Clinical determinants of mammographic dysplasia patterns

The association between the clinical manifestations of benign breast disease (BBD) and mammographic patterns was investigated among 1394 women (923 pre-menopausal and 471 post-menopausal) participating to the Canadian National Breast Screening Study in Vancouver, who completed a questionnaire designed to collect detailed information on the symptoms and signs of BBD, hormonal, reproductive and dietary factors. Mastalgia was present in 637 (46%) women and was cyclical in 505 (79%). Breast swelling was noted in 331 women (23%) and mammary dysplasia involving 50% or more of the breast parenchyma in 733 (43%). Mastalgia was highly associated with breast swelling (odds ratios [OR] = 29.9, 95% confidence interval [CI] = 21.3-41.8), particularly when cyclical and characterized by tenderness with pain (OR = 58.4, 95% CI = 39.1-87.0). The relative risk for mammary dysplasia involving 50% or over of the breast parenchyma was significant in pre-menopausal women having breast swelling (OR = 2.96, 95% CI = 1.81-4.83), being highest in women with cyclical mastalgia associated with tenderness and pain (OR = 3.43, 95% CI = 1.49-7.92); similar associations were noted in post-menopausal women. This study indicates that mastalgia is strongly related to breast swelling, especially when tenderness is associated with pain. Furthermore, mastalgia associated with breast swelling is highly related to the presence of mammary dysplasia involving 50% or more of the breast parenchyma in both pre- and post-menopausal women, suggesting that cyclical tenderness and breast swelling may carry an increased breast cancer risk.