Cancer research at the London Breast Institute

Breast density research at London Breast Institute

Vast amounts of clinical data are gathered at the Princess Grace Hospital as we care for our patients. That data includes more than 40,000 digital mammograms and the clinical records of hundreds of women diagnosed with breast cancer, many from younger age groups. Breast cancer rates are known to be increasing among younger women. By analysing this data, we further the knowledge of diagnosing and treating breast disease.


In 2007, the London Breast Institute undertook its first research project, investigating a sample of digital mammograms of women living or working in an urban environment (London). The objective of this research was to determine whether these women are more likely to have denser breast tissue than more rural based women. Following its launch at the Radiological Society of North America’s annual conference, worldwide media exposure reached more than 300 million people.

Breast tissue in women may be fatty, glandular or a mix of both. Those with more glandular breasts show denser tissue on a mammogram. X-rays of fatty breast tissue (left image) and X-ray of dense breast tissue (right image)
The more dense the tissue, the more difficult it is to identify abnormalities on traditional mammogram x-rays, making it essential to use digital mammography to reveal potential breast cancers at the earliest stages of development.

It is commonly known that denser breast tissue is the most likely to develop breast cancer.

Findings

Women who live or work in the City and central London were found to have denser, more glandular breasts than their non-urban counterparts. Reasons for these findings are uncertain but may include factors such as stress, pollution and lifestyle.

The study found that women:

  • living in most highly populated areas in the UK have denser breast tissue
  • working and/or living in the Square Mile of central London, had the densest breasts of the study population
  • under 50 years old accounted for no less than 40 per cent of all the cancers diagnosed at the London Breast Institute.
This graph shows the percentage of study population showing greater than 25 per cent density present. These results indicate, for the first time, that women living and working in an urban environment have a higher risk of more dense breast tissue.

Papers published by the London Breast Institute

  1.  Perry, N M. Wickham, J E A. Whitfield, H N. 
    Hypothermic Nephrolithotomy in Solitary Kidneys
    British Journal of Urology
    1980: 52 : 415-418
  2. Hendry, W F. Manning, N. Perry N M. Whitfield, H N. Wickham, J E A.
    The effects of hæmaturia Service on the early diagnosis of Bladder Cancer (1981)
    In Bladder Cancer pp 19-25. Butterworth & Company
  3. Perry, N M. Webb, J A W, White. F E and Whitfield, H N.
    Hæmorrhagic Angiomyolipoma of the Kidney
    The Journal of Urology
    1984; 132 : 749-751
  4. Perry, N M. Irfan, A Y. Thomas, J M. Simmons, S. Rees R S O.
    Heart size in high Kv Chest Radiography
    Clinical Radiology
    1985; 36 : 335-339
  5. Dacie, J E. Perry N M.
    Surgery Quiz
    Familiar Adenomatous Polyposis
    1985; Surgery (1) 23, 574a
  6. Dacie, J E. Perry N M.
    Surgery Quiz
    Percutaneous transphepatic cholangiography in Carcinoma of the Pancreas
    1985; Surgery (1) 25,603a.
  7. Large, S R. Perry, N M. Reznek, R H. Young, C P. McLean, A. Hurt, R. Rees, G M. Edmondson, S J.
    The role of Computed Tomography (CT) in staging bronchogenic cancer
    Thorax,1987. 42,207
  8. Perry, N M. Tucker, A K.
    Pre-operative localisation of Occult Breast Lesions
    1987. Radiology Now, 4,4,35-37.
  9. Ng, Y Y. Perry, N M. Kingston, J E. Reznek, R H.
    CT of Rhabdomyosarcoma of the Head and Neck in Children (abstract)
    Clinical Radiology 1988. 39, 676.
  10. Ng ,Y Y. Perry, N M. Kingston, J E. Reznek, R H.
    The role of computerized tomographic scanning in the management of Rhabdomysarcoma in non-orbital head and neck sites
    Pædiatric Hæmatology and Oncology 1990. 7, 141-149.
  11. Perry, N M. Kearns, W E.
    Breast Screening (letter)
    British Medical Journal 1990 300, 332
  12. Perry, N M.
    Quality Assurance in the National Breast Screening Programme
    British Journal of Radiology 1991. 64, 475-476.
  13. Perry, N M.
    Targeting Breast Cancer and getting results
    Siemens review 2/93. 60, 12-16.
  14. Perry, N M. Law, P J. Kearns, W E.
    Mammography in Hospital Patients: Use and Misuse
    Journal of the Royal College of Surgeons of Edinburgh. 1992 37,349
  15. Burnett, S J D. Ng, Y Y. Perry, N M. Wells, C A.
    Benign Biopsies in the Prevalent Round of Breast Screening : A retrospective analysis
    Clinical Radiology, 1993 350.
  16. Wells, C A. Curling, O M. Perry, N M. Ng, Y Y. Nockler, I B N. Gilmore, O J. Allum, W H. Carpenter, R.
    Fine Needle Aspiration of breast lesions in Breast Cancer Screening – Benefits of full Quality Control
    Journal of Pathology. (abstract) 1994
  17. Makanura, C N. Curling, O M. Yeomans, P. Perry, N M. Wells, C A.
    Apocrine Adenosis within a Radial Scar – a case of false positive breast cytological diagnosis
    Cyto-Pathology. 1994. 5,2, 123-128
  18. Morrison, I D. Wells, C A. Carpenter, R. Perry, N M.
    Radial Scars associated with a high incidence of carcinoma and atypical hyperplasia
    British Journal of Radiology 1994. 67, 159
  19. Azavedo, E. Cataliotti, L. Ciatto, S. Perry, N M. Svane, G. Vielh, P.
    European Society of Mastology Study Group on detection and diagnosis
    Proceedings of the EUSOMA Seminar on non-palpable breast lesions. Florence, 18th June 1993. Recommendations for the management of non-palpable lesions detected by mammography.
    The Breast 1994. 3, 241-245
  20. De Waard, F. Kirkpatrick, A. Perry, N M. Tornberg, S. Tubiana, M. de Wolf, C.
    Breast Cancer Screening in the Framework of the Europe Against Cancer Programme
    European Journal of Cancer Prevention 1994. Vol 3, Supp 1, 3-5
  21. Burnett, S J D. Ng, Y Y. Perry, N M. Makunura, C. Yeomans, P. McGregor, I L. Carpenter, R. Wells, C A.
    Benign biopsies in the prevalent round of breast screening: A review of 137 cases
    Clinical Radiology 1995. 50, 254-258.
  22. Gui, G P H. Wells, C A. Perry, N M. Makunura, C. Yeomans, P. McGregor, I L. Carpenter, R.
    What do markers of tumour biology measure?
    British Journal Surg (abstract) 1994. 81, 796.
  23. Gui, G P H. Perry, N M. Wells, C A. Curling, O M. Allum, W H. McLean, A. Oommen, R. Denton, S. Sullivan, M. Carpenter, R.
    Immediate diagnosis for symptomatic breast disease
    European Journal Surgical Oncology (abstract) 1994 20, 100
  24. Gui, G P H. Allum, W H. Perry, N M. Wells, C A. Curling, O M. McLean, A. Oommen, R. Sullivan, M. Denton, S. Carpenter, R.
    Clinical Audit of a specialist symptomatic breast clinic
    Journal Royal Society Medicine 1995. 88, 330-333
  25. Gui, G P H. Allum, W H. Perry, N M. Wells, C A. et al
    One stop diagnosis for symptomatic breast disease
    Annals of the Royal College of Surgeons of England 1995 77, 24-27
  26. Taylor, D H. McPherson, K. Parbhoo, S. Perry N M.
    Response of women aged 65 – 74 to invitation for screening for breast cancer by mammography : A Pilot study in London, UK
    Journal of Epidemiology and Community Health 1996. 50, 77-80.
  27. Perry, N M.
    The quality and equality of breast care
    Women’s Health – Volume 2 – Number 2 May 1997.
  28. Perry, N M.
    Quality Assurance in the UK NHSBSP
    Rad magazine 1997.
  29. Hine Dame, D. Perry, N M. Donaldson, L. Pritchard, J.
    QA Working Party report
    Department of Health EL (97) 67.
  30. MG Berry, Shirley Y Y Chan, Alex Engledow, Eno R, Inwang, Nicholas M Perry, Clive A Wells, O Marigold Curling, Alison McLean, Sarah Vinnicombe, Margaret Sullivan and Robert Carpenter.
    An Audit of patient acceptance of one-stop diagnosis for symptomatic breast disease
    European Journal of Surgical Oncology 1998: 24: 492 – 495.
  31. Perry, N M.
    Performance Issues in Detection and Diagnosis (Abstract)
    European Journal of Cancer Vol 34 Supplement 5 S68. 1998.
  32. Perry, N M.
    An update on European Studies and Programmes
    Proceedings of the 5th International Cambridge Conference on Breast Cancer Screening 1997 (Marie Curie Cancer Care).
  33. Hussain, H K. Ng, Y Y. Wells, C A. Courts, M. Nockler, I B. Curling, O M. Carpenter, R. Perry, N M.
    The significance of new densities and microcalcification in the second round of breast screening
    Clinical Radiology (1999) 54, 243 – 247.
  34. Lamb, P. Perry, N M. Vinnicombe, S. Wells, C.
    Correlation Between Ultrasound Characteristics, Mammographic Findings and Histological Grade in Patients with Invasive Ductal Carcinoma of the Breast
    Clinical Radiology 2000 55,40-44.
  35. Lamb, P. Perry, N M. Mulele, C.
    Waldenstrom’s Macroglobulinaemia of the breast detected by colour Doppler ultrasound
    British Journal of Radiology – 72, 82 – 84. 1999.
  36. Mokbel, K. Price, R K. Mostafa, A. Williams, N. Wells, C A. Perry, N M. Carpenter, R.
    Radial Scar and Carcinoma of The Breast: Microscopic Findings in 32 Cases
    The Breast 1999 8. 339 – 342.
  37. Chan, S. Berry, M G. Engledow, A. Perry, N M. Wells, C. Carpenter, R.
    Audit of a One-Stop Breast Clinic Revisited
    Breast Cancer 7: 191-194 (2000).
  38. Perry, N M. on behalf of the EUSOMA Working Party
    Quality Assurance in the Diagnosis of Breast Disease
    European Journal of Cancer 37. 159 – 172 (2001).
  39. Blamey, R W. Blichert-Toft, M. Cataliotti, L. Costa, A. Greco, H. Holland, R. Kaufmann, M. Perry, N M. et al.
    The Requirements of a Specialist Breast Unit
    EUSOMA – Position Paper
    European Journal of Cancer; 36 (2000); 2288-2293.
  40. O’Sullivan, I. Sutton, S. Dixon, S. Perry, N.
    False positive results do not have a negative effect on reattendance for subsequent breast screening
    Journal of Medical Screening 2001 8: 145-148.
  41. Warren Burhenne, L J. Smith, R A. Tabar, L. Dean, P D. Perry, N M. Sickles, E A.
    Mammographic Screening: International Perspective
    Seminars in Roentgenology, Vol XXXVI, No 3 (July) 2001, pp 187-194.
  42. Bartella, L. Perry, N. Young, K. Lawinski, C.
    Low spatial resolution is no disadvantage to assessment of Microcalcifications
    European Journal of Cancer, Vol 38 Supplement 3; S140 (378.)
  43. Athow, A C. Gattuso, J M. Perry, N M. Wells, C. Dutt, N. Bashir, C M. Mair, G. Carpenter, R.
    Is Radiotherapy Needed After Breast Conservation For Small Invasive Breast Cancers?
    European Journal of Surgical Oncology, 2002, 28:379 – 382.
  44. Kessar, P. Perry, N M. Vinnicombe, S J. Hussain, H K. Carpenter, R. Wells, C A.
    How Significant is Detection of Ductal Carcinoma In Situ in a Breast Screening Programme ?
    Clinical Radiology 2002, 57:807-814.
  45. Bartella, L. Kaye, J. Perry, N M. Malhotra, A. Evans, D. Ryan, D. Wells, C. Vinnicombe, S J.
    Metastases to the Breast Revisited: Radiological - Histopathological Correlation
    Clinical Radiology 2003. 58: 524-531.
  46. McCormack, V A. dos Santos Silva, I. De Stavola, B L. Perry, N. Vinnicombe, S. Swerdlow, A J. et al.
    Life-course body size and perimenopausal mammographic parenchymal patterns in the MRC 1946 British birth cohort
    Br J Cancer 2003; 852-9.
  47. Perry, N M.
    Interpretive Skills in the National Health Service Breast Screening Programme: Performance Indicators and Remedial Measures
    Seminars in Breast Disease 2003 (published 2004) Volume 6, no. 3; 108-113
  48. Perry, N M.
    Breast Cancer Screening – The European Experience
    International Journal of Fertility. 2004. 49 (5).
  49. Riza, E. dos Santos Silva, I. De Stavola, B. Perry, N M. et al.
    Correlates of high - density mammographic parenchymal patterns by menopausal status in a rural population in Northern Greece
    European Journal of Cancer 41 (2005) 590 - 600.
  50. Perry, N M. Allgood, P C. Milner, S E. Mokbel, K. Duffy, S W.
    Mammographic Breast Density by area of Residence: possible evidence of higher density in urban areas
    Current Medical Research and Opinion 24 (2008) 365-368.
  51. Perry, N M. Broeders, M. de Wolf, C. Tornberg, S. Holland, R. Von Karsa, L.
    European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. Fourth Edition Summary Document
    Annals of Oncology 19 (2008) 614-622.
  52. McCormack, V. Perry, N M. et al
    Ethnic Variations in Mammographic Density: A British Multi-Ethnic Longitudinal Study
    American Journal of Epidemiology. 168, 412-421.2008.
  53. Vinnicombe, S. Pinto Pereira, S. McCormack, V. Shiel, S. Perry, N M. dos Santos Silva, I.
    Full Field Digital versus Screen Film Mammography: Comparison within the UK Breast Screening Programme and Systematic review of Published Data
    Radiology 251. 347-358. 2009.
  54. Pinker, K. Perry, N M.
    Conspicuity of Breast Cancer according to histopathological type and breast density when imaged by Full Field Digital Mammography compared with Screen Film Mamography
    European Radiology. 2010.
  55. Reefy, S. Osman, H. Perry, N. Mokbel, K.
    Surgical Excision for B3 Breast lesions diagnosed by Vacuum-assisted Core Biopsy
    Anticancer Res. 2010 Jun; 30 (6):2287-90.
  56. Perry, N M. Patani, N. Milner, S E. Mokbel, K. Allgood, P C. Duffy, S W.
    The Impact of Digital Mammography on Screening a Young Cohort of Women for Breast Cancer in an Urban Specialist Breast Unit
    European Radiology 2011, 21,4, 676-682

View more than 280 papers published by Prof K Mokbel and Dr N Perry of the London Breast Institute on PubMed. It comprises more than 29 million citations for biomedical literature from MEDLINE, life science journals, and online books.

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