicri:level="1"><nlm:aff id="aff046"><addr-line>Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt</addr-line>
</nlm:aff>
<country xml:lang="fr">Égypte</country>
<wicri:regionArea>Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo</wicri:regionArea>
<wicri:noRegion>Cairo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Boyd, Norman" sort="Boyd, Norman" uniqKey="Boyd N" first="Norman" last="Boyd">Norman Boyd</name>
<affiliation wicri:level="1"><nlm:aff id="aff044"><addr-line>Princess Margaret Cancer Centre, Toronto, Ontario, Canada</addr-line>
</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Princess Margaret Cancer Centre, Toronto, Ontario</wicri:regionArea>
<wicri:noRegion>Ontario</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Dos Santos Silva, Isabel" sort="Dos Santos Silva, Isabel" uniqKey="Dos Santos Silva I" first="Isabel" last="Dos-Santos-Silva">Isabel Dos-Santos-Silva</name>
<affiliation wicri:level="3"><nlm:aff id="aff047"><addr-line>Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Mccormack, Valerie" sort="Mccormack, Valerie" uniqKey="Mccormack V" first="Valerie" last="Mccormack">Valerie Mccormack</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Section of Environment and Radiation, International Agency for Research on Cancer, Lyon</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Lyon</settlement>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS Medicine</title>
<idno type="ISSN">1549-1277</idno>
<idno type="eISSN">1549-1676</idno>
<imprint><date when="2017">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Aging</term>
<term>Breast Density</term>
<term>Cross-Sectional Studies</term>
<term>Female</term>
<term>Humans</term>
<term>Middle Aged</term>
<term>Perimenopause</term>
<term>Postmenopause</term>
<term>Premenopause</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Densité mammaire</term>
<term>Femelle</term>
<term>Humains</term>
<term>Post-ménopause</term>
<term>Préménopause</term>
<term>Périménopause</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Vieillissement</term>
<term>Études transversales</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Aging</term>
<term>Breast Density</term>
<term>Cross-Sectional Studies</term>
<term>Female</term>
<term>Humans</term>
<term>Middle Aged</term>
<term>Perimenopause</term>
<term>Postmenopause</term>
<term>Premenopause</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Densité mammaire</term>
<term>Femelle</term>
<term>Humains</term>
<term>Post-ménopause</term>
<term>Préménopause</term>
<term>Périménopause</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Vieillissement</term>
<term>Études transversales</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known.</p>
</sec>
<sec id="sec002"><title>Methods and findings</title>
<p>We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35–85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of pooled data, adjusted for body mass index, reproductive factors, mammogram view, image type, and reader. In all, 4,534 women were premenopausal, and 6,481 postmenopausal, at the time of mammography. A large age-adjusted difference in percent MD (PD) between post- and premenopausal women was apparent (–0.46 cm [95% CI: −0.53, −0.39]) and appeared greater in women with lower breast cancer risk profiles; variation across population groups due to heterogeneity (<italic>I</italic>
<sup>2</sup>
) was 16.5%. Among premenopausal women, the √PD difference per 10-year increase in age was −0.24 cm (95% CI: −0.34, −0.14; <italic>I</italic>
<sup>2</sup>
= 30%), reflecting a compositional change (lower dense area and higher non-dense area, with no difference in breast area). In postmenopausal women, the corresponding difference in √PD (−0.38 cm [95% CI: −0.44, −0.33]; I<sup>2</sup>
= 30%) was additionally driven by increasing breast area. The study is limited by different mammography systems and its cross-sectional rather than longitudinal nature.</p>
</sec>
<sec id="sec003"><title>Conclusions</title>
<p>Declines in MD with increasing age are present premenopausally, continue postmenopausally, and are most pronounced over the menopausal transition. These effects were highly consistent across diverse groups of women worldwide, suggesting that they result from an intrinsic biological, likely hormonal, mechanism common to women. If cumulative breast density is a key determinant of breast cancer risk, younger ages may be the more critical periods for lifestyle modifications aimed at breast density and breast cancer risk reduction.</p>
</sec>
</div>
</front>
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<biblStruct><analytic><author><name sortKey="Dickens, C" uniqKey="Dickens C">C Dickens</name>
</author>
<author><name sortKey="Duarte, R" uniqKey="Duarte R">R Duarte</name>
</author>
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<author><name sortKey="Schuz, J" uniqKey="Schuz J">J Schuz</name>
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</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Gierach, Gl" uniqKey="Gierach G">GL Gierach</name>
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<author><name sortKey="Patel, Da" uniqKey="Patel D">DA Patel</name>
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<author><name sortKey="Papathomas, D" uniqKey="Papathomas D">D Papathomas</name>
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</analytic>
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<biblStruct><analytic><author><name sortKey="Pinto Pereira, Sm" uniqKey="Pinto Pereira S">SM Pinto Pereira</name>
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</biblStruct>
<biblStruct><analytic><author><name sortKey="Burger, Hg" uniqKey="Burger H">HG Burger</name>
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</analytic>
</biblStruct>
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</biblStruct>
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<li>Australie</li>
<li>Canada</li>
<li>Chili</li>
<li>Corée du Sud</li>
<li>Espagne</li>
<li>France</li>
<li>Iran</li>
<li>Israël</li>
<li>Japon</li>
<li>Kenya</li>
<li>Malaisie</li>
<li>Mexique</li>
<li>Norvège</li>
<li>Pays-Bas</li>
<li>Pologne</li>
<li>Royaume-Uni</li>
<li>République populaire de Chine</li>
<li>Singapour</li>
<li>Turquie</li>
<li>Égypte</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Auvergne-Rhône-Alpes</li>
<li>Californie</li>
<li>Communauté de Madrid</li>
<li>Gauteng</li>
<li>Grand Londres</li>
<li>Hawaï</li>
<li>Massachusetts</li>
<li>Minnesota</li>
<li>Préfecture de Gifu</li>
<li>Rhône-Alpes</li>
<li>Région capitale de Séoul</li>
<li>Région du Chūbu</li>
<li>Utrecht (province)</li>
<li>Victoria (État)</li>
<li>Østlandet</li>
</region>
<settlement><li>Gifu (ville)</li>
<li>Johannesbourg</li>
<li>Londres</li>
<li>Los Angeles</li>
<li>Lyon</li>
<li>Madrid</li>
<li>Melbourne</li>
<li>Oslo</li>
<li>Séoul</li>
<li>Utrecht</li>
</settlement>
<orgName><li>University College de Londres</li>
<li>Université de Californie du Sud</li>
<li>Université de Gifu</li>
<li>Université de Londres</li>
<li>Université de Melbourne</li>
<li>Université du Witwatersrand</li>
<li>Université nationale de Singapour</li>
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<name sortKey="Moss, Sue" sort="Moss, Sue" uniqKey="Moss S" first="Sue" last="Moss">Sue Moss</name>
</country>
<country name="Kenya"><noRegion><name sortKey="Ndumia, Rose" sort="Ndumia, Rose" uniqKey="Ndumia R" first="Rose" last="Ndumia">Rose Ndumia</name>
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<name sortKey="Teo, Soo Hwang" sort="Teo, Soo Hwang" uniqKey="Teo S" first="Soo-Hwang" last="Teo">Soo-Hwang Teo</name>
</country>
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</region>
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<name sortKey="Giles, Graham" sort="Giles, Graham" uniqKey="Giles G" first="Graham" last="Giles">Graham Giles</name>
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<name sortKey="Wanders, Johanna O P" sort="Wanders, Johanna O P" uniqKey="Wanders J" first="Johanna O. P." last="Wanders">Johanna O. P. Wanders</name>
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</region>
<name sortKey="Lee, Jong Won" sort="Lee, Jong Won" uniqKey="Lee J" first="Jong Won" last="Lee">Jong Won Lee</name>
</country>
<country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Dickens, Caroline" sort="Dickens, Caroline" uniqKey="Dickens C" first="Caroline" last="Dickens">Caroline Dickens</name>
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