Abstract P4-04-14: High mammographic density is associated with deposition of organised fibrillar collagen and increased stiffness in periductal breast stroma
Authors: Gandhi Ashu , Kirwan Cliona C , McConnell James C , O'Connell Oliver V , Sherratt Michael J , Streuli Charles H 
Published: May 2015

Abstract
Introduction
High mammographic density (MD) in women is strongly associated with breast cancer risk. However the structural and compositional differences between dense and non-dense breast tissues are not well defined. We determined the relationship between MD, collagen deposition and fibril alignment, and tissue micro-stiffness, in similarly aged individuals without adjacent cancer.
Methods
Fresh tissue samples were collected from post-menopausal women undergoing breast screening. Collagen deposition and fibril organisation were analysed using light microscopy of wax-sections stained with H&E, Trichrome or Picrosirius Red (with polarising light), and quantified using ImageJ. Local tissue stiffness was measured using atomic force microscopy (AFM) of hydrated tissue. For AFM, 3 x 25 µm2 areas of each sample were indented at 400 equally spaced points with a 1 µm diameter spherical probe at a loading rate of 1 Hz (Reduced Modulus; YM).
Results
Volumetric MD (VolparaTM) was determined in 22 women (54-66y) undergoing risk-reducing surgery or mastectomy. Localised regions of elevated density, determined from digital mammograms, were isolated from patients of low and high overall MD, using a new collaborative workflow linking radiologist, surgeon, pathologist, and tissue biobank.
All elevated-density regions contained considerable amounts of stromal connective tissue. However, there were significant differences in these regions from women with low vs high overall MD. Picrosirius Red staining of the localised areas of density revealed that the percentage organised fibrillar collagen content, particularly in the periductal breast stroma, strongly correlated with overall MD.
AFM showed that the localised micro-stiffness of dense areas increased significantly in the breast stroma of patients with high overall MD (Volpara score &gt; 15) compared with those of low overall MD (Volpara score &lt; 5).
Conclusions
High MD is a significant risk factor for breast cancer, yet its molecular determinants in the normal, non-cancerous breast are poorly defined. We have shown that high MD is associated with more organised fibrillar collagen, leading to increased stiffness of the periductal breast stroma. Women with low and high MD all have regions with localised density, which contain both stromal connective tissue and epithelial ducts/lobules. However, our results show that these localised areas have differences in collagen organisation and tissue micro-mechanics. We now hypothesise that in the connective tissue of women with high MD, altered synthesis, deposition and turnover of stromal proteins alters the local biomechanical properties within the breast, providing a stiffer microenvironment, and contributing to cancer onset.
Citation Format: Ashu Gandhi, Cliona C Kirwan, James C McConnell, Oliver V O'Connell, Michael J Sherratt, Charles H Streuli. High mammographic density is associated with deposition of organised fibrillar collagen and increased stiffness in periductal breast stroma [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-04-14.