To the Editor

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I want to congratulate Hanna et al1 for their article in which they investigated the association between expression levels of proinflammatory and anti-inflammatory markers in normal breast tissue with mammographic density among 163 breast cancer patients. They reported that women having higher expression of proinflammatory markers in their breasts had remarkably higher mammographic density (percent mammographic density) than those having lower expression of proinflammatory markers, particularly among premenopausal women. Sartor et al2 reported that higher mammographic density was associated with estrogen receptor-negative tumors including triple negative breast cancer (TNBC). All subtypes that are more aggressive than luminal A were significantly more frequent in younger (<45 years) rather than older women. Furthermore, TNBC was found to be associated with chronic inflammation in premenopausal women.3 Taken all together, premenopausal breast cancers showed more aggressive tumor subtypes such as TNBC and HER-2-positive tumors, which are associated with higher PMD and higher inflammatory markers. The authors did not mention any association between tumor subtypes and inflammatory markers and PMD, and we would be interested in learning whether there is one.

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