Abstract
Current evidences state clear that both normal development of breast tissue as well as its malignant progression need many-sided local and systemic communications between epithelial cells and stromal components. During development, the stroma, through remarkably regulated contextual signals, affects the fate of the different mammary cells regarding their specification and differentiation. Likewise, the stroma can generate tumour environments that facilitate the neoplastic growth of the breast carcinoma. Mammographic density has been described as a risk factor in the development of breast cancer and is ascribed to modifications in the composition of breast tissue, including both stromal and glandular compartments. Thus, stroma composition can dramatically affect the progression of breast cancer but also its early detection since it is mainly responsible for the differences in mammographic density among individuals. This review highlights both the pathological and biological evidences for a pivotal role of the breast stroma in mammographic density, with particular emphasis on dense and malignant stromas, their clinical meaning and potential therapeutic implications for breast cancer patients.
Highlights
Breast cancer (BC), impacting over 2 million women each year, is the most common cancer occurring in women and constitutes the second most frequent cancer overall
In 2018, 627000 women died because of BC [1], the greatest number of cancer-related deaths in women. In this scenario, growing evidence suggests that the percentage of mammographic density (MD), a concept first described in the 1970s and obtained by weighing the proportion of high dense and low dense tissue, can be a risk factor for BC
The mammary gland constitutes a complex structure in which mammary epithelial cells are embedded in a stroma composed of different types of cells and an intricate extracellular matrix (ECM)
Summary
Breast cancer (BC), impacting over 2 million women each year, is the most common cancer occurring in women and constitutes the second most frequent cancer overall. The composition of the mammary gland experiences dramatic changes along the life of women (expansion and development during puberty, repetitive proliferation and apoptosis episodes during menstrual cycle, full development of alveoli during lactation) Because of this dynamic and flexible scenario, a significant feature of MD compared to other well-known risk factors is that it is modifiable and, as a consequence of this plasticity, the reduction of breast density would be a valuable strategy to prevent cancer onset. Homeostasis in this kind of dynamic tissues imposes a strict control between cell proliferation and cell death. Ensuring a correct organ homeostasis can help preventing neoplastic transformation [7]
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