High Levels of Microplastics in the Arctic Sea Ice Alga Melosira arctica, a Vector to Ice-Associated and Benthic Food Webs.

Plastic pollution has become ubiquitous with very high quantities detected even in ecosystems as remote as Arctic sea ice and deep-sea sediments. Ice algae growing underneath sea ice are released upon melting and can form fast-sinking aggregates. In this pilot study, we sampled and analyzed the ice algaeMelosira arcticaand ambient sea water from three locations in the Fram Strait to assess their microplastic content and potential as a temporary sink and pathway to the deep seafloor. Analysis by µ-Raman and fluorescence microscopy detected microplastics (≥2.2 µm) in all samples at concentrations ranging from 1.3 to 5.7 × 104 microplastics (MP) m-3 in ice algae and from 1.4 to 4.5 × 103 MP m-3 in sea water, indicating magnitude higher concentrations in algae. On average, 94% of the total microplastic particles were identified as 10 µm or smaller in size and comprised 16 polymer types without a clear dominance. The high concentrations of microplastics found in our pilot study suggest thatM. arctica could trap microplastics from melting ice and ambient sea water. The algae appear to be a temporary sink and could act as a key vector to food webs near the sea surface and on the deep seafloor, to which its fast-sinking aggregates could facilitate an important mechanism of transport.

Microplastic accumulation in endorheic river basins - The example of the Okavango Panhandle (Botswana).

The Okavango Panhandle is the main influent watercourse of the Okavango Delta, an inland sink of the entire sediment load of the Cubango-Okavango River Basin (CORB). The sources of pollution in the CORB, and other endorheic basins, are largely understudied when compared to exorheic systems and the world's oceans. We present the first study of the distribution of microplastic (MP) pollution in surface sediments of the Okavango Panhandle in Northern Botswana. MP concentrations (64 µm-5 mm size range) in sediment samples from the Panhandle range between 56.7 and 399.5 particles kg-1 (dry weight) when analysed with fluorescence microscopy. The concentrations of MP in the 20 µm to 5 mm grain size range (analysed with Raman spectroscopy) range between 1075.7 and 1756.3 particles kg-1. One shallow core (15 cm long) from an oxbow lake suggests that MP size decreases with depth while MP concentration increases downcore. Raman Spectroscopy revealed that the compositions of the MP are dominated by polyethene terephthalate (PET), polypropylene (PP), polyethene (PE), polystyrene (PS), and polyvinyl chloride (PVC). From this novel data set it was possible to estimate that 10.9-336.2 billion particles could be transported into the Okavango Delta annually, indicating that the region represents a significant sink for MP, raising concerns for the unique wetland ecosystem.

Remote consultations: experiences of UK patients with prostate cancer during the COVID-19 pandemic.

Aim: Explore UK prostate cancer patients' experiences and preferences for in-person and remote consultations. Materials & methods: In January-March 2021, patients completed a survey of consultation format preferences. Results: Of 971 patients, most preferred in-person consultations when receiving diagnosis and results (92.3 and 66.5%, respectively) and discussing first and further treatment options (92.0 and 84.0%, respectively). Fewer patients considered follow-up (40.9%) or side effect consultations (47.7%) should be in person. Patients with longer travel preferred telephone consultations for receiving test results post-treatment. Patients over 55 preferred in-person consultations for discussing first treatment. Conclusion: To optimize prostate cancer care in the wake of COVID-19, we recommend patients have the option of consultation format, although key decisions should be made in person.

During the COVID-19 pandemic, there was a move away from in-person to remote consultations for patients with prostate cancer. However, it is not clear if remote consultations work well for every interaction. We surveyed UK-based men with prostate cancer about their preferences for consultation format. Patients wanted in-person consultations when receiving their diagnosis, discussing treatment options or getting test results after treatment. They were more accepting of remote consultations for regular follow-up or support with treatment side effects. Patients should ideally be offered a choice between in-person and remote consultations, although consultations should be in person when key decisions have to be made. These findings will be of value in planning care for patients with prostate cancer post pandemic.

The association of age at menarche and adult height with mammographic density in the International Consortium of Mammographic Density.

BACKGROUND: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk. METHODS: Participants were 10,681 breast-cancer-free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemiologic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi-level linear regression models estimated changes in square-root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult height in pooled analyses and population-specific meta-analyses. Models were adjusted for age at mammogram, body mass index, menopausal status, hormone therapy use, mammography view and type, mammographic density assessor, parity and height/age at menarche. RESULTS: In pooled analyses, later age at menarche was associated with higher per cent density (ß√PD = 0.023 SE = 0.008, P = 0.003) and larger dense area (ß√DA = 0.032 SE = 0.010, P = 0.002). Taller women had larger dense area (ß√DA = 0.069 SE = 0.028, P = 0.012) and higher per cent density (ß√PD = 0.044, SE = 0.023, P = 0.054), although the observed effect on per cent density depended upon the adjustment used for body size. Similar overall effect estimates were observed in meta-analyses across population groups. CONCLUSIONS: In one of the largest international studies to date, later age at menarche was positively associated with mammographic density. This is in contrast to its association with breast cancer risk, providing little evidence of mediation. Increased height was also positively associated with mammographic density, particularly dense area. These results suggest a complex relationship between growth and development, mammographic density and breast cancer risk. Future studies should evaluate the potential mediation of the breast cancer effects of taller stature through absolute breast density.

Restraint upon Embryonic Metatarsal Ex Vivo Growth by Hydrogel Reveals Interaction between Quasi-Static Load and the mTOR Pathway.

Mechanical cues play a vital role in limb skeletal development, yet their influence and underpinning mechanisms in the regulation of endochondral ossification (EO) processes are incompletely defined. Furthermore, interactions between endochondral growth and mechanics and the mTOR/NF-ĸB pathways are yet to be explored. An appreciation of how mechanical cues regulate EO would also clearly be beneficial in the context of fracture healing and bone diseases, where these processes are recapitulated. The study herein addresses the hypothesis that the mTOR/NF-ĸB pathways interact with mechanics to control endochondral growth. To test this, murine embryonic metatarsals were incubated ex vivo in a hydrogel, allowing for the effects of quasi-static loading on longitudinal growth to be assessed. The results showed significant restriction of metatarsal growth under quasi-static loading during a 14-day period and concentration-dependent sensitivity to hydrogel-related restriction. This study also showed that hydrogel-treated metatarsals retain their viability and do not present with increased apoptosis. Metatarsals exhibited reversal of the growth-restriction when co-incubated with mTOR compounds, whilst it was found that these compounds showed no effects under basal culture conditions. Transcriptional changes linked to endochondral growth were assessed and downregulation of Col2 and Acan was observed in hydrogel-treated metatarsi at day 7. Furthermore, cell cycle analyses confirmed the presence of chondrocytes exhibiting S-G2/M arrest. These data indicate that quasi-static load provokes chondrocyte cell cycle arrest, which is partly overcome by mTOR, with a less marked interaction for NF-ĸB regulators.

Filling in the knowledge gap: Observing MacroPlastic litter in South Africa's rivers.

Only 12% of the world's published plastic research includes references to Africa despite it being a significant contributor to the global plastic waste and mismanagement problem (~88.5% of Africa's plastic waste is mismanaged). Ocean plastics are transported from land by rivers to the sea. However, source contextualization is complex. Many African rivers predominantly run alongside human settlements that host informal waste dumpsites. In this study a simple cost effective, easily deployed, consistent and replicable survey methodology was employed. The study quantified macroplastic in three rivers discharging into Algoa Bay, South Africa. The results indicated that industrial Swartkops and metropolitan Baakens Rivers both illustrate moderate plastic pollution (>3000 plastic particles/day), with the relatively natural Sundays River to showing minimal evidence of river macro plastic (<100 plastic particles/day). The types of plastic were noted using the RIMMEL app (premier African implementation), enabling proportional comparison of different plastic litter types to be completed.

Microplastics in glaciers of the Tibetan Plateau: Evidence for the long-range transport of microplastics.

Microplastics are globally prevalent on a large scale in various marine and terrestrial environments, including Arctic snow and precipitation in protected areas of the United Sates. However, reports of microplastics from glaciers are rare, especially for the Tibetan Plateau (TP), which is widely known as the world's Third Pole and Asian Water Tower. Adjacent to human settlements in South Asia, East China, and Central Asia, the TP features regular cross-border air pollution (e.g., black carbon and mercury), which can affect its vulnerable and pristine environments. In previous studies, abundant microplastics have been reported from Tibetan rivers/lakes water and sediments, and surface soils. We detected microplastics in glacier surface snow on the TP, which were isolated from the impact of human activities, indicating that microplastics can be transported over long distances. This evidence is expected to be significant for understanding the atmospheric transport of microplastics to the TP, and provides a global perspective on the microplastic cycle.

Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions.

BACKGROUND: Guide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques. METHODS: A single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes. RESULTS: 168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4). CONCLUSIONS: This is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.

Gathering at the top? Environmental controls of microplastic uptake and biomagnification in freshwater food webs.

Microplastics are ubiquitous in the environment, with high concentrations being detected now also in river corridors and sediments globally. Whilst there has been increasing field evidence of microplastics accumulation in the guts and tissues of freshwater and marine aquatic species, the uptake mechanisms of microplastics into freshwater food webs, and the physical and geological controls on pathway-specific exposures to microplastics, are not well understood. This knowledge gap is hampering the assessment of exposure risks, and potential ecotoxicological and public health impacts from microplastics. This review provides a comprehensive synthesis of key research challenges in analysing the environmental fate and transport of microplastics in freshwater ecosystems, including the identification of hydrological, sedimentological and particle property controls on microplastic accumulation in aquatic ecosystems. This mechanistic analysis outlines the dominant pathways for exposure to microplastics in freshwater ecosystems and identifies potentially critical uptake mechanisms and entry pathways for microplastics and associated contaminants into aquatic food webs as well as their risk to accumulate and biomagnify. We identify seven key research challenges that, if overcome, will permit the advancement beyond current conceptual limitations and provide the mechanistic process understanding required to assess microplastic exposure, uptake, hazard, and overall risk to aquatic systems and humans, and provide key insights into the priority impact pathways in freshwater ecosystems to support environmental management decision making.

Dimethyl-2-oxoglutarate improves redox balance and mitochondrial function in muscle pericytes of individuals with diabetes mellitus.

AIMS/HYPOTHESIS: Treatment of vascular complications of diabetes remains inadequate. We reported that muscle pericytes (MPs) from limb muscles of vascular patients with diabetes mellitus display elevated levels of oxidative stress causing a dysfunctional phenotype. Here, we investigated whether treatment with dimethyl-2-oxoglutarate (DM-2OG), a tricarboxylic acid cycle metabolite with antioxidant properties, can restore a healthy metabolic and functional phenotype. METHODS: MPs were isolated from limb muscles of diabetes patients with vascular disease (D-MPs) and from non-diabetic control participants (ND-MPs). Metabolic status was assessed in untreated and DM-2OG-treated (1 mmol/l) cells using an extracellular flux analyser and anion-exchange chromatography-mass spectrometry (IC-MS/MS). Redox status was measured using commercial kits and IC-MS/MS, with antioxidant and metabolic enzyme expression assessed by quantitative RT-PCR and western blotting. Myogenic differentiation and proliferation and pericyte-endothelial interaction were assessed as functional readouts. RESULTS: D-MPs showed mitochondrial dysfunction, suppressed glycolytic activity and reduced reactive oxygen species-buffering capacity, but no suppression of antioxidant systems when compared with ND-MP controls. DM-2OG supplementation improved redox balance and mitochondrial function, without affecting glycolysis or antioxidant systems. Nonetheless, this was not enough for treated D-MPs to regain the level of proliferation and myogenic differentiation of ND-MPs. Interestingly, DM-2OG exerted a positive effect on pericyte-endothelial cell interaction in the co-culture angiogenesis assay, independent of the diabetic status. CONCLUSIONS/INTERPRETATION: These novel findings support the concept of using DM-2OG supplementation to improve pericyte redox balance and mitochondrial function, while concurrently allowing for enhanced pericyte-endothelial crosstalk. Such effects may help to prevent or slow down vasculopathy in skeletal muscles of people with diabetes. Graphical abstract.

Examination of the ocean as a source for atmospheric microplastics.

Global plastic litter pollution has been increasing alongside demand since plastic products gained commercial popularity in the 1930's. Current plastic pollutant research has generally assumed that once plastics enter the ocean they are there to stay, retained permanently within the ocean currents, biota or sediment until eventual deposition on the sea floor or become washed up onto the beach. In contrast to this, we suggest it appears that some plastic particles could be leaving the sea and entering the atmosphere along with sea salt, bacteria, virus' and algae. This occurs via the process of bubble burst ejection and wave action, for example from strong wind or sea state turbulence. In this manuscript we review evidence from the existing literature which is relevant to this theory and follow this with a pilot study which analyses microplastics (MP) in sea spray. Here we show first evidence of MP particles, analysed by µRaman, in marine boundary layer air samples on the French Atlantic coast during both onshore (average of 2.9MP/m3) and offshore (average of 9.6MP/m3) winds. Notably, during sampling, the convergence of sea breeze meant our samples were dominated by sea spray, increasing our capacity to sample MPs if they were released from the sea. Our results indicate a potential for MPs to be released from the marine environment into the atmosphere by sea-spray giving a globally extrapolated figure of 136000 ton/yr blowing on shore.

The role of chick Ebf genes in the mediolateral patterning of the somites.

This study was conducted to check whether the three chick Early B-cell Factor (Ebf) genes, particularly cEbf1, would be targets for Shh and Bmp signals during somites mediolateral (ML) patterning. Tissue manipulations and gain and loss of function experiments for Shh and Bmp4 were performed and the results revealed that cEbf1 expression was initiated in the cranial presomitic mesoderm by low dose of Bmp4 from the lateral mesoderm and maintained in the ventromedial part of the epithelial somite and the medial sclerotome by Shh from the notochord; while cEbf2/3 expression was induced and maintained by Bmp4 and inhibited by high dose of Shh. To determine whether Ebf1 plays a role in somite patterning, transfection of a dominant-negative construct was carried out; this showed suppression of cPax1 expression in the medial sclerotome and upregulation and medial expansion of cEbf3 and cPax3 expression in sclerotome and dermomyotome, respectively, suggesting that Ebf1 is important for ML patterning. Thus, it is possible that low doses of Bmp4 set up Ebf1 expression which, together with Shh from the notochord, leads to establishment of the medial sclerotome and suppression of lateral identities. These data also conclude that Bmp4 is required in both the medial and lateral domain of the somitic mesoderm to keep the ML identity of the sclerotome through maintenance of cEbf gene expression. These striking findings are novel and give a new insight on the role of Bmp4 on mediolateral patterning of somites.

Adjusting for BMI in analyses of volumetric mammographic density and breast cancer risk.

BACKGROUND: Fully automated assessment of mammographic density (MD), a biomarker of breast cancer risk, is being increasingly performed in screening settings. However, data on body mass index (BMI), a confounder of the MD-risk association, are not routinely collected at screening. We investigated whether the amount of fat in the breast, as captured by the amount of mammographic non-dense tissue seen on the mammographic image, can be used as a proxy for BMI when data on the latter are unavailable. METHODS: Data from a UK case control study (numbers of cases/controls: 414/685) and a Norwegian cohort study (numbers of cases/non-cases: 657/61059), both with volumetric MD measurements (dense volume (DV), non-dense volume (NDV) and percent density (%MD)) from screening-age women, were analysed. BMI (self-reported) and NDV were taken as measures of adiposity. Correlations between BMI and NDV, %MD and DV were examined after log-transformation and adjustment for age, menopausal status and parity. Logistic regression models were fitted to the UK study, and Cox regression models to the Norwegian study, to assess associations between MD and breast cancer risk, expressed as odds/hazard ratios per adjusted standard deviation (OPERA). Adjustments were first made for standard risk factors except BMI (minimally adjusted models) and then also for BMI or NDV. OPERA pooled relative risks (RRs) were estimated by fixed-effect models, and between-study heterogeneity was assessed by the I2 statistics. RESULTS: BMI was positively correlated with NDV (adjusted r = 0.74 in the UK study and r = 0.72 in the Norwegian study) and with DV (r = 0.33 and r = 0.25, respectively). Both %MD and DV were positively associated with breast cancer risk in minimally adjusted models (pooled OPERA RR (95% confidence interval): 1.34 (1.25, 1.43) and 1.46 (1.36, 1.56), respectively; I2 = 0%, P >0.48 for both). Further adjustment for BMI or NDV strengthened the %MD-risk association (1.51 (1.41, 1.61); I2 = 0%, P = 0.33 and 1.51 (1.41, 1.61); I2 = 0%, P = 0.32, respectively). Adjusting for BMI or NDV marginally affected the magnitude of the DV-risk association (1.44 (1.34, 1.54); I2 = 0%, P = 0.87 and 1.49 (1.40, 1.60); I2 = 0%, P = 0.36, respectively). CONCLUSIONS: When volumetric MD-breast cancer risk associations are investigated, NDV can be used as a measure of adiposity when BMI data are unavailable.

Motional Stark effect imaging first results on the DIII-D tokamak.

A motional Stark effect (MSE) imaging diagnostic was benchmarked against existing conventional MSE polarimeters on the DIII-D tokamak and delivered new capabilities for measuring the magnetic pitch angle from 2 neutral beams and on the high field side of DIII-D. Line integration across flux surfaces was considerable for the radial view utilised; nevertheless, the imaging MSE measurements from both beams were self-consistent and in close agreement with conventional MSE measurements. The ferroelectric liquid crystal waveplate used in the imaging polarimeter was discovered to have spatially non-uniform retardance; hence, it is necessary for the calibration source to replicate the ray paths of the neutral beam emission through the optical system.

Dynamic changes in gene expression and signalling during trophoblast development in the horse

Equine chorionic girdle trophoblast cells play important endocrine and immune functions critical in supporting pregnancy. Very little is known about the genes and pathways that regulate chorionic girdle trophoblast development. Our aim was to identify genes and signalling pathways active in vivo in equine chorionic girdle trophoblast within a critical 7-days window. We exploited the late implantation of the equine conceptus to obtain trophoblast tissue. An Agilent equine 44K microarray was performed using RNA extracted from chorionic girdle and chorion (control) from equine pregnancy days 27, 30, 31 and 34 (n = 5), corresponding to the initiation of chorionic girdle trophoblast proliferation, differentiation and migration. Data were analysed using R packages limma and maSigPro, Ingenuity Pathway Analysis and DAVID and verified using qRT-PCR, promoter analysis, western blotting and migration assays. Microarray analysis showed gene expression (absolute log FC >2, FDR-adjusted P < 0.05) was rapidly and specifically induced in the chorionic girdle between days 27 and 34 (compared to day 27, day 30 = 116, day 31 = 317, day 34 = 781 genes). Pathway analysis identified 35 pathways modulated during chorionic girdle development (e.g. FGF, integrin, Rho GTPases, MAPK) including pathways that have limited description in mammalian trophoblast (e.g. IL-9, CD40 and CD28 signalling). Rho A and ERK/MAPK activity was confirmed as was a role for transcription factor ELF5 in regulation of the CGB promoter. The purity and accessibility of chorionic girdle trophoblast proved to be a powerful resource to identify candidate genes and pathways involved in early equine placental development.

Multi-tasking Sulf1/Sulf2 enzymes do not only facilitate extracellular cell signalling but also participate in cell cycle related nuclear events.

This study demonstrates highly dynamic spatial and temporal pattern of SULF1/SULF2 expression in a number of neuronal cell types growing in normal culture medium that included their transient nuclear mobilisation. Their nuclear translocation became particularly apparent during cell proliferation as both SULF1/SULF2 demonstrated not only cell membrane associated expression, their known site of function but also transient nuclear mobilisation during nuclear cell division. Nuclear localisation was apparent not only by immunocytochemical staining but also confirmed by immunoblotting staining of isolated nuclear fractions of C6, U87 and N2A cells. Immunocytochemical analysis demonstrated rapid nuclear exit of both SULF1/SULF2 following cell division that was slightly delayed but not blocked in a fraction of the polyploid cells observed in C6 cells. The overexpression of both Sulf1 and Sulf2 genes in C6 and U87 cells markedly promoted in vitro growth of these cells accompanied by nuclear mobilisation while inhibition of both these genes inhibited cell proliferation with little or no nuclear SULF1/SULF2 mobilisation. SULF1/SULF2 activity in these cells thus demonstrated a clear co-ordination of extracellular cell signalling with nuclear events related to cell proliferation.

Resource Usage Implementing the Surgical Resident Prep Curriculum at a Single Institution.

OBJECTIVE: The Resident Prep Curriculum (RPC), published in 2014 and developed as a collaboration of the American College of Surgeons, Association of Program Directors in Surgery, and the Association for Surgical Education, was designed to improve the quality and consistency of medical student preparation for surgical residency. We aim to assess the feasibility of and resource usage for implementation of this curriculum at our institution. DESIGN: Our institution expanded upon a pre-existing 2-week surgical preparatory course, adding modules designed to meet the goals and objectives of the RPC. We performed an evaluation of the resources required for these additions, namely time, logistics and incremental cost. SETTING: The course took place at the Perelman School of Medicine, which is a large, academic medical center affiliated with the Hospital of the University of Pennsylvania. RESULTS: Our course satisfied each of the six domains outlined in the RPC. In 2015, 22 students were enrolled in the course. It was run over a consecutive 4-week period in the spring of 2015, with 9 full and 9 half days. To meet the needs of the Curriculum, approximately 33 hours (38%) were spent in the classroom, 34 hours (39%) in a simulation center, and 20 hours (23%) in the anatomical laboratory. Seventy faculty-hours (from 5 disciplines) and 73 resident-hours (double-counting for cotaught modules) were required to support the course. Besides room availability, funding was required for certain aspects of the course such as cadavers, dedicated anatomy teaching, and the costs of supplies in the simulation center. There is also a cost associated with the use of the Penn Medicine Simulation Center. Taking these into account, the total cost of implementing the curriculum amounted to $30,627.10. CONCLUSION: The implementation of the RPC was feasible but relied heavily upon faculty/resident time. As a result of the success of this initiative, our medical school seeks to expand the idea across multiple specialties.

Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.

BACKGROUND: Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known. METHODS AND FINDINGS: We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35-85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of pooled data, adjusted for body mass index, reproductive factors, mammogram view, image type, and reader. In all, 4,534 women were premenopausal, and 6,481 postmenopausal, at the time of mammography. A large age-adjusted difference in percent MD (PD) between post- and premenopausal women was apparent (-0.46 cm [95% CI: -0.53, -0.39]) and appeared greater in women with lower breast cancer risk profiles; variation across population groups due to heterogeneity (I2) was 16.5%. Among premenopausal women, the √PD difference per 10-year increase in age was -0.24 cm (95% CI: -0.34, -0.14; I2 = 30%), reflecting a compositional change (lower dense area and higher non-dense area, with no difference in breast area). In postmenopausal women, the corresponding difference in √PD (-0.38 cm [95% CI: -0.44, -0.33]; I2 = 30%) was additionally driven by increasing breast area. The study is limited by different mammography systems and its cross-sectional rather than longitudinal nature. CONCLUSIONS: Declines in MD with increasing age are present premenopausally, continue postmenopausally, and are most pronounced over the menopausal transition. These effects were highly consistent across diverse groups of women worldwide, suggesting that they result from an intrinsic biological, likely hormonal, mechanism common to women. If cumulative breast density is a key determinant of breast cancer risk, younger ages may be the more critical periods for lifestyle modifications aimed at breast density and breast cancer risk reduction.