Association Between Lifestyle Changes, Mammographic Breast Density, and Breast Cancer

Abstract

In screening for breast cancer (BC), mammographic breast density (MBD) is a powerful risk factor that increases breast carcinogenesis and synergistically reduces the sensitivity of mammography. It also reduces specificity of lesion identification, leading to recalls, additional testing, and delayed and later-stage diagnoses, which result in increased health care costs. These findings provide the foundation for dense breast notification laws and lead to the increase in patient and provider interest in MBD. However, unlike other risk factors for BC, MBD is dynamic through a woman’s lifetime and is modifiable. Although MBD is known to change as a result of factors such as reproductive history and hormonal status, few conclusions have been reached for lifestyle factors such as alcohol, diet, physical activity, smoking, body mass index (BMI), and some commonly used medications. Our review examines the emerging evidence for the association of modifiable factors on MBD and the influence of MBD on BC risk. There are clear associations between alcohol use and menopausal hormone therapy and increased MBD. Physical activity and the Mediterranean diet lower the risk of BC without significant effect on MBD. Although high BMI and smoking are known risk factors for BC, they have been found to decrease MBD. The influence of several other factors, including caffeine intake, nonhormonal medications, and vitamins, on MBD is unclear. We recommend counseling patients on these modifiable risk factors and using this knowledge to help with informed decision making for tailored BC prevention strategies.

Associations between breast cancer risk factors and mammographic breast density in a large cross-section of Korean women

“…The associations between parity-related factors including parity, breastfeeding, and increased density were reported in a recent study, suggesting a higher proportion of epithelial tissue related to parity and decreased density (Azam et al ., 2019). A recent meta-analysis and a review identified HRT use and increased mammographic density (Azam et al ., 2020; Lester et al ., 2022). Breast epithelial cell proliferation or stromal edema due to estrogen and progestin exposure was suggested as a possible mechanism of this association, and the increased association among estrogen plus progestin combination HRT users compared to other HRT regimens supported this mechanism (Azam et al ., 2020; Lester et al ., 2022).…”

Notification de la densité mammaire

“…origines asiatiques) contribuent à la densité mammaire, des facteurs modifiables comme l'exposition aux hormones (p. ex. utilisation de la pilule contraceptive, hormonothérapie), la consommation d'alcool et l'alimentation contribuent aussi à une densité mammaire plus élevée 9 .…”

Breast density notification

“…8 Although many nonmodifiable factors, such as genetics and race (eg, Asian heritage) contribute to breast density, modifiable factors such as hormone exposure (eg, oral contraceptive pill use, hormone replacement therapy), alcohol intake, and diet can also contribute to increased breast density. 9 The risks of dense breasts are 3-fold. First, extremely dense breasts confer a risk of breast cancer that is greater than that of having a first-degree relative with breast cancer.…”