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Perez-Gomez B.,Institute Salud Carlos III | Perez-Gomez B.,CIBER ISCIII | Ruiz F.,Breast Cancer Screening Programme | Martinez I.,Breast Cancer Screening Programme | And 10 more authors.
Breast Cancer Research and Treatment | Year: 2012

Measurement of mammographic density (MD), one of the leading risk factors for breast cancer, still relies on subjective assessment. However, the consistency of MD measurement in full-digital mammograms has yet to be evaluated. We studied inter- and intra-rater agreement with respect to estimation of breast density in full-digital mammograms, and tested whether any of the women's characteristics might have some influence on them. After an initial training period, three experienced radiologists estimated MD using Boyd scale in a left breast cranio-caudal mammogram of 1,431 women, recruited at three Spanish screening centres. A subgroup of 50 randomly selected images was read twice to estimate short-term intra-rater agreement. In addition, a reading of 1,428 of the images, performed 2 years before by one rater, was used to estimate long-term intra-rater agreement. Pair-wise weighted kappas with 95% bootstrap confidence intervals were calculated. Dichotomous variables were defined to identify mammograms in which any rater disagreed with other raters or with his/her own assessment, respectively. The association between disagreement and women's characteristics was tested using multivariate mixed logistic models, including centre as a random-effects term, and taking into account repeated measures when required. All quadratic-weighted kappa values for inter- and intra-rater agreement were excellent (higher than 0.80). None of the studied women's features, i.e. body mass index, brassiere size, menopause, nulliparity, lactation or current hormonal therapy, was associated with higher risk of inter- or intra-rater disagreement. However, raters differed significantly more in images that were classified in the higher-density MD categories, and disagreement in intra-rater assessment was also lower in low-density mammograms. The reliability of MD assessment in full-field digital mammograms is comparable to that for original or digitised images. The reassuring lack of association between subjects' MD-related characteristics and agreement suggests that bias from this source is unlikely. © 2011 Springer Science+Business Media, LLC. Source

Isidoro B.,Carlos III Institute of Health | Isidoro B.,Puerta Of Hierro Majadahonda University Teaching Hospital | Lope V.,Carlos III Institute of Health | Lope V.,Consortium for Biomedical Research in Epidemiology and Public Health | And 11 more authors.
BMC Public Health | Year: 2011

Background: Measurement of obesity using self-reported anthropometric data usually involves underestimation of weight and/or overestimation of height. The dual aim of this study was, first, to ascertain and assess the validity of new cut-off points, for both overweight and obesity, using self-reported Body Mass Index furnished by women participants in breast cancer screening programmes, and second, to estimate and validate a predictive model that allows recalculate individual BMI based on self-reported data. Methods. The study covered 2927 women enrolled at 7 breast cancer screening centres. At each centre, women were randomly selected in 2 samples, in a ratio of 2:1. The larger sample (n = 1951) was used to compare the values of measured and self-reported weight and height, to ascertain new overweight and obesity cut-off points with self-reported data, using ROC curves, and to estimate a predictive model of real BMI using a regression model. The second sample (n = 976) was used to validate the proposed cut-off points and the predictive model. Results: Whereas reported prevalence of obesity was 19.8%, measured prevalence was 28.2%. The sensitivity and specificity of this classification would be maximised if the new cut-off points were 24.30 kg/m2 for overweight and 28.39 kg/m2 for obesity. The probability of classifying women correctly in their real weight categories on the basis of these points was 82.5% in the validation sample. Sensitivity and specificity for determining obesity using the new cut-off point in the validation sample were 90.0% and 92.3% respectively. The predictive model for real BMI included the self-reported BMI, age and educational level (university studies vs lower levels of education). This model succeeded in correctly classifying 90.5% of women according to BMI categories, but its performance was similar to that obtained with the new cut-off points. Conclusions: Quantification of self-reported obesity entails a considerable underestimation of this problem, thereby questioning its validity. The new cut-off points established in this study and the predictive equation both allow for more accurate estimation of these prevalences. © 2011 Isidoro et al; licensee BioMed Central Ltd. Source

Fernandez-Navarro P.,Carlos III Institute of Health | Fernandez-Navarro P.,Consortium for Biomedical Research in Epidemiology and Public Health | Pita G.,Human Genotyping Unit CeGen | Santamarina C.,Galicia Breast Cancer Screening Programme | And 14 more authors.
European Journal of Cancer | Year: 2013

Background: Mammographic density (MD) is regarded as an intermediate phenotype in breast cancer development. This association study investigated the influence of 14 breast cancer susceptibility loci identified through previous genome-wide association studies on MD among the participants in the "Determinants of Density in Mammographies in Spain" (DDM-Spain) study. Methods: Our study covered a total of 3348 Caucasian women aged 45-68 years, recruited from seven Spanish breast cancer screening centres having DNA available. Mammographic density was blindly assessed by a single reader using a semiquantitative scale. Ordinal logistic models, adjusted for age, body mass index and menopausal status, were used to estimate the association between each genotype and MD. Results: Evidence of association with MD was found for variant rs3803662 (TOX3) (Odds Ratio (OR) = 1.13, 95% Confidence Interval (CI) = 1.03-1.25), and marginal evidence of association for susceptibility loci rs3817198 (LSP1) (OR = 1.09, 95% CI = 1.00-1.20) and rs2981582 (FGFR2) (OR = 0.92, 95% CI = 0.84-1.01). Two other loci were associated with MD solely among pre-menopausal women, namely, rs4973768 (SLC4A7) (OR = 0.83, 95% CI = 0.70-1.00) and rs4415084 (MEPS30) (OR = 1.22, 95% CI = 1.00-1.49). Conclusions: Our findings lend some support to the hypothesis which links these susceptibility loci to MD. © 2012 Elsevier Ltd. All rights reserved. Source

Peiro-Perez R.,Cancer and Public Health Area | Peiro-Perez R.,CIBER ISCIII | Salas D.,Cancer and Public Health Area | Valles G.,Cancer and Public Health Area | And 17 more authors.
European Journal of Public Health | Year: 2015

Background: The aim is to analyse physical activity (PA), the fulfilment recommendation of at least 150 min of moderate PA, through walking/biking (W&B), sport, both types of PA and the factors associated with inactivity by Spanish women who attended breast cancer screening programmes. Methods: The DDM-Spain is a multicentre cross-sectional study involving 3584 women, aged 45-68, attending screening in seven Spanish cities. Data were collected using a questionnaire, including age, socio-demographic and lifestyle characteristics, family burden and PA. PA was converted into metabolic equivalent of task (METs), categorized as low ≤600 METs min per week (m/w), moderate 600-3000 METs m/w and high ≥3000 METs m/w. A multivariate logistic regression was performed to identify variables associated with inactivity for each type of PA. Results: No women achieved a high level of PA through sport. 79.2% achieved a high or moderate level of PA by W&B. Lack of sport was associated with being overweight (odds ratio OR = 1.31; 95% confidence interval CI: 1.06 to 1.62), body mass index (BMI) ≥30 (OR = 1.85; 95% CI: 1.44 to 2.38), smoking (OR = 1.56; 95% CI: 1.22 to 2.00) and living with a disabled person (OR = 1.64; 95% CI: 1.0 to 2.81), whereas enough sport practice was associated with higher educational or socio-economic level (SEL). Regarding W&B, inactivity was associated with BMI ≥ 30 (OR = 1.91; 95% CI: 1.49 to 2.45) and living with someone >74 (OR = 1.96; 95% CI: 1.48 to 2.58). Inactivity for both types of exercise was associated with a BMI ≥30 (OR = 2.13; 95% CI: 1.63 to 2.8), smoking (OR = 1.41; 95% CI: 1.09 to 1.81) and living with someone >74 (OR = 1.69; 95% CI: 1.24 to 2.28). Conclusions: Family burden and BMI ≥30 are inversely associated with both types of PA. W&B is the most common type of PA regardless of educational and SEL. © 2015 The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. Source

Isidoro B.,Institute Salud Carlos III | Lope V.,Institute Salud Carlos III | Lope V.,CIBER ISCIII | Lope V.,Cancer Epidemiology Research Group | And 17 more authors.
Menopause | Year: 2016

Objective: The use of some forms of hormone therapy (HT) is associated with an increase in mammographic density-a major risk factor for breast cancer. The role of isoflavones, however, is unclear. Here, we quantify the prevalence of HT and isoflavone use among postmenopausal Spanish women, determine associated risk factors, and explore the relationship between these therapies and mammographic density. Methods: This cross-sectional study included 2,754 postmenopausal women who underwent breast cancer screening in seven geographical areas. Mammographic density was evaluated using Boyd's semiquantitative scale. Multinomial logistic regression models were adjusted to assess risk factors associated with both therapies. Ordinal regression models were fitted to study the association between HT and isoflavone consumption with mammographic density. Results: The prevalence of ever-use of HT was 12%, whereas that of the current use was 2.3%. Isoflavone lifetime prevalence was 3.7%, and current use was 1.7%. The most common HT types were tibolone and estrogens. Surgical menopause, oral contraceptive use, educational level, population density, and years since menopause were positively associated with HT, whereas body mass index and parity were inversely associated. Mammographic density was not associated with current or past HT use. However, women who reported having consumed isoflavones in the past and those who started their use after menopause had a higher mammographic density when compared with never-users (odds ratio 1.98, 95% CI 1.21-3.25, P0.007; and odds ratio 1.60, 95% CI 1.01- 2.53, P0.045 respectively). Conclusions: Our results show a low prevalence of HT and isoflavone use in postmenopausal Spanish women. In this population, HT use was not associated with mammographic density, whereas some categories of isoflavone users had higher density. © 2016 by The North American Menopause Society. Source

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