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Oh H, Yaghjyan L, Heng YJ, Rosner B, Mahoney MB, Murthy D, Baker GM, Tamimi RM. Associations of Early-Life and Adult Anthropometric Measures with the Expression of Stem Cell Markers CD44, CD24, and ALDH1A1 in Women with Benign Breast Biopsies. Cancer Epidemiol Biomarkers Prev 2024; 33:933-943. [PMID: 38652503 PMCID: PMC11216865 DOI: 10.1158/1055-9965.epi-23-1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/06/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND According to the stem cell hypothesis, breast carcinogenesis may be related to the breast stem cell pool size. However, little is known about associations of breast cancer risk factors, such as anthropometric measures, with the expression of stem cell markers in noncancerous breast tissue. METHODS The analysis included 414 women with biopsy-confirmed benign breast disease in the Nurses' Health Study and Nurses' Health Study II. Birthweight, weight at age 18, current weight, and current height were reported via self-administered questionnaires. IHC staining of stem cell markers (CD44, CD24, and aldehyde dehydrogenase family 1 member A1) in histopathologically normal epithelial and stromal breast tissue was quantified using an automated computational image analysis system. Linear regression was used to examine the associations of early-life and adult anthropometric measures with log-transformed stem cell marker expression, adjusting for potential confounders. RESULTS Birthweight [≥10.0 vs. <5.5 lbs: β (95% confidence interval) = 4.29 (1.02, 7.56); P trend = 0.001 in the stroma] and adult height [≥67.0 vs. <63.0 inch: 0.86 (0.14, 1.58); P trend = 0.02 in the epithelium and stroma combined] were positively associated with CD44 expression. Childhood body fatness was inversely associated (P trend = 0.03) whereas adult height was positively associated with CD24 expression in combined stroma and epithelium (P trend = 0.03). CONCLUSIONS Our data suggest that anthropometric measures, such as birthweight, adult height, and childhood body fatness, may be associated with the stem cell expression among women with benign breast disease. IMPACT Anthropometric measures, such as birthweight, height, and childhood body fatness, may have long-term impacts on stem cell population in the breast.
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Affiliation(s)
- Hannah Oh
- Department of Health Policy and Management, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Korea University, Seoul, South Korea
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Yujing J Heng
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matt B Mahoney
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Divya Murthy
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gabrielle M Baker
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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2
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Lloyd R, Pirikahu S, Walter J, Cadby G, Warrington N, Perera D, Hickey M, Saunders C, Hackmann M, Sampson DD, Shepherd J, Lilge L, Stone J. The Prospective Association between Early Life Growth and Breast Density in Young Adult Women. Cancers (Basel) 2024; 16:2418. [PMID: 39001479 PMCID: PMC11240569 DOI: 10.3390/cancers16132418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Breast density is a strong intermediate endpoint to investigate the association between early-life exposures and breast cancer risk. This study investigates the association between early-life growth and breast density in young adult women measured using Optical Breast Spectroscopy (OBS) and Dual X-ray Absorptiometry (DXA). OBS measurements were obtained for 536 female Raine Cohort Study participants at ages 27-28, with 268 completing DXA measurements. Participants with three or more height and weight measurements from ages 8 to 22 were used to generate linear growth curves for height, weight and body mass index (BMI) using SITAR modelling. Three growth parameters (size, velocity and timing) were examined for association with breast density measures, adjusting for potential confounders. Women who reached their peak height rapidly (velocity) and later in adolescence (timing) had lower OBS-breast density. Overall, women who were taller (size) had higher OBS-breast density. For weight, women who grew quickly (velocity) and later in adolescence (timing) had higher absolute DXA-breast density. Overall, weight (size) was also inversely associated with absolute DXA-breast density, as was BMI. These findings provide new evidence that adolescent growth is associated with breast density measures in young adult women, suggesting potential mediation pathways for breast cancer risk in later life.
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Affiliation(s)
- Rachel Lloyd
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
| | - Sarah Pirikahu
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
| | - Jane Walter
- University Health Network, Toronto, ON M5G 2C4, Canada
| | - Gemma Cadby
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
| | - Nicole Warrington
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4067, Australia
- The Frazer Institute, The University of Queensland, Woolloongabba, QLD 4102, Australia
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Dilukshi Perera
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC 3052, Australia
| | - Christobel Saunders
- Department of Surgery, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Michael Hackmann
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - David D Sampson
- School of Computer Science and Electronic Engineering, The University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - John Shepherd
- Epidemiology and Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Lothar Lilge
- University Health Network, Toronto, ON M5G 2C4, Canada
- Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Jennifer Stone
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
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3
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Dorgan JF, Baer HJ, Bertrand KA, LeBlanc ES, Jung S, Magder LS, Snetselaar LG, Stevens VJ, Zhang Y, Van Horn L. Childhood adiposity, serum metabolites and breast density in young women. Breast Cancer Res 2022; 24:91. [PMID: 36536390 PMCID: PMC9764542 DOI: 10.1186/s13058-022-01588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Childhood adiposity is inversely associated with young adult percent dense breast volume (%DBV) and absolute dense breast volume (ADBV), which could contribute to its protective effect for breast cancer later in life. The objective of this study was to identify metabolites in childhood serum that may mediate the inverse association between childhood adiposity and young adult breast density. METHODS Longitudinal data from 182 female participants in the Dietary Intervention Study in Children (DISC) and the DISC 2006 (DISC06) Follow-Up Study were analyzed. Childhood adiposity was assessed by anthropometry at the DISC visit with serum available that occurred closest to menarche and expressed as a body mass index (BMI) z-score. Serum metabolites were measured by untargeted metabolomics using ultra-high-performance liquid chromatography-tandem mass spectrometry. %DBV and ADBV were measured by magnetic resonance imaging at the DISC06 visit when participants were 25-29 years old. Robust mixed effects linear regression was used to identify serum metabolites associated with childhood BMI z-scores and breast density, and the R package mediation was used to quantify mediation. RESULTS Of the 115 metabolites associated with BMI z-scores (FDR < 0.20), 4 were significantly associated with %DBV and 6 with ADBV before, though not after, adjustment for multiple comparisons. Mediation analysis identified 2 unnamed metabolites, X-16576 and X-24588, as potential mediators of the inverse association between childhood adiposity and dense breast volume. X-16576 mediated 14% (95% confidence interval (CI) = 0.002, 0.46; P = 0.04) of the association of childhood adiposity with %DBV and 11% (95% CI = 0.01, 0.26; P = 0.02) of its association with ADBV. X-24588 also mediated 7% (95% CI = 0.001, 0.18; P = 0.05) of the association of childhood adiposity with ADBV. None of the other metabolites examined contributed to mediation of the childhood adiposity-%DBV association, though there was some support for contributions of lysine, valine and 7-methylguanine to mediation of the inverse association of childhood adiposity with ADBV. CONCLUSIONS Additional large longitudinal studies are needed to identify metabolites and other biomarkers that mediate the inverse association of childhood adiposity with breast density and possibly breast cancer risk.
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Affiliation(s)
- Joanne F Dorgan
- Division of Cancer Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood St., Howard Hall, Room 102E, Baltimore, MD, 21201, USA.
| | - Heather J Baer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Kimberly A Bertrand
- Slone Epidemiology Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, OR, 97227, USA
| | - Seungyoun Jung
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul, South Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Laurence S Magder
- Division of Cancer Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood St., Howard Hall, Room 102E, Baltimore, MD, 21201, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, 52242, USA
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, Portland, OR, 97227, USA
| | - Yuji Zhang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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4
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Colditz GA, Toriola AT. Refining the Focus on Early Life and Adolescent Pathways to Prevent Breast Cancer. J Natl Cancer Inst 2021; 113:658-659. [PMID: 33136152 DOI: 10.1093/jnci/djaa173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO, USA
| | - Adetunji T Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO, USA
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5
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Colditz GA. Understanding Adiposity at Different Times across the Life Course and Cancer Risk: Is Evidence Sufficient to Act? J Natl Cancer Inst 2021; 114:333-334. [PMID: 34057473 PMCID: PMC8902327 DOI: 10.1093/jnci/djab104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
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6
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Pubertal mammary gland development is a key determinant of adult mammographic density. Semin Cell Dev Biol 2020; 114:143-158. [PMID: 33309487 DOI: 10.1016/j.semcdb.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 01/04/2023]
Abstract
Mammographic density refers to the radiological appearance of fibroglandular and adipose tissue on a mammogram of the breast. Women with relatively high mammographic density for their age and body mass index are at significantly higher risk for breast cancer. The association between mammographic density and breast cancer risk is well-established, however the molecular and cellular events that lead to the development of high mammographic density are yet to be elucidated. Puberty is a critical time for breast development, where endocrine and paracrine signalling drive development of the mammary gland epithelium, stroma, and adipose tissue. As the relative abundance of these cell types determines the radiological appearance of the adult breast, puberty should be considered as a key developmental stage in the establishment of mammographic density. Epidemiological studies have pointed to the significance of pubertal adipose tissue deposition, as well as timing of menarche and thelarche, on adult mammographic density and breast cancer risk. Activation of hypothalamic-pituitary axes during puberty combined with genetic and epigenetic molecular determinants, together with stromal fibroblasts, extracellular matrix, and immune signalling factors in the mammary gland, act in concert to drive breast development and the relative abundance of different cell types in the adult breast. Here, we discuss the key cellular and molecular mechanisms through which pubertal mammary gland development may affect adult mammographic density and cancer risk.
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7
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Oh H, Yaghjyan L, Austin-Datta RJ, Heng YJ, Baker GM, Sirinukunwattana K, Vellal AD, Collins LC, Murthy D, Eliassen AH, Rosner BA, Tamimi RM. Early-Life and Adult Adiposity, Adult Height, and Benign Breast Tissue Composition. Cancer Epidemiol Biomarkers Prev 2020; 30:608-615. [PMID: 33288551 DOI: 10.1158/1055-9965.epi-20-1348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early-life and adult anthropometrics are associated with breast density and breast cancer risk. However, little is known about whether these factors also influence breast tissue composition beyond what is captured by breast density among women with benign breast disease (BBD). METHODS This analysis included 788 controls from a nested case-control study of breast cancer within the Nurses' Health Study BBD subcohorts. Body fatness at ages 5 and 10 years was recalled using a 9-level pictogram. Weight at age 18, current weight, and height were reported via questionnaires. A deep-learning image analysis was used to quantify the percentages of epithelial, fibrous stromal, and adipose tissue areas within BBD slides. We performed linear mixed models to estimate beta coefficients (β) and 95% confidence intervals (CI) for the relationships between anthropometrics and the log-transformed percentages of individual tissue type, adjusting for confounders. RESULTS Childhood body fatness (level ≥ 4.5 vs. 1), BMI at age 18 (≥23 vs. <19 kg/m2), and current adult BMI (≥30 vs. <21 kg/m2) were associated with higher proportions of adipose tissue [β (95% CI) = 0.34 (0.03, 0.65), 0.19 (-0.04-0.42), 0.40 (0.12, 0.68), respectively] and lower proportions of fibrous stromal tissue [-0.05 (-0.10, 0.002), -0.03 (-0.07, 0.003), -0.12 (-0.16, -0.07), respectively] during adulthood (all P trend < 0.04). BMI at age 18 was also inversely associated with epithelial tissue (P trend = 0.03). Adult height was not associated with any of the individual tissue types. CONCLUSIONS Our data suggest that body fatness has long-term impacts on breast tissue composition. IMPACT This study contributes to our understanding of the link between body fatness and breast cancer risk.See related commentary by Oskar et al., p. 590.
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Affiliation(s)
- Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea. .,Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Rebecca J Austin-Datta
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gabrielle M Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Korsuk Sirinukunwattana
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Engineering Science, Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, United Kingdom
| | - Adithya D Vellal
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Divya Murthy
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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8
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Lian J, Li K. A Review of Breast Density Implications and Breast Cancer Screening. Clin Breast Cancer 2020; 20:283-290. [DOI: 10.1016/j.clbc.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
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9
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Oh H, Rice MS, Warner ET, Bertrand KA, Fowler EE, Eliassen AH, Rosner BA, Heine JJ, Tamimi RM. Early-Life and Adult Anthropometrics in Relation to Mammographic Image Intensity Variation in the Nurses' Health Studies. Cancer Epidemiol Biomarkers Prev 2020; 29:343-351. [PMID: 31826913 PMCID: PMC7007347 DOI: 10.1158/1055-9965.epi-19-0832] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/29/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The V measure captures grayscale intensity variation on a mammogram and is positively associated with breast cancer risk, independent of percent mammographic density (PMD), an established marker of breast cancer risk. We examined whether anthropometrics are associated with V, independent of PMD. METHODS The analysis included 1,700 premenopausal and 1,947 postmenopausal women without breast cancer within the Nurses' Health Study (NHS) and NHSII. Participants recalled their body fatness at ages 5, 10, and 20 years using a 9-level pictogram (level 1: most lean) and reported weight at age 18 years, current adult weight, and adult height. V was estimated by calculating standard deviation of pixels on screening mammograms. Linear mixed models were used to estimate beta coefficients (ß) and 95% confidence intervals (CI) for the relationships between anthropometric measures and V, adjusting for confounders and PMD. RESULTS V and PMD were positively correlated (Spearman r = 0.60). Higher average body fatness at ages 5 to 10 years (level ≥ 4.5 vs. 1) was significantly associated with lower V in premenopausal (ß = -0.32; 95% CI, -0.48 to -0.16) and postmenopausal (ß = -0.24; 95% CI, -0.37 to -0.10) women, independent of current body mass index (BMI) and PMD. Similar inverse associations were observed with average body fatness at ages 10 to 20 years and BMI at age 18 years. Current BMI was inversely associated with V, but the associations were largely attenuated after adjustment for PMD. Height was not associated with V. CONCLUSIONS Our data suggest that early-life body fatness may reflect lifelong impact on breast tissue architecture beyond breast density. However, further studies are needed to confirm the results. IMPACT This study highlights strong inverse associations of early-life adiposity with mammographic image intensity variation.
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Affiliation(s)
- Hannah Oh
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea.
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Megan S Rice
- Biostatistics, Sanofi Genzyme, Cambridge, Massachusetts
| | - Erica T Warner
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Erin E Fowler
- Division of Population Sciences, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John J Heine
- Division of Population Sciences, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Lynge E, Vejborg I, Andersen Z, von Euler-Chelpin M, Napolitano G. Mammographic Density and Screening Sensitivity, Breast Cancer Incidence and Associated Risk Factors in Danish Breast Cancer Screening. J Clin Med 2019; 8:jcm8112021. [PMID: 31752353 PMCID: PMC6912479 DOI: 10.3390/jcm8112021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Attention in the 2000s on the importance of mammographic density led us to study screening sensitivity, breast cancer incidence, and associations with risk factors by mammographic density in Danish breast cancer screening programs. Here, we summarise our approaches and findings. Methods: Dichotomized density codes: fatty, equal to BI-RADS density code 1 and part of 2, and other mixed/dense data from the 1990s—were available from two counties, and BI-RADS density codes from one region were available from 2012/13. Density data were linked with data on vital status, incident breast cancer, and potential risk factors. We calculated screening sensitivity by combining data on screen-detected and interval cancers. We used cohorts to study high density as a predictor of breast cancer risk; cross-sectional data to study the association between life style factors and density, adjusting for age and body mass index (BMI); and time trends to study the prevalence of high density across birth cohorts. Results: Sensitivity decreased with increasing density from 78% in women with BI-RADS 1 to 47% in those with BI-RADS 4. For women with mixed/dense compared with those with fatty breasts, the rate ratio of incident breast cancer was 2.45 (95% CI 2.14–2.81). The percentage of women with mixed/dense breasts decreased with age, but at a higher rate the later the women were born. Among users of postmenopausal hormone therapy, the percentage of women with mixed/dense breasts was higher than in non-users, but the patterns across birth cohorts were similar. The occurrence of mixed/dense breast at screening age decreased by a z-score unit of BMI at age 13—odds ratio (OR) 0.56 (95% CI 0.53–0.58)—and so did breast cancer risk and hazard ratio (HR) 0.92 (95% CI 0.84–1.00), but it changed to HR 1.01 (95% CI 0.93–1.11) when controlled for density. Age and BMI adjusted associations between life style factors and density were largely close to unity; physical activity OR 1.06 (95% CI 0.93–1.21); alcohol consumption OR 1.01 (95% CI 0.81–1.27); air pollution OR 0.96 (95% 0.93–1.01) per 20 μg/m3; and traffic noise OR 0.94 (95% CI 0.86–1.03) per 10 dB. Weak negative associations were seen for diabetes OR 0.61 (95% CI 0.40–0.92) and cigarette smoking OR 0.86 (95% CI 0.75–0.99), and a positive association was found with hormone therapy OR 1.24 (95% 1.14–1.35). Conclusion: Our data indicate that breast tissue in middle-aged women is highly dependent on childhood body constitution while adult life-style plays a modest role, underlying the need for a long-term perspective in primary prevention of breast cancer.
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Affiliation(s)
- Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Ejegodvej 63, DK-4800 Nykøbing Falster, Denmark
- Correspondence: ; Tel.: +45-2042-1863
| | - Ilse Vejborg
- Radiology Clinic, Copenhagen University Hospital, Rigshospitalet, DK-2100 København Ø, Denmark;
| | - Zorana Andersen
- Department of Public Health, University of Copenhagen, DK-1014 København K, Denmark; (Z.A.); (M.v.E.-C.); (G.N.)
| | - My von Euler-Chelpin
- Department of Public Health, University of Copenhagen, DK-1014 København K, Denmark; (Z.A.); (M.v.E.-C.); (G.N.)
| | - George Napolitano
- Department of Public Health, University of Copenhagen, DK-1014 København K, Denmark; (Z.A.); (M.v.E.-C.); (G.N.)
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11
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Nguyen TL, Li S, Dite GS, Aung YK, Evans CF, Trinh HN, Baglietto L, Stone J, Song YM, Sung J, English DR, Jenkins MA, Dugué PA, Milne RL, Southey MC, Giles GG, Pike MC, Hopper JL. Interval breast cancer risk associations with breast density, family history and breast tissue aging. Int J Cancer 2019; 147:375-382. [PMID: 31609476 PMCID: PMC7318124 DOI: 10.1002/ijc.32731] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 01/04/2023]
Abstract
Interval breast cancers (those diagnosed between recommended mammography screens) generally have poorer outcomes and are more common among women with dense breasts. We aimed to develop a risk model for interval breast cancer. We conducted a nested case-control study within the Melbourne Collaborative Cohort Study involving 168 interval breast cancer patients and 498 matched control subjects. We measured breast density using the CUMULUS software. We recorded first-degree family history by questionnaire, measured body mass index (BMI) and calculated age-adjusted breast tissue aging, a novel measure of exposure to estrogen and progesterone based on the Pike model. We fitted conditional logistic regression to estimate odds ratio (OR) or odds ratio per adjusted standard deviation (OPERA) and calculated the area under the receiver operating characteristic curve (AUC). The stronger risk associations were for unadjusted percent breast density (OPERA = 1.99; AUC = 0.66), more so after adjusting for age and BMI (OPERA = 2.26; AUC = 0.70), and for family history (OR = 2.70; AUC = 0.56). When the latter two factors and their multiplicative interactions with age-adjusted breast tissue aging (p = 0.01 and 0.02, respectively) were fitted, the AUC was 0.73 (95% CI 0.69-0.77), equivalent to a ninefold interquartile risk ratio. In summary, compared with using dense breasts alone, risk discrimination for interval breast cancers could be doubled by instead using breast density, BMI, family history and hormonal exposure. This would also give women with dense breasts, and their physicians, more information about the major consequence of having dense breasts-an increased risk of developing an interval breast cancer.
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Affiliation(s)
- Tuong L Nguyen
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Ye K Aung
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Christopher F Evans
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Ho N Trinh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jennifer Stone
- Centre for Genetic Origins of Health and Disease, University of Western Australia, Perth, WA, Australia
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joohon Sung
- Department of Epidemiology School of Public Health, Seoul National University, Seoul, South Korea.,Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Pierre-Antoine Dugué
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Melissa C Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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12
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Terry MB, Cohn BA, Goldberg M, Flom JD, Wei Y, Houghton LC, Tehranifar P, McDonald JA, Protacio A, Cirillo P, Michels KB. Do Birth Weight and Weight Gain During Infancy and Early Childhood Explain Variation in Mammographic Density in Women in Midlife? Results From Cohort and Sibling Analyses. Am J Epidemiol 2019; 188:294-304. [PMID: 30383202 DOI: 10.1093/aje/kwy229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023] Open
Abstract
High birth weight is associated with increased breast cancer risk and, less consistently, with higher mammographic density. In contrast, adolescent body size has been consistently, negatively associated with both MD and breast cancer risk. It is unclear when the direction of these associations changes and whether weight gain in infancy is associated with MD. We evaluated the associations of birth weight and postnatal weight (measured at 4 months, 1 year, and 4 years) by absolute and velocity measures (relative within-cohort percentile changes) with adult mammographic density, assessed using a computer-assisted thresholding program (Cumulus), using linear regression models with generalized estimating equations to account for correlation between siblings in the Early Determinants of Mammographic Density study (1959-2008; n = 700 women with 116 sibling sets; mean age = 44.1 years). Birth weight was positively associated with dense area (per 1-kg increase, β = 3.36, 95% confidence interval (CI): 0.06, 6.66). Weight gains from 0 months to 4 months and 1 year to 4 years were negatively associated with dense area (for 10-unit increase in weight percentile, β = -0.65, 95% CI: -1.23, -0.07, and β = -1.07, 95% CI: -1.98, -0.16, respectively). Findings were similar in the sibling subset. These results support the hypothesis that high birth weight is positively associated with increased breast density and suggest that growth spurts starting in early infancy reduce mammographic dense area in adulthood.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
- Imprints Center for Genetic and Environmental Lifecourse Studies, Mailman School of Public Health, Columbia University, New York, New York
| | - Barbara A Cohn
- The Child Health and Development Studies, Public Health Institute, Berkeley, California
| | - Mandy Goldberg
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Julie D Flom
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Lauren C Houghton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | - Jasmine A McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Angeline Protacio
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Piera Cirillo
- The Child Health and Development Studies, Public Health Institute, Berkeley, California
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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13
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Denholm R, De Stavola B, Hipwell JH, Doran SJ, Busana MC, Leach MO, Hawkes DJ, dos-Santos-Silva I. Growth Trajectories, Breast Size, and Breast-Tissue Composition in a British Prebirth Cohort of Young Women. Am J Epidemiol 2018; 187:1259-1268. [PMID: 29140420 PMCID: PMC5982787 DOI: 10.1093/aje/kwx358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 11/14/2022] Open
Abstract
Mammographic percent density, the proportion of fibroglandular tissue in the breast, is a strong risk factor for breast cancer, but its determinants in young women are unknown. We examined associations of magnetic resonance imaging (MRI) breast-tissue composition at age 21 years with prospectively collected measurements of body size and composition from birth to early adulthood and markers of puberty (all standardized) in a sample of 500 nulliparous women from a prebirth cohort of children born in Avon, United Kingdom, in 1991-1992 and followed up to 2011-2014. Linear models were fitted to estimate relative change in MRI percent water, which is equivalent to mammographic percent density, associated with a 1-standard-deviation increase in the exposure of interest. In mutually adjusted analyses, MRI percent water was positively associated with birth weight (relative change (RC) = 1.03, 95% confidence interval (CI): 1.00, 1.06) and pubertal height growth (RC = 1.07, 95% CI: 1.02, 1.13) but inversely associated with pubertal weight growth (RC = 0.86, 95% CI: 0.84, 0.89) and changes in dual-energy x-ray absorptiometry percent body fat mass (e.g., for change between ages 11 years and 13.5 years, RC = 0.96, 95% CI: 0.93, 0.99). Ages at thelarche and menarche were positively associated with MRI percent water, but these associations did not persist upon adjustment for height and weight growth. These findings support the hypothesis that growth trajectories influence breast-tissue composition in young women, whereas puberty plays no independent role.
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Affiliation(s)
- Rachel Denholm
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bianca De Stavola
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John H Hipwell
- Center for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - Simon J Doran
- Cancer Research UK Cancer Imaging Center, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Marta C Busana
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Center, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Hawkes
- Center for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Roswall N, Andersen ZJ, von Euler-Chelpin M, Vejborg I, Lynge E, Jensen SS, Raaschou-Nielsen O, Tjønneland A, Sørensen M. Residential traffic noise and mammographic breast density in the Diet, Cancer, and Health cohort. Cancer Causes Control 2018. [PMID: 29520472 DOI: 10.1007/s10552-018-1021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Traffic is the most important source of community noise, and it has been proposed to be associated with a range of disease outcomes, including breast cancer. As mammographic breast density (MD) is one of the strongest risk factors for developing breast cancer, the present study investigated whether there is an association between residential exposure to traffic noise and MD in a Danish cohort. METHODS We included women with reproductive and lifestyle information available from the Diet, Cancer, and Health cohort, who also participated in the Copenhagen Mammography Screening Programme (n = 5,260). Present and historical addresses from 1987 to 2011 were found in national registries, and traffic noise was modeled 5 years before mammogram. Analyses between residential traffic noise and MD were performed using logistic regression. RESULTS We found no association between residential road and railway noise exposure 5 years before mammogram, and having a mixed/dense versus a fatty mammogram, and no interaction with menopausal status, BMI, HRT use, and railway noise exposure, for analyses on road traffic noise. CONCLUSION The present study does not suggest an association between residential traffic noise exposure and subsequent MD in a cohort of middle-aged Danish women.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Zorana Jovanovic Andersen
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - My von Euler-Chelpin
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, Diagnostic Imaging Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elsebeth Lynge
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | | | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of natural Science and Environment, Roskilde University, Roskilde, Denmark
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15
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Vinnicombe SJ. Breast density: why all the fuss? Clin Radiol 2017; 73:334-357. [PMID: 29273225 DOI: 10.1016/j.crad.2017.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/17/2017] [Indexed: 01/06/2023]
Abstract
The term "breast density" or mammographic density (MD) denotes those components of breast parenchyma visualised at mammography that are denser than adipose tissue. MD is composed of a mixture of epithelial and stromal components, notably collagen, in variable proportions. MD is most commonly assessed in clinical practice with the time-honoured method of visual estimation of area-based percent density (PMD) on a mammogram, with categorisation into quartiles. The computerised semi-automated thresholding method, Cumulus, also yielding area-based percent density, is widely used for research purposes; however, the advent of fully automated volumetric methods developed as a consequence of the widespread use of digital mammography (DM) and yielding both absolute and percent dense volumes, has resulted in an explosion of interest in MD recently. Broadly, the importance of MD is twofold: firstly, the presence of marked MD significantly reduces mammographic sensitivity for breast cancer, even with state-of-the-art DM. Recognition of this led to the formation of a powerful lobby group ('Are You Dense') in the US, as a consequence of which 32 states have legislated for mandatory disclosure of MD to women undergoing mammography. Secondly, it is now widely accepted that MD is in itself a risk factor for breast cancer, with a four-to sixfold increased relative risk in women with PMD in the highest quintile compared to those with PMD in the lowest quintile. Consequently, major research efforts are underway to assess whether use of MD could provide a major step forward towards risk-adapted, personalised breast cancer prevention, imaging, and treatment.
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Affiliation(s)
- S J Vinnicombe
- Cancer Research, School of Medicine, Level 7, Mailbox 4, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
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16
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Vega S, Basurto L, Saucedo R, Barrera S, Reyes-Maldonado E, Garcia-Latorre EA, Zarate A. Similar to Adiponectin, Serum Levels of Osteocalcin are Associated with Mammographic Breast Density in Postmenopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:186-192. [PMID: 28927816 DOI: 10.1016/j.jogc.2017.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Breast cancer is the most common type of cancer in Canadian women and worldwide. Mammographic density is a well-established breast cancer risk. Recent evidence suggested inverse correlations among adiponectin, osteocalcin, and the risk developing breast cancer. The objective of the study was to evaluate the relationship between breast density and adiponectin and osteocalcin concentrations. METHODS A cross-sectional study was performed in 239 women, age range 40 to 60. Mammographic density, serum adiponectin, and osteocalcin levels were measured. According to the Wolfe method, participants were divided into those with low-risk and high-risk pattern mammograms. RESULTS The study population included 107 premenopausal and 132 postmenopausal women. Parameters were no different between women with low-risk and high-risk patterns. In obese postmenopausal women, the high-risk pattern mammogram group had significantly higher values of adiponectin and osteocalcin compared with the low-risk pattern group. Multiple linear regression analyses showed that adiponectin and osteocalcin levels were associated with high-risk pattern mammograms. CONCLUSION Adiponectin and osteocalcin levels were directly associated with high-risk pattern mammograms in obese postmenopausal women. These results do not support the use of adipokines as biomarkers; nevertheless, the most important factor is to assess the risk through breast density.
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Affiliation(s)
- Sara Vega
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lourdes Basurto
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Renata Saucedo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Susana Barrera
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elba Reyes-Maldonado
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Ethel A Garcia-Latorre
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Arturo Zarate
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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17
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Rosner B, Eliassen AH, Toriola AT, Chen WY, Hankinson SE, Willett WC, Berkey CS, Colditz GA. Weight and weight changes in early adulthood and later breast cancer risk. Int J Cancer 2017; 140:2003-2014. [PMID: 28133728 DOI: 10.1002/ijc.30627] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 12/28/2022]
Abstract
Obesity is a well-established cause of postmenopausal breast cancer. However, early life adiposity is inversely associated with breast cancer incidence. To understand these conflicting relations, we use validated measures to assess adiposity in childhood and late adolescence, as well as weight change, in relation to total invasive breast cancer incidence and receptor subtypes. We conducted a prospective observational study among 74,177 women from the Nurses' Health Study from 1980-2012, with updated risk factors every 2 years during which 4,965 incident invasive breast cancers occurred. Overall, weight at age 18 was inversely associated with both premenopausal (HR per 30 kg = 0.52, 95% CI = 0.39-0.71) and postmenopausal (HR per 30 kg = 0.81, 95% CI = 0.72-0.92) breast cancer which was largely explained by adiposity at age 10. Long-term weight gain from age 18 both during premenopause and postmenopause were positively associated with postmenopausal breast cancer risk. However, premenopausal weight gain was not related to premenopausal breast cancer risk. Furthermore, weight gain since age 18 was positively associated with ER+/PR+ postmenopausal breast cancer (HR per 30 kg = 1.50, 95% CI = 1.36-1.65) but not ER+/PR- (HR per 30 kg = 0.96, 95% CI = 0.78-1.19) or ER-/PR- (HR per 30 kg = 1.16, 95% CI = 0.95-1.42) postmenopausal breast cancer. Overall, 17% of ER+/PR+ postmenopausal breast cancer and 14% of total postmenopausal breast cancer are attributable to weight gain of > 5 kg since age 18.
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Affiliation(s)
- Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115
| | - Adetunji T Toriola
- Siteman Cancer Center and Washington University School of Medicine, Saint Louis, MO, 63110
| | - Wendy Y Chen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02115
| | - Susan E Hankinson
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115.,Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003-9304
| | - Walter C Willett
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115
| | - Catherine S Berkey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115
| | - Graham A Colditz
- Siteman Cancer Center and Washington University School of Medicine, Saint Louis, MO, 63110
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18
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Childhood body size and pubertal timing in relation to adult mammographic density phenotype. Breast Cancer Res 2017; 19:13. [PMID: 28173872 PMCID: PMC5297131 DOI: 10.1186/s13058-017-0804-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background An earlier age at onset of breast development and longer time between pubertal stages has been implicated in breast cancer risk. It is not clear whether associations of breast cancer risk with puberty or predictors of onset of puberty, such as weight and height, are mediated via mammographic density, an important risk factor for breast cancer. Methods We investigated whether childhood body size and pubertal timing and tempo, collected by questionnaire, are associated with percentage and absolute area mammographic density at ages 47–73 years in 1105 women recruited to a prospective study. Results After controlling for adult adiposity, weight at ages 7 and 11 years was strongly significantly inversely associated with percentage and absolute dense area (p trend <0.001), and positively associated with absolute non-dense area. Greater height at age 7, but not age 11, was associated with lower percentage density (p trend = 0.016). Later age at menarche and age at when regular periods were established was associated with increased density, but additional adjustment for childhood weight attenuated the association. A longer interval between thelarche and menarche, and between thelarche and regular periods, was associated with increased dense area, even after adjusting for childhood weight (p trend = 0.013 and 0.028, respectively), and was independent of age at pubertal onset. Conclusions Greater prepubertal weight and earlier pubertal onset are associated with lower adult breast density, but age at pubertal onset does not appear to have an independent effect on adult density after controlling for childhood adiposity. A possible effect of pubertal tempo on density needs further investigation. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0804-y) contains supplementary material, which is available to authorized users.
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19
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Denholm R, De Stavola B, Hipwell JH, Doran SJ, Busana MC, Eng A, Jeffreys M, Leach MO, Hawkes D, dos Santos Silva I. Pre-natal exposures and breast tissue composition: findings from a British pre-birth cohort of young women and a systematic review. Breast Cancer Res 2016; 18:102. [PMID: 27729066 PMCID: PMC5059986 DOI: 10.1186/s13058-016-0751-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/23/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Breast density, the amount of fibroglandular tissue in the adult breast for a women's age and body mass index, is a strong biomarker of susceptibility to breast cancer, which may, like breast cancer risk itself, be influenced by events early in life. In the present study, we investigated the association between pre-natal exposures and breast tissue composition. METHODS A sample of 500 young, nulliparous women (aged approximately 21 years) from a U.K. pre-birth cohort underwent a magnetic resonance imaging examination of their breasts to estimate percent water, a measure of the relative amount of fibroglandular tissue equivalent to mammographic percent density. Information on pre-natal exposures was collected throughout the mothers' pregnancy and shortly after delivery. Regression models were used to investigate associations between percent water and pre-natal exposures. Mediation analysis, and a systematic review and meta-analysis of the published literature, were also conducted. RESULTS Adjusted percent water in young women was positively associated with maternal height (p for linear trend [p t] = 0.005), maternal mammographic density in middle age (p t = 0.018) and the participant's birth size (p t < 0.001 for birthweight). A 1-SD increment in weight (473 g), length (2.3 cm), head circumference (1.2 cm) and Ponderal Index (4.1 g/cm3) at birth were associated with 3 % (95 % CI 2-5 %), 2 % (95 % CI 0-3 %), 3 % (95 % CI 1-4 %) and 1 % (95 % CI 0-3 %), respectively, increases in mean adjusted percent water. The effect of maternal height on the participants' percent water was partly mediated through birth size, but there was little evidence that the effect of birthweight was primarily mediated via adult body size. The meta-analysis supported the study findings, with breast density being positively associated with birth size. CONCLUSIONS These findings provide strong evidence of pre-natal influences on breast tissue composition. The positive association between birth size and relative amount of fibroglandular tissue indicates that breast density and breast cancer risk may share a common pre-natal origin.
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Affiliation(s)
- Rachel Denholm
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Bianca De Stavola
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - John H. Hipwell
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, UK
| | - Simon J. Doran
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research (ICH) and Royal Marsden NHS Foundation Trust (RHM), London, UK
| | - Marta C. Busana
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amanda Eng
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Mona Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research (ICH) and Royal Marsden NHS Foundation Trust (RHM), London, UK
| | - David Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, UK
| | - Isabel dos Santos Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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20
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Rice MS, Bertrand KA, VanderWeele TJ, Rosner BA, Liao X, Adami HO, Tamimi RM. Mammographic density and breast cancer risk: a mediation analysis. Breast Cancer Res 2016; 18:94. [PMID: 27654859 PMCID: PMC5031307 DOI: 10.1186/s13058-016-0750-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High mammographic density (MD) is a strong risk factor for breast cancer. However, it is unclear whether high MD is an intermediate phenotype or whether breast cancer risk factors influence breast cancer risk and MD independently. METHODS Our study population included 1290 invasive breast cancer cases and 3422 controls from the Nurses' Health Studies. We estimated the percent of the total association between the risk factor and breast cancer that was mediated by MD. RESULTS In both pre- and postmenopausal women, the association between history of biopsy-confirmed benign breast disease and risk was partially mediated by percent MD (percent mediated (PM) = 17 %, p < 0.01 and PM = 33 %, p = 0.04, respectively). In premenopausal women, the associations between early life body size (adolescent somatotype and BMI at age 18) and breast cancer risk were substantially mediated by percent MD (PM = 73 %, p = 0.05 and PM = 82 %, p = 0.04, respectively). In postmenopausal women, the proportion of the associations of childhood somatotype and adolescent somatotype that were mediated by percent MD were lower (PM = 26 %, p = 0.01 for both measures). Hormone therapy use at mammogram was significantly mediated by percent MD in postmenopausal women (PM = 22 %, p < 0.01). Associations with other risk factors, such as age at menarche or family history of breast cancer, were not mediated by percent MD. CONCLUSIONS Percent MD partially mediated some of the associations between risk factors and breast cancer, though the magnitude varied by risk factor and menopausal status. These findings suggest that high MD may be an intermediate in some biological pathways for breast cancer development.
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Affiliation(s)
- Megan S Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Bartlett 9, Boston, MA, 02116, USA.
| | | | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Xiaomei Liao
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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21
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Akinyemiju TF, Tehranifar P, Flom JD, Liao Y, Wei Y, Terry MB. Early life growth, socioeconomic status, and mammographic breast density in an urban US birth cohort. Ann Epidemiol 2016; 26:540-545.e2. [PMID: 27497679 DOI: 10.1016/j.annepidem.2016.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 05/24/2016] [Accepted: 06/25/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Rapid infant and childhood growth has been associated with chronic disease later in life, including breast cancer. Early life socioeconomic status (SES) influences childhood growth, but few studies have prospective measures from birth to consider the effects of early life growth and SES on breast cancer risk. METHODS We used prospectively measured early life SES and growth (percentile weight change in height and weight between each pair of consecutive time points at birth, 4 months, 1 and 7 years). We performed linear regression models to obtain standardized estimates of the association between 1 standard deviation increase in early life SES and growth and adult mammographic density (MD), a strong risk factor for breast cancer, in a diverse birth cohort (n = 151; 37% white, 38% black, 25% Puerto Rican; average age at mammogram = 42.4). RESULTS In models adjusted for race/ethnicity, prenatal factors, birthweight, infant and childhood growth, and adult body mass index, percentile weight change from 1 year to 7 years was inversely associated with percent MD (standardized coefficient (Stdβ) = -0.28, 95% CI: -0.55 to -0.01), and higher early life SES was positively associated with percent MD (Stdβ = 0.24, 95% CI: 0.04-0.43). Similar associations were observed for dense area, but those estimates were not statistically significant. CONCLUSIONS These results suggest opposite and independent effects of early life SES and growth on MD.
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Affiliation(s)
- Tomi F Akinyemiju
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Julie D Flom
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Yuyan Liao
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.
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22
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Bertrand KA, Baer HJ, Orav EJ, Klifa C, Kumar A, Hylton NM, LeBlanc ES, Snetselaar LG, Van Horn L, Dorgan JF. Early Life Body Fatness, Serum Anti-Müllerian Hormone, and Breast Density in Young Adult Women. Cancer Epidemiol Biomarkers Prev 2016; 25:1151-7. [PMID: 27197299 DOI: 10.1158/1055-9965.epi-16-0185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Emerging evidence suggests positive associations between serum anti-Müllerian hormone (AMH), a marker of ovarian function, and breast cancer risk. Body size at young ages may influence AMH levels, but few studies have examined this. Also, no studies have examined the relation of AMH levels with breast density, a strong predictor of breast cancer risk. METHODS We examined associations of early life body fatness, AMH concentrations, and breast density among 172 women in the Dietary Intervention Study in Children (DISC). Height and weight were measured at baseline (ages 8-10) and throughout adolescence. Serum AMH concentrations and breast density were assessed at ages 25-29 at the DISC 2006 Follow-up visit. We used linear mixed effects models to quantify associations of AMH (dependent variable) with quartiles of age-specific youth body mass index (BMI) Z-scores (independent variable). We assessed cross-sectional associations of breast density (dependent variable) with AMH concentration (independent variable). RESULTS Neither early life BMI nor current adult BMI was associated with AMH concentrations. There were no associations between AMH and percent or absolute dense breast volume. In contrast, women with higher AMH concentrations had significantly lower absolute nondense breast volume (Ptrend < 0.01). CONCLUSIONS We found no evidence that current or early life BMI influences AMH concentrations in later life. Women with higher concentrations of AMH had similar percent and absolute dense breast volume, but lower nondense volume. IMPACT These results suggest that AMH may be associated with lower absolute nondense breast volume; however, future prospective studies are needed to establish temporality. Cancer Epidemiol Biomarkers Prev; 25(7); 1151-7. ©2016 AACR.
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Affiliation(s)
| | - Heather J Baer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Nola M Hylton
- Department of Radiology, University of California, San Francisco, California
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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23
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Hopper JL, Nguyen TL, Stone J, Aujard K, Matheson MC, Abramson MJ, Burgess JA, Walters EH, Dite GS, Bui M, Evans C, Makalic E, Schmidt DF, Ward G, Jenkins MA, Giles GG, Dharmage SC, Apicella C. Childhood body mass index and adult mammographic density measures that predict breast cancer risk. Breast Cancer Res Treat 2016; 156:163-70. [DOI: 10.1007/s10549-016-3719-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/11/2016] [Indexed: 01/01/2023]
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McDonald JA, Michels KB, Cohn BA, Flom JD, Tehranifar P, Terry MB. Alcohol intake from early adulthood to midlife and mammographic density. Cancer Causes Control 2016; 27:493-502. [PMID: 26830901 DOI: 10.1007/s10552-016-0723-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/16/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Moderate alcohol consumption (15 g/day) has been consistently associated with increased breast cancer risk; however, the association between alcohol and mammographic density, a strong marker of breast cancer risk, has been less consistent. Less is known about the effect of patterns of alcohol intake across the lifecourse. METHODS Using the Early Determinants of Mammographic Density study, an adult follow-up of women born in two US birth cohorts (n = 697; Collaborative Perinatal Project in Boston and Providence sites and the Childhood Health and Development Studies in California), we examined the association between alcohol intake in early adulthood (ages 20-29 years) and at time of interview and mammographic density (percent density and total dense area). We report the difference between nondrinkers and three levels of alcohol intake. We considered confounding by age at mammogram, body mass index, geographic site, race/ethnicity, and reproductive characteristics. RESULTS Seventy-nine percent of women reported ever consuming alcohol. Compared to nondrinkers in early adulthood, we observed an inverse association between >7 servings/week and percent density in fully adjusted models (β = -5.1, 95% CI -8.7, -1.5; p for trend = <0.01). Associations with dense area were inverse for the highest category of drinking in early adulthood but not statistically significant (p for trend = 0.15). Compared to noncurrent drinkers, the association for current intake of >7 servings/week and percent density was also inverse (β = -3.1, 95% CI -7.0, 0.8; p for trend = 0.01). In contrast, moderate alcohol intake (>0-≤7 servings/week) in either time period was positively associated with dense area; but associations were not statistically significant in fully adjusted models. CONCLUSIONS Our study does not lend support to the hypothesis that the positive association between alcohol intake and breast cancer risk is through increasing mammographic density.
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Affiliation(s)
- Jasmine A McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
| | - Karin B Michels
- Obstetrics and Gynecology, Epidemiology Center Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.,Division of Cancer Epidemiology, Comprehensive Cancer Center Freiburg, Freiburg University, Freiburg, Germany
| | - Barbara A Cohn
- Public Health Institute, Child Health and Development Studies, Berkeley, CA, USA
| | - Julie D Flom
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.,The Imprints Center for Genetic and Environmental Lifecourse Studies, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
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25
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Rice MS, Bertrand KA, Lajous M, Tamimi RM, Torres G, López-Ridaura R, Romieu I. Reproductive and lifestyle risk factors and mammographic density in Mexican women. Ann Epidemiol 2015; 25:868-73. [PMID: 26475982 PMCID: PMC4791972 DOI: 10.1016/j.annepidem.2015.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Several breast cancer risk factors have been consistently associated with mammographic density (MD); however, data are limited for Hispanic women. METHODS We examined data from 1007 premenopausal and 600 postmenopausal women in the Mexican Teachers' Cohort. Multivariable linear regression was used to estimate associations between risk factors and MD. RESULTS Among premenopausal women, age, current body mass index (BMI), BMI at age 18 years, and weight change since age 18 years were inversely associated with percent MD, whereas benign breast disease, alcohol intake, and breastfeeding 12 months or more were associated with higher percent MD. Among postmenopausal women, age, current BMI, BMI at age 18 years, weight change since age 18 years, and speaking or having parents who speak an indigenous language were inversely associated with percent MD, whereas benign breast disease and greater age at natural menopause were positively associated with percent MD. Other breast cancer risk factors, such as age at menarche, parity, and age at first pregnancy, were not significantly associated with density in either premenopausal or postmenopausal women. CONCLUSIONS Results from the Mexican Teachers' Cohort are generally consistent with predictors of mammographic density observed in primarily non-Hispanic white populations; however, certain risk factors (e.g., parity) were not significantly associated with MD.
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Affiliation(s)
- Megan S Rice
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kimberly A Bertrand
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico; Center for Research in Epidemiology and Population Health (CESP), Inserm (Institut National de la Santé et de la Recherche Médicale), U1018, Villejuif, France; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Gabriela Torres
- Center for Research on Population Health, National Institute of Public Health, Mexico
| | - Ruy López-Ridaura
- Center for Research on Population Health, National Institute of Public Health, Mexico
| | - Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
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26
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Bertrand KA, Baer HJ, Orav EJ, Klifa C, Shepherd JA, Van Horn L, Snetselaar L, Stevens VJ, Hylton NM, Dorgan JF. Body fatness during childhood and adolescence and breast density in young women: a prospective analysis. Breast Cancer Res 2015; 17:95. [PMID: 26174168 PMCID: PMC4502611 DOI: 10.1186/s13058-015-0601-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/18/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Overweight and obesity in childhood and adolescence are associated with reduced breast cancer risk, independent of adult body mass index (BMI). These associations may be mediated through breast density. METHODS We prospectively examined associations of early life body fatness with adult breast density measured by MRI in 182 women in the Dietary Intervention Study in Children (DISC) who were ages 25-29 at follow-up. Height, weight, and other factors were measured at baseline (ages 8-10) and annual clinic visits through adolescence. We used linear mixed-effects models to quantify associations of percent breast density and dense and non-dense breast volume at ages 25-29 with quartiles of age-specific youth body mass index (BMI) Z-scores, adjusting for clinic, treatment group, current adult BMI, and other well-established risk factors for breast cancer and predictors of breast density. RESULTS We observed inverse associations between age-specific BMI Z-scores at all youth clinic visits and percent breast density, adjusting for current adult BMI and other covariates (all p values <0.01). Women whose baseline BMI Z-scores (at ages 8-10 years) were in the top quartile had significantly lower adult breast density, after adjusting for current adult BMI and other covariates [least squares mean (LSM): 23.4 %; 95 % confidence interval (CI): 18.0 %, 28.8 %] compared to those in the bottom quartile (LSM: 31.8 %; 95 % CI: 25.2 %, 38.4 %) (p trend <0.01). Significant inverse associations were also observed for absolute dense breast volume (all p values <0.01), whereas there were no clear associations with non-dense breast volume. CONCLUSIONS These results support the hypothesis that body fatness during childhood and adolescence may play an important role in premenopausal breast density, independent of current BMI, and further suggest direct or indirect influences on absolute dense breast volume. CLINICAL TRIALS REGISTRATION NUMBER NCT00458588 ; April 9, 2007.
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Affiliation(s)
- Kimberly A Bertrand
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Heather J Baer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02120, USA.
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02120, USA. .,Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Catherine Klifa
- Dangeard Group, 740 chemin de la Commanderie St Jean de Malte, 13080, Luynes, France.
| | - John A Shepherd
- Department of Radiology, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, 680 North Lake Shore Drive, Chicago, IL, 60611, USA.
| | - Linda Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, 145 North Riverside Drive, Iowa City, IA, 52242, USA.
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227, USA.
| | - Nola M Hylton
- Department of Radiology, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA.
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Yochum L, Tamimi RM, Hankinson SE. Birthweight, early life body size and adult mammographic density: a review of epidemiologic studies. Cancer Causes Control 2014; 25:1247-59. [PMID: 25053404 DOI: 10.1007/s10552-014-0432-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/01/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the association between birth weight and early life body size with adult mammographic density in the peer-reviewed literature. METHODS A comprehensive literature search was conducted through January, 2014. English language articles that assessed adult mammographic density (MD) in relation to early life body size (≤18 years old), or birthweight were included. RESULTS Nine studies reported results for early life body size and %MD. Both exposure and outcome were assessed at different ages using multiple methods. In premenopausal women, findings were inconsistent; two studies reported significant, inverse associations, one reported a non-significant, inverse association, and two observed no association. Reasons for these inconsistencies were not obvious. In postmenopausal women, four of five studies supported an inverse association. Two of three studies that adjusted for menopausal status found significant, inverse associations. Birthweight and %MD was evaluated in nine studies. No association was seen in premenopausal women and two of three studies reported positive associations in postmenopausal women. Three of four studies that adjusted for menopausal status found no association. DISCUSSION Early life body size and birthweight appear unrelated to %MD in premenopausal women while an inverse association in postmenopausal women is more likely. Although based on limited data, birthweight and %MD appear positively associated in postmenopausal women. Given the small number of studies, the multiple methods of data collection and analysis, other methodologic issues, and lack of consistency in results, additional research is needed to clarify this complex association and develop a better understanding of the underlying biologic mechanisms.
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Affiliation(s)
- Laura Yochum
- University of Massachusetts Amherst, 426 Arnold House, 716 North Pleasant Street, Amherst, MA, 01003, USA,
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28
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Andersen ZJ, Baker JL, Bihrmann K, Vejborg I, Sørensen TIA, Lynge E. Birth weight, childhood body mass index, and height in relation to mammographic density and breast cancer: a register-based cohort study. Breast Cancer Res 2014; 16:R4. [PMID: 24443815 PMCID: PMC3978910 DOI: 10.1186/bcr3596] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 01/06/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction High breast density, a strong predictor of breast cancer may be determined early in life. Childhood anthropometric factors have been related to breast cancer and breast density, but rarely simultaneously. We examined whether mammographic density (MD) mediates an association of birth weight, childhood body mass index (BMI), and height with the risk of breast cancer. Methods 13,572 women (50 to 69 years) in the Copenhagen mammography screening program (1991 through 2001) with childhood anthropometric measurements in the Copenhagen School Health Records Register were followed for breast cancer until 2010. With logistic and Cox regression models, we investigated associations among birth weight, height, and BMI at ages 7 to 13 years with MD (mixed/dense or fatty) and breast cancer, respectively. Results 8,194 (60.4%) women had mixed/dense breasts, and 716 (5.3%) developed breast cancer. Childhood BMI was significantly inversely related to having mixed/dense breasts at all ages, with odds ratios (95% confidence intervals) ranging from 0.69 (0.66 to 0.72) at age 7 to 0.56 (0.53 to 0.58) at age 13, per one-unit increase in z-score. No statistically significant associations were detected between birth weight and MD, height and MD, or birth weight and breast cancer risk. BMI was inversely associated with breast cancer, with hazard ratios of 0.91 (0.83 to 0.99) at age 7 and 0.92 (0.84 to 1.00) at age 13, whereas height was positively associated with breast cancer risk (age 7, 1.06 (0.98 to 1.14) and age 13, 1.08 (1.00 to 1.16)). After additional adjustment for MD, associations of BMI with breast cancer diminished (age 7, 0.97 (0.88 to 1.06) and age 13, 1.01 (0.93 to 1.11)), but remained with height (age 7, 1.06 (0.99 to 1.15) and age 13, 1.09 (1.01 to 1.17)). Conclusions Among women 50 years and older, childhood body fatness was inversely associated with the breast cancer risk, possibly via a mechanism mediated by MD, at least partially. Childhood tallness was positively associated with breast cancer risk, seemingly via a pathway independent of MD. Birth weight was not associated with MD or breast cancer in this age group.
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29
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Hellmann SS, Lynge E, Schwartz W, Vejborg I, Njor SH. Mammographic density in birth cohorts of Danish women: a longitudinal study. BMC Cancer 2013; 13:409. [PMID: 24106754 PMCID: PMC3766215 DOI: 10.1186/1471-2407-13-409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 08/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the leading malignant disease among western women with incidence increasing over time. High mammographic density is a well-established risk factor for breast cancer. We explored trends in mammographic density across birth cohorts to gain further insight into possible time trends in women's mammographic density that might explain the historical increase in breast cancer incidence. METHODS Data derived from two mammography screening programs in Denmark from 1991 to 2001, including on average 41,091 women from Copenhagen and 52,938 women from Funen aged 50-69. Mammographic density was assessed qualitatively (fatty or mixed/dense) by senior screening radiologists. The proportion of women with mixed/dense mammographic density was calculated by age at screening, screening period, and birth cohort. The Generalized Estimating Equations were used to calculate odds ratios and 95% confidence intervals. All statistical tests were two-sided. RESULTS The proportion of women with mixed/dense mammographic density increased from 45% among women born in the 1920s to 75-80% among women born in the 1940s. In Copenhagen, the age-adjusted odds ratio (95% CI) of mixed/dense mammographic density in women born in 1941-42 was 2.48 (2.22-2.76) compared with women born in 1921-22. In Funen, the age-adjusted odds ratio of mixed/dense mammographic density in women born in 1946-47 was 5.89 (5.32-6.51) compared with women born in 1924-25. Hormone use had a greater impact on mammographic density in birth cohorts of the 1920s compared with those of the 1940s. CONCLUSIONS We found suggestive evidence of a birth cohort pattern in mammographic density and an attenuated impact of hormone use in younger compared with older birth cohorts suggesting that postmenopausal mammographic density could be linked to changing exposures accumulated over time in women's lives.
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30
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Lokate M, van Duijnhoven FJB, van den Berg SW, Peeters PHM, van Gils CH. Early life factors and adult mammographic density. Cancer Causes Control 2013; 24:1771-8. [DOI: 10.1007/s10552-013-0254-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 06/20/2013] [Indexed: 11/29/2022]
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Rice MS, Bertrand KA, Lajous M, Tamimi RM, Torres-Mejía G, Biessy C, López-Ridaura R, Romieu I. Body size throughout the life course and mammographic density in Mexican women. Breast Cancer Res Treat 2013; 138:601-10. [PMID: 23460247 PMCID: PMC3627398 DOI: 10.1007/s10549-013-2463-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/18/2013] [Indexed: 12/19/2022]
Abstract
Mammographic density (MD) is a strong risk factor for breast cancer, but the biological mechanism underlying this association is not clear. Current adult body mass index (BMI) is inversely associated with percent MD; however, few studies have included Hispanic women or evaluated associations with measures of body fatness earlier in life. ESMaestras was established in 2006, when 28,345 women ages ≥35 responded to a detailed questionnaire that assessed possible disease risk factors, including body fatness in childhood, adolescence, and young adulthood. In 2007, 2084 ESMaestras participants underwent a clinical examination, which included measurements of weight, height, and sitting height and a mammogram. We measured percent MD using a computer-assisted method. The current analysis includes 972 premenopausal and 559 postmenopausal women. We used multivariable linear regression to evaluate associations between measures of body size and MD, independent of current BMI. Among pre- and postmenopausal women, we observed no significant associations between body fatness during childhood, adolescence, or young adulthood and percent MD. Among postmenopausal women, we observed a modest positive association between body fatness immediately before first pregnancy and between ages 25 and 35 after adjustment for current BMI, with differences of 4.9 and 3.6 % points, respectively, in percent MD between the heaviest and leanest women (p-trend = 0.02). There were no significant associations between height, sitting height, and percent MD among pre- or postmenopausal women in multivariable models adjusting for BMI. In general, we found no clear associations between measures of body size in early life, current sitting height, or current height, and percent MD, after adjusting for current BMI, in this population of Mexican women. Our observation of a positive association between early adult body fatness (i.e., before first pregnancy and ages 25-35) and percent MD among postmenopausal women is inconsistent with prior research and requires confirmation in other studies.
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Affiliation(s)
- Megan S Rice
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Dorgan JF, Klifa C, Shepherd JA, Egleston BL, Kwiterovich PO, Himes JH, Gabriel K, Horn L, Snetselaar LG, Stevens VJ, Barton BA, Robson AM, Lasser NL, Deshmukh S, Hylton NM. Height, adiposity and body fat distribution and breast density in young women. Breast Cancer Res 2012; 14:R107. [PMID: 22800711 PMCID: PMC3680938 DOI: 10.1186/bcr3228] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/13/2012] [Indexed: 12/15/2022] Open
Abstract
Introduction Breast density is one of the strongest risk factors for breast cancer, but determinants of breast density in young women remain largely unknown. Methods Associations of height, adiposity and body fat distribution with percentage dense breast volume (%DBV) and absolute dense breast volume (ADBV) were evaluated in a cross-sectional study of 174 healthy women, 25 to 29 years old. Adiposity and body fat distribution were measured by anthropometry and dual-energy X-ray absorptiometry (DXA), while %DBV and ADBV were measured by magnetic resonance imaging. Associations were evaluated using linear mixed-effects models. All tests of statistical significance are two-sided. Results Height was significantly positively associated with %DBV but not ADBV; for each standard deviation (SD) increase in height, %DBV increased by 18.7% in adjusted models. In contrast, all measures of adiposity and body fat distribution were significantly inversely associated with %DBV; a SD increase in body mass index (BMI), percentage fat mass, waist circumference and the android:gynoid fat mass ratio (A:G ratio) was each associated significantly with a 44.4 to 47.0% decrease in %DBV after adjustment for childhood BMI and other covariates. Although associations were weaker than for %DBV, all measures of adiposity and body fat distribution also were significantly inversely associated with ADBV before adjustment for childhood BMI. After adjustment for childhood BMI, however, only the DXA measures of percentage fat mass and A:G ratio remained significant; a SD increase in each was associated with a 13.8 to 19.6% decrease in ADBV. In mutually adjusted analysis, the percentage fat mass and the A:G ratio remained significantly inversely associated with %DBV, but only the A:G ratio was significantly associated with ADBV; a SD increase in the A:G ratio was associated with an 18.5% decrease in ADBV. Conclusion Total adiposity and body fat distribution are independently inversely associated with %DBV, whereas in mutually adjusted analysis only body fat distribution (A:G ratio) remained significantly inversely associated with ADBV in young women. Research is needed to identify biological mechanisms underlying these associations.
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Karahalios A, Baglietto L, Carlin JB, English DR, Simpson JA. A review of the reporting and handling of missing data in cohort studies with repeated assessment of exposure measures. BMC Med Res Methodol 2012; 12:96. [PMID: 22784200 PMCID: PMC3464662 DOI: 10.1186/1471-2288-12-96] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/11/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Retaining participants in cohort studies with multiple follow-up waves is difficult. Commonly, researchers are faced with the problem of missing data, which may introduce biased results as well as a loss of statistical power and precision. The STROBE guidelines von Elm et al. (Lancet, 370:1453-1457, 2007); Vandenbroucke et al. (PLoS Med, 4:e297, 2007) and the guidelines proposed by Sterne et al. (BMJ, 338:b2393, 2009) recommend that cohort studies report on the amount of missing data, the reasons for non-participation and non-response, and the method used to handle missing data in the analyses. We have conducted a review of publications from cohort studies in order to document the reporting of missing data for exposure measures and to describe the statistical methods used to account for the missing data. METHODS A systematic search of English language papers published from January 2000 to December 2009 was carried out in PubMed. Prospective cohort studies with a sample size greater than 1,000 that analysed data using repeated measures of exposure were included. RESULTS Among the 82 papers meeting the inclusion criteria, only 35 (43%) reported the amount of missing data according to the suggested guidelines. Sixty-eight papers (83%) described how they dealt with missing data in the analysis. Most of the papers excluded participants with missing data and performed a complete-case analysis (n=54, 66%). Other papers used more sophisticated methods including multiple imputation (n=5) or fully Bayesian modeling (n=1). Methods known to produce biased results were also used, for example, Last Observation Carried Forward (n=7), the missing indicator method (n=1), and mean value substitution (n=3). For the remaining 14 papers, the method used to handle missing data in the analysis was not stated. CONCLUSIONS This review highlights the inconsistent reporting of missing data in cohort studies and the continuing use of inappropriate methods to handle missing data in the analysis. Epidemiological journals should invoke the STROBE guidelines as a framework for authors so that the amount of missing data and how this was accounted for in the analysis is transparent in the reporting of cohort studies.
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Affiliation(s)
- Amalia Karahalios
- Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, VIC, Australia
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Phipps AI, Buist DSM, Malone KE, Barlow WE, Porter PL, Kerlikowske K, O'Meara ES, Li CI. Breast density, body mass index, and risk of tumor marker-defined subtypes of breast cancer. Ann Epidemiol 2012; 22:340-8. [PMID: 22366170 DOI: 10.1016/j.annepidem.2012.02.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/04/2012] [Accepted: 02/01/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Breast density and body mass index (BMI) are correlated attributes and are both potentially modifiable risk factors for breast cancer. However, relationships between these factors and risk of molecularly-defined subtypes of breast cancer have not been established. METHODS We used breast density and BMI data collected by the Breast Cancer Surveillance Consortium from 1,054,466 women ages 40 to 84 years receiving mammography, including 13,797 women subsequently diagnosed with breast cancer. Cases were classified into three groups on the basis of expression of the estrogen receptor (ER), progesterone receptor (PR), and HER2:1) ER-positive (ER+, n = 10,026), 2) HER2-expressing (ER-negative/PR-negative/HER2-positive, n = 308), or triple-negative (ER-negative/PR-negative/HER2-negative, n = 705). Using Cox regression, we evaluated subtype-specific associations with breast density and BMI. RESULTS Breast density was similarly positively associated with risk of all subtypes, especially among women ages 40 to 64 years. BMI was positively associated with risks of ER+ and triple-negative breast cancer in women ages 50 to 84 who were not users of hormone therapy. CONCLUSIONS Breast density is positively associated with breast cancer risk, regardless of disease subtype. Associations with BMI appear to vary more by breast cancer subtype. Additional studies are needed to confirm and further characterize risk factors for HER2-expressing and triple-negative breast cancer.
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Affiliation(s)
- Amanda I Phipps
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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Lope V, Pérez-Gómez B, Sánchez-Contador C, Santamariña MC, Moreo P, Vidal C, Laso MS, Ederra M, Pedraz-Pingarrón C, González-Román I, García-López M, Salas-Trejo D, Peris M, Moreno MP, Vázquez-Carrete JA, Collado F, Aragonés N, Pollán M. Obstetric history and mammographic density: a population-based cross-sectional study in Spain (DDM-Spain). Breast Cancer Res Treat 2012; 132:1137-46. [PMID: 22215386 PMCID: PMC3332340 DOI: 10.1007/s10549-011-1936-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 12/19/2011] [Indexed: 12/29/2022]
Abstract
High mammographic density (MD) is used as a phenotype risk marker for developing breast cancer. During pregnancy and lactation the breast attains full development, with a cellular-proliferation followed by a lobular-differentiation stage. This study investigates the influence of obstetric factors on MD among pre- and post-menopausal women. We enrolled 3,574 women aged 45–68 years who were participating in breast cancer screening programmes in seven screening centers. To measure MD, blind anonymous readings were taken by an experienced radiologist, using craniocaudal mammography and Boyd’s semiquantitative scale. Demographic and reproductive data were directly surveyed by purpose-trained staff at the date of screening. The association between MD and obstetric variables was quantified by ordinal logistic regression, with screening centre introduced as a random effect term. We adjusted for age, number of children and body mass index, and stratified by menopausal status. Parity was inversely associated with density, the probability of having high MD decreased by 16% for each new birth (P value < 0.001). Among parous women, a positive association was detected with duration of lactation [>9 months: odds ratio (OR) = 1.33; 95% confidence interval (CI) = 1.02–1.72] and weight of first child (>3,500 g: OR = 1.32; 95% CI = 1.12–1.54). Age at first birth showed a different effect in pre- and post-menopausal women (P value for interaction = 0.030). No association was found among pre-menopausal women. However, in post-menopausal women the probability of having high MD increased in women who had their first child after the age of 30 (OR = 1.53; 95% CI = 1.17–2.00). A higher risk associated with birth of twins was also mainly observed in post-menopausal women (OR = 2.02; 95% CI = 1.18–3.46). Our study shows a greater prevalence of high MD in mothers of advanced age at first birth, those who had twins, those who have breastfed for longer periods, and mothers whose first child had an elevated birth weight. These results suggest the influence of hormones and growth factors over the proliferative activity of the mammary gland.
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Affiliation(s)
- Virginia Lope
- Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
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The health and well-being of cancer survivors in the UK: findings from a population-based survey. Br J Cancer 2011; 105 Suppl 1:S11-20. [PMID: 22048028 PMCID: PMC3251954 DOI: 10.1038/bjc.2011.418] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: To compare self-reported health and well-being in a sample of cancer survivors with individuals who have not had cancer and with individuals who have a serious chronic condition other than cancer. Patients and methods A cross-sectional survey drawn from an online panel of 400 000 UK citizens supplemented with other online recruitment and telephone recruitment. The participants were 4892 individuals 30 years of age or above, including 780 individuals with a previous cancer diagnosis, 1372 individuals with one or more of 10 chronic conditions but not cancer and 2740 individuals without a previous cancer diagnosis or chronic condition. Thirteen measures of health and well-being were constructed from answers to 25 survey items covering physical, psychological and social dimensions of health and well-being. Results: Cancer survivors were significantly more likely to report poor health outcomes across all 13 measures than those with no history of cancer or a chronic condition. The adjusted odds ratios for cancer survivors with no chronic conditions compared with healthy participants ranged from 1.37 (95% confidence interval (CI): 1.31–1.96) for emotional well-being to 3.34 (95% CI: 2.74–4.08) for number of health professionals consulted in the last 12 months. The health profile of cancer survivors was similar to those with a history of a serious chronic health condition. Conclusions: A substantial number of individuals who have had a diagnosis of cancer experience ongoing poor health and well-being following cancer and cancer treatment. The results of this study provide an initial basis for the development of specific help and support for cancer survivors.
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Women's features and inter-/intra-rater agreement on mammographic density assessment in full-field digital mammograms (DDM-SPAIN). Breast Cancer Res Treat 2011; 132:287-95. [PMID: 22042363 DOI: 10.1007/s10549-011-1833-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 10/11/2011] [Indexed: 01/09/2023]
Abstract
Measurement of mammographic density (MD), one of the leading risk factors for breast cancer, still relies on subjective assessment. However, the consistency of MD measurement in full-digital mammograms has yet to be evaluated. We studied inter- and intra-rater agreement with respect to estimation of breast density in full-digital mammograms, and tested whether any of the women's characteristics might have some influence on them. After an initial training period, three experienced radiologists estimated MD using Boyd scale in a left breast cranio-caudal mammogram of 1,431 women, recruited at three Spanish screening centres. A subgroup of 50 randomly selected images was read twice to estimate short-term intra-rater agreement. In addition, a reading of 1,428 of the images, performed 2 years before by one rater, was used to estimate long-term intra-rater agreement. Pair-wise weighted kappas with 95% bootstrap confidence intervals were calculated. Dichotomous variables were defined to identify mammograms in which any rater disagreed with other raters or with his/her own assessment, respectively. The association between disagreement and women's characteristics was tested using multivariate mixed logistic models, including centre as a random-effects term, and taking into account repeated measures when required. All quadratic-weighted kappa values for inter- and intra-rater agreement were excellent (higher than 0.80). None of the studied women's features, i.e. body mass index, brassiere size, menopause, nulliparity, lactation or current hormonal therapy, was associated with higher risk of inter- or intra-rater disagreement. However, raters differed significantly more in images that were classified in the higher-density MD categories, and disagreement in intra-rater assessment was also lower in low-density mammograms. The reliability of MD assessment in full-field digital mammograms is comparable to that for original or digitised images. The reassuring lack of association between subjects' MD-related characteristics and agreement suggests that bias from this source is unlikely.
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Lope V, Pérez-Gómez B, Moreno MP, Vidal C, Salas-Trejo D, Ascunce N, Román IG, Sánchez-Contador C, Santamariña MC, Carrete JAV, Collado-García F, Pedraz-Pingarrón C, Ederra M, Ruiz-Perales F, Peris M, Abad S, Cabanes A, Pollán M. Childhood factors associated with mammographic density in adult women. Breast Cancer Res Treat 2011; 130:965-74. [PMID: 21748293 DOI: 10.1007/s10549-011-1664-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/26/2011] [Indexed: 10/18/2022]
Abstract
Growth and development factors could contribute to the development of breast cancer associated with an increase in mammographic density. This study examines the influence of certain childhood-related, socio-demographic and anthropometric variables on mammographic density in adult woman. The study covered 3574 women aged 45-68 years, participating in breast cancer-screening programmes in seven Spanish cities. Based on a craniocaudal mammogram, blind, anonymous measurement of mammographic density was made by a single radiologist, using Boyd's semiquantitative scale. Data associated with the early stages of life were obtained from a direct survey. Ordinal logistic regression and generalised linear models were employed to estimate the association between mammographic density and the variables covered by the questionnaire. Screening programme was introduced as a random effects term. Age, number of children, body mass index (BMI) and other childhood-related variables were used as adjustment variables, and stratified by menopausal status. A total of 811 women (23%) presented mammographic density of over 50%, and 5% of densities exceeded 75%. Our results show a greater prevalence of high mammographic density in women with low prepubertal weight (OR: 1.18; 95% CI: 1.02-1.36); marked prepubertal height (OR: 1.25; 95% CI: 0.97-1.60) and advanced age of their mothers at their birth (>39 years: OR: 1.28; 95% CI: 1.03-1.60); and a lower prevalence of high mammographic density in women with higher prepubertal weight, low birth weight and earlier menarche. The influence of these early-life factors may be explained by greater exposure to hormones and growth factors during the development of the breast gland, when breast tissue would be particularly susceptible to proliferative and carcinogenic stimulus.
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Affiliation(s)
- Virginia Lope
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain.
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Novotny R, Daida Y, Morimoto Y, Shepherd J, Maskarinec G. Puberty, body fat, and breast density in girls of several ethnic groups. Am J Hum Biol 2011; 23:359-65. [DOI: 10.1002/ajhb.21145] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 11/26/2010] [Accepted: 12/01/2010] [Indexed: 11/05/2022] Open
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Tehranifar P, Reynolds D, Flom J, Fulton L, Liao Y, Kudadjie-Gyamfi E, Terry MB. Reproductive and menstrual factors and mammographic density in African American, Caribbean, and white women. Cancer Causes Control 2011; 22:599-610. [PMID: 21327938 DOI: 10.1007/s10552-011-9733-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/17/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We investigated the associations between reproductive and menstrual risk factors for breast cancer and mammographic density, a strong risk factor for breast cancer, in a predominantly ethnic minority and immigrant sample. METHODS We interviewed women (42% African American, 22% African Caribbean, 22% White, 9% Hispanic Caribbean, 5% other) without a history of breast cancer during their mammography appointment (n = 191, mean age = 50). We used a computer-assisted method to measure the area and percentage of dense breast tissue from cranio-caudal mammograms. We used multivariable linear regression analyses to estimate the associations between reproductive and menstrual risk factors and mammographic density. RESULTS Age was inversely associated with percent density and dense area, and body mass index (BMI) was inversely associated with percent density. Adjusting for age, BMI, ethnicity and menopausal status, later age at menarche (e.g., β = -7.37, 95% CI: -12.29, -2.46 for age ≥ 13 years vs. ≤ 11 years), and any use of hormonal birth control (HBC) methods (β = -5.10, 95% CI: -9.37, -0.84) were associated with reduced dense area. Ethnicity and nativity (foreign- vs. US-born) were not directly associated with density despite variations in the distribution of several risk factors across ethnic and nativity groups. CONCLUSIONS The mean level of mammographic density did not differ across ethnic and nativity groups, but several risk factors for breast cancer were associated with density in ethnic minority and immigrant women.
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Affiliation(s)
- Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA.
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Energy intake and dietary patterns in childhood and throughout adulthood and mammographic density: results from a British prospective cohort. Cancer Causes Control 2010; 22:227-35. [PMID: 21113794 PMCID: PMC3399075 DOI: 10.1007/s10552-010-9690-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 11/08/2010] [Indexed: 11/22/2022]
Abstract
Objectives To examine the role of energy intake and dietary patterns in childhood and throughout adulthood on subsequent mammographic density. Methods Prospective data were available from a cohort of 1161 British women followed up since their birth in 1946. Dietary intakes at age 4 years were determined by 24-hour recalls and during adulthood, average food consumed at ages 36 and 43 years by 5-day food records. Dietary patterns were determined by factor analysis. Associations between energy intake, dietary patterns, and percent breast density were investigated using regression analysis. Results During adulthood, energy intake was positively associated with percent breast density (adjusted regression coefficient [per SD) (95% CI): 0.12 (0.01, 0.23)]. The effect of the high fat and sugar dietary pattern remained similar when adjusted for total energy intake [0.06 (−0.01, 0.13)]. There was no evidence of an associations for the patterns low fat, high fiber pattern 0.03 (−0.04, 0.11); the alcohol and fish −0.02 (−0.13, 0.17); meat, potatoes, and vegetables −0.03 (−0.10, 0.04). No association was found for dietary pattern at age 4 and percent breast density. Conclusions This study supports the hypothesis that overall energy intake during middle life is a determinant of subsequent mammographic breast density measured 15 years later.
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Li J, Humphreys K, Eriksson L, Czene K, Liu J, Hall P. Effects of childhood body size on breast cancer tumour characteristics. Breast Cancer Res 2010; 12:R23. [PMID: 20398298 PMCID: PMC2879571 DOI: 10.1186/bcr2564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 02/22/2010] [Accepted: 04/15/2010] [Indexed: 12/15/2022] Open
Abstract
Introduction Although a role of childhood body size in postmenopausal breast cancer risk has been established, less is known about its influence on tumour characteristics. Methods We studied the relationships between childhood body size and tumour characteristics in a Swedish population-based case-control study consisting of 2,818 breast cancer cases and 3,111 controls. Our classification of childhood body size was derived from a nine-level somatotype. Relative risks were estimated by odds ratios with 95% confidence intervals, derived from fitting unconditional logistic regression models. Association between somatotype at age 7 and tumour characteristics were evaluated in a case-only analysis where P values for heterogeneity were obtained by performing one degree of freedom trend tests. Results A large somatotype at age 7 was found to be associated with decreased postmenopausal breast cancer risk. Although strongly associated with other risk factors such as age of menarche, adult body mass index and mammographic density, somatotype at age 7 remained a significant protective factor (odds ratio (OR) comparing large to lean somatotype at age 7 = 0.73, 95% confidence interval (CI) = 0.58-0.91, P trend = 0.004) after adjustment. The significant protective effect was observed within all subgroups defined by estrogen receptor (ER) and progesterone receptor (PR) status, with a stronger effect for ER-negative (0.40, 95% CI = 0.21-0.75, P trend = 0.002), than for ER-positive (0.80, 95% CI = 0.62-1.05, P trend = 0.062), tumours (P heterogeneity = 0.046). Somatotype at age 7 was not associated with tumour size, histology, grade or the presence or absence of metastatic nodes. Conclusions Greater body size at age 7 is associated with a decreased risk of postmenopausal breast cancer, and the associated protective effect is stronger for the ER-negative breast cancer subtype than for the ER-positive subtype.
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Affiliation(s)
- Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Tamimi RM, Eriksson L, Lagiou P, Czene K, Ekbom A, Hsieh CC, Adami HO, Trichopoulos D, Hall P. Birth weight and mammographic density among postmenopausal women in Sweden. Int J Cancer 2010; 126:985-91. [PMID: 19642103 DOI: 10.1002/ijc.24786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Birth weight is a significant predictor of breast cancer risk in adult life and mammary gland mass could be an intermediate stage in this long process. We have studied the association of birth size measurements with mammographic density, a marker of mammary gland mass. For a population-based sample of 893 postmenopausal women without previous cancer in Sweden, we retrieved information on birth size from birth records and their most recent mammography. Film mammograms of the medio-lateral oblique view were digitized and the Cumulus software was used for computer-assisted semi-automated thresholding of mammographic density. Results were analyzed using generalized linear models controlling for possible confounders. Mean percent mammographic density increased when comparing the extreme categories of birth weight (from 15.6% to 18.6%) and head circumference (from 15.5% to 20.4%), and the corresponding linear trends were statistically significant (p values 0.02 and 0.007, respectively). The associations were particularly strong when the cutoff for high versus low mammographic density was set at the relatively high value of 50%. Compared to women weighing 3001-3500 grams at birth, women with birth weights >4000g were at almost 3-fold risk of developing high mammographic density (odds ratio: 2.9, 95% confidence interval 1.1 to 7.9). No association with mammographic density was evident with respect to birth length which, however, is known to be less accurately measured. These results indicate that adult breast density, a powerful predictor of breast cancer risk, has intrauterine roots, as reflected in birth size.
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Affiliation(s)
- Rulla M Tamimi
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Jordan HL, Hopper JL, Thomson RJ, Kavanagh AM, Gertig DM, Stone J, Venn AJ. Influence of High-Dose Estrogen Exposure during Adolescence on Mammographic Density for Age in Adulthood. Cancer Epidemiol Biomarkers Prev 2010; 19:121-9. [DOI: 10.1158/1055-9965.epi-09-0434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Crandall CJ, Sehl ME, Crawford SL, Gold EB, Habel LA, Butler LM, Sowers MR, Greendale GA, Sinsheimer JS. Sex steroid metabolism polymorphisms and mammographic density in pre- and early perimenopausal women. Breast Cancer Res 2009; 11:R51. [PMID: 19630952 PMCID: PMC2750112 DOI: 10.1186/bcr2340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 07/08/2009] [Accepted: 07/27/2009] [Indexed: 12/02/2022] Open
Abstract
Introduction We examined the association between mammographic density and single-nucleotide polymorphisms (SNPs) in genes encoding CYP1A1, CYP1B1, aromatase, 17β-HSD, ESR1, and ESR2 in pre- and early perimenopausal white, African-American, Chinese, and Japanese women. Methods The Study of Women's Health Across the Nation is a longitudinal community-based cohort study. We analyzed data from 451 pre- and early perimenopausal participants of the ancillary SWAN Mammographic Density study for whom we had complete information regarding mammographic density, genotypes, and covariates. With multivariate linear regression, we examined the relation between percentage mammographic breast density (outcome) and each SNP (primary predictor), adjusting for age, race/ethnicity, parity, cigarette smoking, and body mass index (BMI). Results After multivariate adjustment, the CYP1B1 rs162555 CC genotype was associated with a 9.4% higher mammographic density than the TC/TT genotype (P = 0.04). The CYP19A1 rs936306 TT genotype was associated with 6.2% lower mammographic density than the TC/CC genotype (P = 0.02). The positive association between CYP1A1 rs2606345 and mammographic density was significantly stronger among participants with BMI greater than 30 kg/m2 than among those with BMI less than 25 kg/m2 (Pinteraction = 0.05). Among white participants, the ESR1 rs2234693 CC genotype was associated with a 7.0% higher mammographic density than the CT/TT genotype (P = 0.01). Conclusions SNPs in certain genes encoding sex steroid metabolism enzymes and ESRs were associated with mammographic density. Because the encoded enzymes and ESR1 are expressed in breast tissue, these SNPs may influence breast cancer risk by altering mammographic density.
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Affiliation(s)
- Carolyn J Crandall
- Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, UCLA Medicine/GIM, 911 Broxton Ave, 1st floor, Los Angeles, CA 90024, USA.
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Reeves KW, Stone RA, Modugno F, Ness RB, Vogel VG, Weissfeld JL, Habel LA, Sternfeld B, Cauley JA. Longitudinal association of anthropometry with mammographic breast density in the Study of Women's Health Across the Nation. Int J Cancer 2009; 124:1169-77. [PMID: 19065651 DOI: 10.1002/ijc.23996] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
High percent mammographic breast density is strongly associated with increased breast cancer risk. Though body mass index (BMI) is positively associated with risk of postmenopausal breast cancer, BMI is negatively associated with percent breast density in cross-sectional studies. Few longitudinal studies have evaluated associations between BMI and weight and mammographic breast density. We studied the longitudinal relationships between anthropometry and breast density in a prospective cohort of 834 pre- and perimenopausal women enrolled in an ancillary study to the Study of Women's Health Across the Nation (SWAN). Routine screening mammograms were collected and read for breast density. Random intercept regression models were used to evaluate whether annual BMI change was associated with changes over time in dense breast area and percent density. The study population was 7.4% African-American, 48.8% Caucasian, 21.8% Chinese, and 21.9% Japanese. Mean follow-up was 4.8 years. Mean annual weight change was +0.32 kg/year, mean change in dense area was -0.77 cm(2)/year, and mean change in percent density was -1.14%/year. In fully adjusted models, annual change in BMI was not significantly associated with changes in dense breast area (-0.17 cm(2), 95% CI -0.64, 0.29). Borderline significant negative associations were observed between annual BMI change and annual percent density change, with percent density decreasing 0.36% (95% CI -0.74, 0.02) for a one unit increase in BMI over a year. This longitudinal study provides modest evidence that changes in BMI are not associated with changes in dense area, yet may be negatively associated with percent density.
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Affiliation(s)
- Katherine W Reeves
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
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Ruder EH, Dorgan JF, Kranz S, Kris-Etherton PM, Hartman TJ. Examining breast cancer growth and lifestyle risk factors: early life, childhood, and adolescence. Clin Breast Cancer 2008; 8:334-42. [PMID: 18757260 DOI: 10.3816/cbc.2008.n.038] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The perinatal period, childhood, and adolescence are important intervals for breast cancer risk development. Endogenous estrogen exposure is thought to be highest in utero, and exposure to estrogens throughout life plays an important role in increasing breast cancer risk. Some evidence suggests that breast tissue is not fully differentiated until after the first full-term pregnancy; thus, breast tissue might be more susceptible to carcinogenic influences during early life and adolescence. Birth characteristics of the daughter, including gestational age, birth weight, and birth length are associated with maternal hormone levels during the index pregnancy, and birth size has been related to daughter's timing of puberty and adult breast cancer incidence. Furthermore, early life and adolescence are critical times for maturation of the hypothalamic pituitary ovarian axis, which regulates production of ovarian hormones including estrogen and progesterone. Childhood height, growth, diet, and body mass index (BMI) have also been associated with breast cancer risk later in life. Of the examined characteristics, we conclude that the available evidence is suggestive of a positive relationship of breast cancer risk with birth weight, birth length, and adolescent height, and an inverse relationship with gestational age and childhood BMI, although several inconsistencies exist in the literature. The best evidence for a relationship of adolescent diet and adult breast cancer risk is indirect, and the relationship of diet, weight status, and weight gain in childhood deserves further attention. The interaction of birth characteristics with established risk factors over the life course, such as age at menarche, in addition to gene-environment interactions, require more research. Further study is also needed to clarify the biologic mechanisms influencing the observed associations.
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Affiliation(s)
- Elizabeth H Ruder
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
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48
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Dietary calcium and vitamin D intakes in childhood and throughout adulthood and mammographic density in a British birth cohort. Br J Cancer 2008; 99:1539-43. [PMID: 18827811 PMCID: PMC2579681 DOI: 10.1038/sj.bjc.6604697] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We examined the role of dietary calcium and vitamin D intakes in childhood and throughout adulthood in relation to mammographic density using data from a nationally representative cohort of 1161 women followed up since their birth in 1946. Dietary intakes at the age of 4 years were determined by 24-h recalls and at the ages of 36, 43 and 53 years by 5-day food records. After adjusting for known risk factors and confounders, no evidence of a relationship between dietary calcium or vitamin D intakes and mammographic density approximately at the age of 50 years was found, except for a cross-sectional relationship between dietary calcium intake at the age of 53 years and breast density in women who were post-menopausal at the time of mammography, with those in the top fifth of the distribution of calcium intake having a 0.53 s.d. lower percent breast density than those in the lowest fifth (P-value <0.01 for linear trend).
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49
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Anthropometric characteristics and mammographic parenchymal patterns in post-menopausal women: a population-based study in Northern Greece. Cancer Causes Control 2008; 20:181-91. [DOI: 10.1007/s10552-008-9232-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
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Gupta R, Alhajri FA, Mohammed AM, Chavan VNK, Gupta P. Relationship between mammography breast density and bone mineral density. J Clin Densitom 2008; 11:431-6. [PMID: 18164638 DOI: 10.1016/j.jocd.2007.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 11/05/2007] [Accepted: 11/05/2007] [Indexed: 01/23/2023]
Abstract
Mammography breast density (MBD) is a well-established and strong predictive risk factor for breast cancer. Bone mineral density (BMD) is another predictor of breast cancer risk in women. Both MBD and BMD are linked to a common pathway, which involves estrogens, and are highly heritable. This study evaluated the relationship between MBD and hip and spine BMD in Kuwaiti women. Mammograms and BMD data of 248 women were studied. BMD was measured at total lumbar spine (L1-L4) and total left hip using dual-energy X-ray absorptiometry. The women were classified into 3 groups: normal, osteopenia, and osteoporosis by their BMD, using the World Health Organization criteria. They were divided into another 4 groups: fatty, fibroglandular, heterogeneously dense, and extremely dense breast according to their MBD and as defined by the Breast Imaging Reporting and Data System. All MBD and BMD data were analyzed statistically. Statistical analysis showed no significant difference or correlation between the MBD and BMD groups even after adjusting for obesity and menopausal status. However, a highly significant difference in body weight was found among the MBD groups (p<0.005). No correlation between MBD and BMD was observed in the group of Kuwaiti women who took part in the present study.
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Affiliation(s)
- R Gupta
- Department of Radiology, Kuwait University, Kuwait.
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