Development of a Sampling Strategy and Sample Size Calculation to Estimate the Distribution of Mammographic Breast Density in Korean Women

Jae Kwan Jun,Mina Suh,Kyu-Won Jung,Mi Jin Kim,Kui Son Choi

doi:10.7314/apjcp.2012.13.9.4661

Jae Kwan Jun, Mina Suh + Show 3 more

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https://doi.org/10.7314/apjcp.2012.13.9.4661

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Abstract

Mammographic breast density is a known risk factor for breast cancer. To conduct a survey to estimate the distribution of mammographic breast density in Korean women, appropriate sampling strategies for representative and efficient sampling design were evaluated through simulation. Using the target population from the National Cancer Screening Programme (NCSP) for breast cancer in 2009, we verified the distribution estimate by repeating the simulation 1,000 times using stratified random sampling to investigate the distribution of breast density of 1,340,362 women. According to the simulation results, using a sampling design stratifying the nation into three groups (metropolitan, urban, and rural), with a total sample size of 4,000, we estimated the distribution of breast density in Korean women at a level of 0.01% tolerance. Based on the results of our study, a nationwide survey for estimating the distribution of mammographic breast density among Korean women can be conducted efficiently.

Highlights

Human mammary gland tissue has 15–20 lobes, each with 20–40 lobules that form the anatomical and functional units of breast tissue
Using the target population from the National Cancer Screening Programme (NCSP) for breast cancer in 2009, we verified the distribution estimate by repeating the simulation 1,000 times using stratified random sampling to investigate the distribution of breast density of 1,340,362 women
Values estimated according to American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) categories were 30.59% (95% predicted interval (PI) 29.14–32.04), 27.49% (95% PI 26.14–28.84), 27.89% (95% PI 26.56–29.22), and 14.03% (95% PI 12.95–15.11), respectively

Summary

Introduction

Human mammary gland tissue has 15–20 lobes, each with 20–40 lobules that form the anatomical and functional units of breast tissue. The lobules in turn, contain 10–100 acini, the secretory structures of the breast. The lobules are surrounded by stroma and fat, which varies in amount based on age and lactational status (Ghosh et al, 2010). The radiographic appearance of the breast on mammography varies among women, reflecting variations in breast tissue composition. Fat is radiologically lucent and appears dark on a mammogram, whereas fibroglandular tissue, stroma, and epithelium are radiologically dense and appear light. The proportion of the breast that comprises fibroglandular tissue, stroma, and epithelium is usually expressed as the mammographic breast density (Boyd et al, 2010)

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