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Vabistsevits M, Davey Smith G, Richardson TG, Richmond RC, Sieh W, Rothstein JH, Habel LA, Alexeeff SE, Lloyd-Lewis B, Sanderson E. Mammographic density mediates the protective effect of early-life body size on breast cancer risk. Nat Commun 2024; 15:4021. [PMID: 38740751 DOI: 10.1038/s41467-024-48105-7] [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: 09/03/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
The unexplained protective effect of childhood adiposity on breast cancer risk may be mediated via mammographic density (MD). Here, we investigate a complex relationship between adiposity in childhood and adulthood, puberty onset, MD phenotypes (dense area (DA), non-dense area (NDA), percent density (PD)), and their effects on breast cancer. We use Mendelian randomization (MR) and multivariable MR to estimate the total and direct effects of adiposity and age at menarche on MD phenotypes. Childhood adiposity has a decreasing effect on DA, while adulthood adiposity increases NDA. Later menarche increases DA/PD, but when accounting for childhood adiposity, this effect is attenuated. Next, we examine the effect of MD on breast cancer risk. DA/PD have a risk-increasing effect on breast cancer across all subtypes. The MD SNPs estimates are heterogeneous, and additional analyses suggest that different mechanisms may be linking MD and breast cancer. Finally, we evaluate the role of MD in the protective effect of childhood adiposity on breast cancer. Mediation MR analysis shows that 56% (95% CIs [32%-79%]) of this effect is mediated via DA. Our finding suggests that higher childhood adiposity decreases mammographic DA, subsequently reducing breast cancer risk. Understanding this mechanism is important for identifying potential intervention targets.
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Affiliation(s)
- Marina Vabistsevits
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, UK.
- University of Bristol, Population Health Sciences, Bristol, UK.
| | - George Davey Smith
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, UK
- University of Bristol, Population Health Sciences, Bristol, UK
| | - Tom G Richardson
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, UK
- University of Bristol, Population Health Sciences, Bristol, UK
| | - Rebecca C Richmond
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, UK
- University of Bristol, Population Health Sciences, Bristol, UK
| | - Weiva Sieh
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, Department of Population Health Science and Policy, New York, NY, USA
- University of Texas MD Anderson Cancer Center, Department of Epidemiology, Houston, TX, USA
| | - Joseph H Rothstein
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, Department of Population Health Science and Policy, New York, NY, USA
- University of Texas MD Anderson Cancer Center, Department of Epidemiology, Houston, TX, USA
| | - Laurel A Habel
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Stacey E Alexeeff
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Bethan Lloyd-Lewis
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, UK
| | - Eleanor Sanderson
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, UK
- University of Bristol, Population Health Sciences, Bristol, UK
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2
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Kehm RD, Lilge L, Walter EJ, White M, Herbstman JB, Perera FP, Miller RL, Terry MB, Tehranifar P. Socioeconomic Status at Birth and Breast Tissue Composition in Adolescence and Adulthood. Cancer Epidemiol Biomarkers Prev 2023; 32:1294-1301. [PMID: 37436425 PMCID: PMC10804240 DOI: 10.1158/1055-9965.epi-23-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) at birth is associated with breast cancer risk. Whether this association is driven by changes in breast tissue composition (BTC) prior to adulthood remains unclear. METHODS We used multivariable linear regression models to examine whether SES at birth is associated with BTC in adolescence and adulthood using data from a New York City cohort of daughters (n = 165, 11-20 years) and mothers (n = 160, 29-55 years). We used maternal-reported data on daughters' household income and maternal education at birth, analyzed individually and in combination (SES index). Women also reported their own mothers' education at birth. We used optical spectroscopy to evaluate BTC measures that positively (water content, collagen content, optical index) and negatively (lipid content) correlate with mammographic breast density, a recognized breast cancer risk factor. RESULTS Being in the highest versus lowest category of the SES index was associated with lower lipid content [βadjusted (βadj) = -0.80; 95% confidence interval (CI), -1.30 to -0.31] and higher collagen content (βadj = 0.54; 95% CI, 0.09-0.99) in adolescence. In women with a body mass index (BMI) <30 kg/m2, higher maternal education at birth (≥ vs. < high school degree) was associated with lower lipid content (βadj = -0.57; 95% CI, -0.97 to -0.17), higher water content (βadj = 0.70; 95% CI, 0.26-1.14), and higher optical index (βadj = 0.53; 95% CI, 0.10-0.95). CONCLUSIONS This study supports that SES at birth is associated with BTC in adolescence and adulthood, although the latter association may depend on adult BMI. IMPACT Further research is needed to identify the socially patterned early life factors influencing BTC.
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Affiliation(s)
- Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168 St, New York, NY 10032, USA
| | - Lothar Lilge
- Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, ON M5G 0A3, Canada
- Princess Margaret Cancer Centre, University Health Network, 101 College St, Toronto, ON M5G 0A3, Canada
| | - E Jane Walter
- Princess Margaret Cancer Centre, University Health Network, 101 College St, Toronto, ON M5G 0A3, Canada
| | - Melissa White
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168 St, New York, NY 10032, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168 St, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168 St, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
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3
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Vabistsevits M, Smith GD, Richardson TG, Richmond RC, Sieh W, Rothstein JH, Habel LA, Alexeeff SE, Lloyd-Lewis B, Sanderson E. The mediating role of mammographic density in the protective effect of early-life adiposity on breast cancer risk: a multivariable Mendelian randomization study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.01.23294765. [PMID: 37693539 PMCID: PMC10491349 DOI: 10.1101/2023.09.01.23294765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Observational studies suggest that mammographic density (MD) may have a role in the unexplained protective effect of childhood adiposity on breast cancer risk. Here, we investigated a complex and interlinked relationship between puberty onset, adiposity, MD, and their effects on breast cancer using Mendelian randomization (MR). We estimated the effects of childhood and adulthood adiposity, and age at menarche on MD phenotypes (dense area (DA), non-dense area (NDA), percent density (PD)) using MR and multivariable MR (MVMR), allowing us to disentangle their total and direct effects. Next, we examined the effect of MD on breast cancer risk, including risk of molecular subtypes, and accounting for genetic pleiotropy. Finally, we used MVMR to evaluate whether the protective effect of childhood adiposity on breast cancer was mediated by MD. Childhood adiposity had a strong inverse effect on mammographic DA, while adulthood adiposity increased NDA. Later menarche had an effect of increasing DA and PD, but when accounting for childhood adiposity, this effect attenuated to the null. DA and PD had a risk-increasing effect on breast cancer across all subtypes. The MD single-nucleotide polymorphism (SNP) estimates were extremely heterogeneous, and examination of the SNPs suggested different mechanisms may be linking MD and breast cancer. Finally, MR mediation analysis estimated that 56% (95% CIs [32% - 79%]) of the childhood adiposity effect on breast cancer risk was mediated via DA. In this work, we sought to disentangle the relationship between factors affecting MD and breast cancer. We showed that higher childhood adiposity decreases mammographic DA, which subsequently leads to reduced breast cancer risk. Understanding this mechanism is of great importance for identifying potential targets of intervention, since advocating weight gain in childhood would not be recommended.
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Affiliation(s)
- Marina Vabistsevits
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
- University of Bristol, Population Health Sciences, Bristol, United Kingdom
| | - George Davey Smith
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
- University of Bristol, Population Health Sciences, Bristol, United Kingdom
| | - Tom G. Richardson
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
- University of Bristol, Population Health Sciences, Bristol, United Kingdom
| | - Rebecca C. Richmond
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
- University of Bristol, Population Health Sciences, Bristol, United Kingdom
| | - Weiva Sieh
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, Department of Population Health Science and Policy, New York, NY, United States
- University of Texas MD Anderson Cancer Center, Department of Epidemiology, Houston, TX, United States
| | - Joseph H. Rothstein
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, Department of Population Health Science and Policy, New York, NY, United States
- University of Texas MD Anderson Cancer Center, Department of Epidemiology, Houston, TX, United States
| | - Laurel A. Habel
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Stacey E. Alexeeff
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Bethan Lloyd-Lewis
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - Eleanor Sanderson
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
- University of Bristol, Population Health Sciences, Bristol, United Kingdom
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Getz KR, Adedokun B, Xu S, Toriola AT. Breastfeeding and Mammographic Breast Density: A Cross-sectional Study. Cancer Prev Res (Phila) 2023; 16:353-361. [PMID: 36930943 PMCID: PMC10239347 DOI: 10.1158/1940-6207.capr-22-0482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/23/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Breastfeeding is inversely associated with breast cancer risk but the associations of breastfeeding with mammographic breast density (MBD) are not clear. We investigated the association between breastfeeding and volumetric measures of MBD [volumetric percent density (VPD), dense volume (DV), and non-dense volume (NDV)] and evaluated whether it differs by race, menopausal status, and body mass index (BMI). The study population was comprised of 964 women (67% non-Hispanic White, 29% non-Hispanic Black) who had screening mammography at Washington University School of Medicine, St. Louis, MO. VPD, DV and NDV were log10 transformed. We performed multivariable linear regression models adjusted for age, BMI, family history of breast cancer, race, and age at menarche among all participants and exclusively in parous women. Mean age was 50.7 years. VPD was 12% lower among women who breastfed 0-6 months, [10β = 0.88, 95% confidence interval (CI; 0.79-0.98)] compared with nulliparous women. Breastfeeding was not associated with VPD among women who breastfed >7 months. Breastfeeding was inversely associated with DV [parous never breastfed: 10β = 0.93; 95% CI (0.83-1.04), breastfed 0-6 months: 10β = 0.91, 95% CI (0.79-1.05), breastfed 7-12 months: 10β = 0.94; 95% CI (0.81-1.10), breastfed >12 months: 10β = 0.87, 95% CI (0.78-0.98), Ptrend = 0.03]. BMI modified the association between breastfeeding and VPD. Women who breastfed for 0-6 months and had a BMI < 25 kg/m2 had lower VPD compared with nulliparous women, but among women with a BMI ≥ 25 kg/m2 there was no association (Pinteraction = 0.04). In this diverse study population, the association of breastfeeding with VPD appears to be modified by BMI, but not by race or menopausal status. Future research exploring the associations of breastfeeding with other mammographic features are needed. PREVENTION RELEVANCE Breastfeeding for up to 6 months may be associated with lower VPD among women with a BMI < 25 kg/m2. The potential role of MBD in mediating the associations of breastfeeding with breast cancer risk in a select group of women deserves further evaluation. See related Spotlight, p. 309.
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Affiliation(s)
- Kayla R. Getz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Babatunde Adedokun
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Shuai Xu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adetunji T. Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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5
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Gastounioti A, Cohen EA, Pantalone L, Ehsan S, Vasudevan S, Kurudi A, Conant EF, Chen J, Kontos D, McCarthy AM. Changes in mammographic density and risk of breast cancer among a diverse cohort of women undergoing mammography screening. Breast Cancer Res Treat 2023; 198:535-544. [PMID: 36800118 DOI: 10.1007/s10549-023-06879-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Mammographic density (MD) is a strong breast cancer risk factor. MD may change over time, with potential implications for breast cancer risk. Few studies have assessed associations between MD change and breast cancer in racially diverse populations. We investigated the relationships between MD and MD change over time and breast cancer risk in a large, diverse screening cohort. MATERIALS AND METHODS We retrospectively analyzed data from 8462 women who underwent ≥ 2 screening mammograms from Sept. 2010 to Jan. 2015 (N = 20,766 exams); 185 breast cancers were diagnosed 1-7 years after screening. Breast percent density (PD) and dense area (DA) were estimated from raw digital mammograms (Hologic Inc.) using LIBRA (v1.0.4). For each MD measure, we modeled breast density change between two sequential visits as a function of demographic and risk covariates. We used Cox regression to examine whether varying degrees of breast density change were associated with breast cancer risk, accounting for multiple exams per woman. RESULTS PD at any screen was significantly associated with breast cancer risk (hazard ratio (HR) for PD = 1.03 (95% CI [1.01, 1.05], p < 0.0005), but neither change in breast density nor more extreme than expected changes in breast density were associated with breast cancer risk. We found no evidence of differences in density change or breast cancer risk due to density change by race. Results using DA were essentially identical. CONCLUSIONS Using a large racially diverse cohort, we found no evidence of association between short-term change in MD and risk of breast cancer, suggesting that short-term MD change is not a strong predictor for risk.
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Affiliation(s)
- Aimilia Gastounioti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric A Cohen
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Pantalone
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Ehsan
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjana Vasudevan
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Avinash Kurudi
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily F Conant
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jinbo Chen
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Despina Kontos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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6
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Masala G, Bendinelli B, Caini S, Duroni G, Ermini I, Pastore E, Fontana M, Facchini L, Querci A, Gilio MA, Mazzalupo V, Assedi M, Ambrogetti D, Palli D. Lifetime changes in body fatness and breast density in postmenopausal women: the FEDRA study. Breast Cancer Res 2023; 25:35. [PMID: 37004102 PMCID: PMC10067176 DOI: 10.1186/s13058-023-01624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND High mammographic breast density (MBD) is an established risk factor for breast cancer (BC). Body fatness conveys an increased BC risk in postmenopause but is associated with less dense breasts. Here, we studied the relationship between body fatness and breast composition within the FEDRA (Florence-EPIC Digital mammographic density and breast cancer Risk Assessment) longitudinal study. METHODS Repeated anthropometric data and MBD parameters (obtained through an automated software on BC screening digital mammograms) were available for all participants, as well as information on other BC risk factors. Multivariate linear regression and functional data analysis were used to longitudinally evaluate the association of body fatness, and changes thereof over time, with dense (DV) and non-dense (NDV) breast volumes and volumetric percent density (VPD). RESULTS A total of 5,262 women were included, with anthropometric data available at 20 and 40 years of age, at EPIC baseline (mean 49.0 years), and an average of 9.4 years thereafter. The mean number of mammograms per woman was 3.3 (SD 1.6). Body fatness (and increases thereof) at any age was positively associated with DV and NDV (the association being consistently stronger for the latter), and inversely associated with VPD. For instance, an increase by 1 kg/year between the age of 40 years and EPIC baseline was significantly associated with 1.97% higher DV, 8.85% higher NDV, and 5.82% lower VPD. CONCLUSION Body fatness and its increase from young adulthood until midlife are inversely associated with volumetric percent density, but positively associated with dense and non-dense breast volumes in postmenopausal women.
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Affiliation(s)
- Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Benedetta Bendinelli
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy.
| | - Giacomo Duroni
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Ilaria Ermini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Miriam Fontana
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Luigi Facchini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Andrea Querci
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Maria Antonietta Gilio
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Vincenzo Mazzalupo
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Melania Assedi
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Daniela Ambrogetti
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
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7
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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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Body Mass Index Is Inversely Associated with Risk of Postmenopausal Interval Breast Cancer: Results from the Women’s Health Initiative. Cancers (Basel) 2022; 14:cancers14133228. [PMID: 35804998 PMCID: PMC9264843 DOI: 10.3390/cancers14133228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Interval breast cancer refers to cancer diagnosed after a negative screening mammogram and before the next scheduled screening mammogram. Interval breast cancer has worse prognosis than screening-detected cancer. Body mass index (BMI) influences the accuracy of mammography and overall postmenopausal breast cancer risk, yet how is obesity associated with postmenopausal interval breast cancer incidence is unclear. The current study included cancer-free postmenopausal women aged 50–79 years at enrollment in the Women’s Health Initiative who were diagnosed with breast cancer during follow-up. Analyses include 324 interval breast cancer cases diagnosed within one year after the participant’s last negative screening mammogram and 1969 screening-detected breast cancer patients. Obesity (BMI ≥ 30 kg/m2) was measured at baseline. Associations between obesity and incidence of interval cancer were determined by sequential logistic regression analyses. In multivariable-adjusted models, obesity was inversely associated with interval breast cancer risk [OR (95% CI) = 0.65 (0.46, 0.92)]. The inverse association persisted after excluding women diagnosed within 2 years [OR (95% CI) = 0.60 (0.42, 0.87)] or 4 years [OR (95% CI) = 0.56 (0.37, 0.86)] of enrollment, suggesting consistency of the association regardless of screening practices prior to trial entry. These findings warrant confirmation in studies with body composition measures.
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9
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Vabistsevits M, Davey Smith G, Sanderson E, Richardson TG, Lloyd-Lewis B, Richmond RC. Deciphering how early life adiposity influences breast cancer risk using Mendelian randomization. Commun Biol 2022; 5:337. [PMID: 35396499 PMCID: PMC8993830 DOI: 10.1038/s42003-022-03272-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
Studies suggest that adiposity in childhood may reduce the risk of breast cancer in later life. The biological mechanism underlying this effect is unclear but is likely to be independent of body size in adulthood. Using a Mendelian randomization framework, we investigate 18 hypothesised mediators of the protective effect of childhood adiposity on later-life breast cancer, including hormonal, reproductive, physical, and glycaemic traits. Our results indicate that, while most of the hypothesised mediators are affected by childhood adiposity, only IGF-1 (OR: 1.08 [1.03: 1.15]), testosterone (total/free/bioavailable ~ OR: 1.12 [1.05: 1.20]), age at menopause (OR: 1.05 [1.03: 1.07]), and age at menarche (OR: 0.92 [0.86: 0.99], direct effect) influence breast cancer risk. However, multivariable Mendelian randomization analysis shows that the protective effect of childhood body size remains unaffected when accounting for these traits (ORs: 0.59-0.67). This suggests that none of the investigated potential mediators strongly contribute to the protective effect of childhood adiposity on breast cancer risk individually. It is plausible, however, that several related traits could collectively mediate the effect when analysed together, and this work provides a compelling foundation for investigating other mediating pathways in future studies.
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Affiliation(s)
- Marina Vabistsevits
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Eleanor Sanderson
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Tom G Richardson
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Novo Nordisk Research Centre, Headington, Oxford, OX3 7FZ, UK
| | - Bethan Lloyd-Lewis
- School of Cellular and Molecular Medicine, University of Bristol, Biomedical Sciences Building, Bristol, BS8 1TD, UK
| | - Rebecca C Richmond
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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Han Y, Colditz GA, Toriola AT. Changes in adiposity over the life course and gene expression in postmenopausal women. Cancer Med 2022; 11:2699-2710. [PMID: 35304837 PMCID: PMC9249983 DOI: 10.1002/cam4.4649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Early life adiposity and changes in adiposity over the life course are associated with mammographic breast density among postmenopausal women. However, the underlying mechanisms are unknown; therefore, we comprehensively examined the associations of early life body mass index (BMI) and changes in BMI from ages 10, 18 to age at mammogram with growth factor, RANK pathway, and sex hormone gene expression in 372 postmenopausal women. METHODS We estimated early life BMI at age 10 using the validated 9-level Stunkard pictogram. We calculated BMI at other ages (18, 30, and current age at mammogram) by dividing weight in kilograms at these ages with height in meters squared. Sequencing for gene expression was performed using the NanoString nCounter system. After adjusting for confounders, we estimated associations using multivariable linear regressions. RESULTS A 10 kg/m2 increase in early life BMI at age 10 was associated with a 17.2% decrease in RANKL gene expression (95% confidence interval [CI] = -30.8, -0.9) but was not associated with changes in other markers. BMI changes from ages 10, 18 to age at mammogram were associated with an increase in BMP2 and decreases in RANK, RANKL, and TNFRSF13B gene expression but were not associated with gene expression of other markers. A 10 kg/m2 increase in early life BMI from age 10 to current age was associated with a 7.8% increase in BMP2 (95% CI = -1.4, 17.8), an 8.5% decrease in RANK (95% CI = -13.9, -2.8), a 10.4% decrease in RANKL (95% CI = -16.9, -3.3), and an 8.5% decrease in TNFRSF13B gene expression (95% CI = -13.8, -2.8). CONCLUSION The results provide new insights into the biological mechanisms underlying the associations of adiposity changes from early life to adulthood and early life adiposity with mammographic breast density in postmenopausal women.
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Affiliation(s)
- Yunan Han
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSaint LouisMissouriUSA
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSaint LouisMissouriUSA,Alvin J. Siteman Cancer CenterBarnes‐Jewish Hospital and Washington University School of MedicineSaint LouisMissouriUSA
| | - Adetunji T. Toriola
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSaint LouisMissouriUSA,Alvin J. Siteman Cancer CenterBarnes‐Jewish Hospital and Washington University School of MedicineSaint LouisMissouriUSA
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Akinjiyan FA, Adams A, Xu S, Wang M, Toriola AT. Plasma Growth Factor Gene Expression and Mammographic Breast Density in Postmenopausal Women. Cancer Prev Res (Phila) 2022; 15:391-398. [PMID: 35288741 DOI: 10.1158/1940-6207.capr-21-0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/28/2021] [Accepted: 03/11/2022] [Indexed: 11/16/2022]
Abstract
Mammographic breast density (MBD) is a risk factor for breast cancer, but its molecular basis is poorly understood. Growth factors stimulate cellular and epithelial proliferation and could influence MBD via these mechanisms. Studies investigating the associations of circulating growth factors with MBD have, however, yielded conflicting results especially in postmenopausal women. We, therefore, investigated the associations of plasma growth factor gene expression (IGF-1, IGFBP-3, FGF-1, FGF-12, TGFB-1 and BMP-2) with MBD in postmenopausal women. We used NanoString nCounter platform to quantify plasma growth factor gene expression and Volpara to evaluate volumetric MBD measures. We investigated the associations of growth factor gene expression with MBD using both multiple linear regression (fold change) and multinomial logistic regression models, adjusted for potential confounders. The mean age of the 368 women enrolled was 58 years (range: 50-64). In analyses using linear regression models, one unit increase in IGF-1 gene expression was associated with a 35% higher VPD (1.35, 95%CI 1.13-1.60, p-value=0.001). There were suggestions that TGFB-1 gene expression was positively associated with VPD while BMP gene expression was inversely associated with VPD, but these were not statistically significant. In analyses using multinomial logistic regression, TGFB-1 gene expression was 33% higher (OR=1.33, 95%CI 1.13-1.56, p-value=0.0008) in women with extremely dense breasts than those with almost entirely fatty breasts. There were no associations between growth factor gene expression and dense volume or non-dense volume. Our study provides insights into the associations of growth factors with MBD in postmenopausal women and require confirmation in other study populations.
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Affiliation(s)
- Favour A Akinjiyan
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Andrea Adams
- Washington University in St. Louis School of Medicine, St. Louis, United States
| | - Shuai Xu
- Washington University in St. Louis School of Medicine, Saint Louis, United States
| | - Mei Wang
- Washington University in St. Louis School of Medicine, St. Louis, United States
| | - Adetunji T Toriola
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Yu T, Ye DM. The epidemiologic factors associated with breast density: A review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:53. [PMID: 36092490 PMCID: PMC9450246 DOI: 10.4103/jrms.jrms_962_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
In recent years, some studies have evaluated the epidemiologic factors associated with breast density. However, the variant and inconsistent results exist. In addition, breast density has been proved to be a significant risk factor associated with breast cancer. Our review summarized the published studies and emphasized the crucial factors including epidemiological factors associated with breast density. In addition, we also discussed the potential reasons for the discrepant results with risk factors. To decrease the incidence and mortality rates for breast cancer, in clinical practice, breast density should be included for clinical risk models in addition to epidemiological factors, and physicians should get more concentrate on those women with risk factors and provide risk-based breast cancer screening regimens.
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Han Y, Lee CT, Xu S, Mi X, Phillip CR, Salazar AS, Rakhmankulova M, Toriola AT. Medication use and mammographic breast density. Breast Cancer Res Treat 2021; 189:585-592. [PMID: 34196899 DOI: 10.1007/s10549-021-06321-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A dense breast on mammogram is a strong risk factor for breast cancer. Identifying factors that reduce mammographic breast density could thus provide insight into breast cancer prevention. Due to the limited number of studies and conflicting findings, we investigated the associations of medication use (specifically statins, aspirin, and ibuprofen) with mammographic breast density. METHODS We evaluated these associations in 775 women who were recruited during an annual screening mammogram at Washington University School of Medicine, St. Louis. We measured mammographic breast density using Volpara. We used multivariable-adjusted linear regressions to determine the associations of medication use (statins, aspirin, and ibuprofen) with mammographic breast density. Least squared means were generated and back-transformed for easier interpretation. RESULTS The mean age of study participants was 52.9 years. Statin use in the prior 12 months was not associated with volumetric percent density or dense volume, but was positively associated with non-dense volume. The mean volumetric percent density was 8.6% among statin non-users, 7.2% among women who used statins 1-3 days/week, and 7.3% among women who used statins ≥ 4 days/week (p trend = 0.07). The non-dense volume was 1297.1 cm3 among statin non-users, 1368.7 cm3 among women who used statins 1-3 days/week, and 1408.4 cm3 among those who used statins ≥ 4 days/week (p trend = 0.02). We did not observe statistically significant differences in mammographic breast density by aspirin or ibuprofen use. CONCLUSION Statin, aspirin, and ibuprofen use was not associated with volumetric percent density and dense volume, but statin use was positively associated with non-dense volume. Any potential associations of these medications with breast cancer risk are unlikely to be mediated through an effect on volumetric percent density.
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Affiliation(s)
- Yunan Han
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA.,Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chee Teik Lee
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA.,School of Medicine, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland
| | - Shuai Xu
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Xiaoyue Mi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Courtnie R Phillip
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Ana S Salazar
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Malika Rakhmankulova
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Adetunji T Toriola
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA. .,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA.
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