High-risk mammographic parenchymal patterns and anthropometric measures: A case–control study

Sala, Evis; Warren, Ruth; McCann, Jenny; Duffy, SW; Luben, Robert; Day, Nicholas E.

doi:10.1038/sj.bjc.6690838

Cited by 51 publications

(45 citation statements)

References 20 publications

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“…When we reanalysed using postmenopausal women alone, our observed effect of BMI on risk remained the same. High BMI is also known to be associated with lower density (Sala et al, 1999) and from the appendix, our results are consistent with this. It may be that the suggestive but nonsignificant interaction in our study of BMI and dense patterns is real and does go some way to explaining the similarity of adjusted and unadjusted effects, despite the apparent negative confounding.…”

Section: Discussionsupporting

confidence: 91%

Interaction of dense breast patterns with other breast cancer risk factors in a case–control study

Duffy

Jakes

et al. 2004

Br J Cancer

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The question of interactions between breast density and other breast cancer risk factors is of interest, since it bears upon the use of density as a marker for changes in breast cancer risk. We studied breast parenchymal patterns and 13 other potential risk factors for breast cancer in 172 breast cancer cases and 338 age-matched controls in Singapore. Dense breast patterns were defined as having Tabar parenchymal pattern IV or V. We found significant interactions between dense patterns and ethnic group (P ¼ 0.046), and between dense patterns and number of deliveries (P ¼ 0.04). Among women with nondense breast patterns, the non-Chinese had lower risk than the Chinese with an odds ratio (OR) of 0.47 (95% CI 0.24, 0.88), whereas in those with dense patterns, the nonChinese had considerably higher risks (OR ¼ 5.34, 95% CI 0.54, 52.51). Alternatively expressed, the increased risk with dense patterns was only observed in the non-Chinese (OR ¼ 13.99, 95% CI 1.33, 146.99). Among parous women, the protective effect of three or more deliveries was only observed in those with dense breast patterns (OR ¼ 0.21, 95% CI 0.06, 0.70). Suggestive but nonsignificant interactions with dense patterns were observed for ever having delivered, age at first delivery, breast feeding and body mass index. The results are consistent with dense breast patterns as a marker for hormonal modification of breast cancer risk. In recent years, there has been increasing interest in breast density as a risk factor for breast cancer, as a potential marker for changes in the breast and as a criterion for inclusion in prevention trials (Warner et al, 1992;Sala et al, 1998;Harrison et al, 2002;Warwick et al, 2003). Radiologically dense breasts are known to be associated with increased risk of breast cancer (Warner et al, 1992;Sala et al, 1998), to be associated with other risk factors for breast cancer (Jakes et al, 2000;Warwick et al, 2003) and to be amenable to exogenous hormonal stimuli (Atkinson et al, 1999;Atkinson and Bingham, 2002;Greendale et al, 2003).The last phenomenon is of particular interest. Increased density (i.e. high-risk pattern) is associated with preparations such as hormone replacement therapy, which increases exposure to oestrogens (Greendale et al, 2003) and therefore risk of breast cancer, and decreased density is associated with preparations such as tamoxifen or isoflavones, which reduce oestrogen exposure and breast cancer risk (Atkinson et al, 1999;Greendale et al, 2003). This suggests that breast density may be of use as an interim marker of response to hormonal chemoprevention therapy. The fundamental issue to be resolved is whether an induced change in breast density automatically confers the corresponding change in breast cancer risk. This may be ascertained by substudies within the chemoprevention trials such as IBIS (Cuzick et al, 2002;Warwick et al, 2003). In the meantime, however, some clues can be gained by studying the interrelationships of dense breast patterns, hormonal and other risk factors, and occurrence of br...

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Section: Discussionsupporting

confidence: 91%

Interaction of dense breast patterns with other breast cancer risk factors in a case–control study

Duffy

Jakes

et al. 2004

Br J Cancer

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“…As expected, overweight and obesity were negatively associated with H-MBD. [24][25][26] The positive association of H-MBD with a previous breast biopsy is also consistent with the results of previous studies. 5,27,28 We found a positive association of borderline significance of H-MBD with a first degree family history of BC, although published results are not consistent.…”

Section: Discussionsupporting

confidence: 81%

Dietary and lifestyle determinants of mammographic breast density. A longitudinal study in a Mediterranean population

Masala

Ambrogetti

Assedi

et al. 2006

Intl Journal of Cancer

139

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High mammographic breast density (H‐MBD) has been associated with increased breast cancer (BC) risk, even after adjustment for established BC risk factors. Only a few studies have examined the influence of diet on MBD. In a longitudinal study in Florence, Italy, we identified about 2,000 women with a mammogram taken 5 years after enrollment, when detailed information on dietary and lifestyle habits and anthropometric measurements had been collected. Original mammograms have been identified and retrieved (1,668; 83%), and MBD was assessed by 2 experienced readers, according to Wolfe's classification and a semiquantitative scale. By logistic analysis, we compared women with H‐MBD (P2 + DY according to Wolfe's classification) with those with low‐MBD (N1 + P1). H‐MBD was confirmed to be inversely associated with BMI, number of children and breast feeding, while it was directly associated with higher educational level, premenopausal status and a previous breast biopsy. In multivariate analyses adjusted for nondietary variables, H‐MBD was inversely associated with increasing consumption of vegetables (p for trend = 0.005) and olive oil (p for trend = 0.04). An inverse association was also evident between H‐MBD and frequent consumption of cheese and high intakes of β‐carotene, vitamin C, calcium and potassium (p for trend ≤ 0.05). On the other hand, we found a positive association with increasing consumption of wine (p for trend = 0.01). This large longitudinal study, the first carried out in Mediterranean women, suggests that specific dietary components may play a key role in determining MBD in this population, thus possibly modulating BC risk. © 2005 Wiley‐Liss, Inc.

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“…The strong inverse association of breast size with Wolfe grade is consistent with previous findings (Brisson et al, 1984;Salminen et al, 1998;Sala et al, 1999). Thus, despite measurement error due to varying degrees of breast compression during mammography, this crude measure of breast size (pectoralis muscle to nipple distance) is useful when no others are available.…”

Section: Main Findingssupporting

confidence: 78%

“…We adjusted for breast size and BMI at age 53 years in all analyses in order to investigate associations with changes in body size independent of body size at mammography, as obesity at mammography is known to be a strong confounder of the mammographic parenchymal pattern (Bartow et al, 1995;Salminen et al, 1998;Sala et al, 1999) and needs to be taken into account when separate measures of the areas of dense and nondense breast are not available.…”

Section: Methodsmentioning

confidence: 99%

“…To our knowledge, only one study (Ekbom et al, 1995) to date has investigated the potential role of perinatal characteristics and found a positive but nonsignificant association with birth weight. Inverse associations have been found between contemporaneous measures of adult adiposity and breast density (Brisson et al, 1984;Grove et al, 1985;Whitehead et al, 1985;De Stavola et al, 1990;Gram et al, 1997;Boyd et al, 1998;Sala et al, 1999), but associations with adult height have been less consistent (Brisson et al, 1984;Gram et al, 1997;Boyd et al, 1998;Sala et al, 1999). These studies were, however, limited to anthropometric measures relating to a single point in time, mostly at mammography, thus a detailed study of the effect of growth and life-course changes in body size could not be investigated.…”

mentioning

confidence: 99%

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Life-course body size and perimenopausal mammographic parenchymal patterns in the MRC 1946 British birth cohort

et al. 2003

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Dense mammographic parenchymal patterns are associated with an increased risk of breast cancer. Certain features of body size have been found to be associated with breast cancer risk, but less is known about their relation to breast density. We investigated the association of birth size, childhood growth and life-course changes in body size with Wolfe grade in 1298 perimenopausal women from a British cohort of women born in 1946. The cohort benefits from repeated measures of body size in childhood and adulthood. We obtained mammograms for 90% of women who at age 53 years reported having previously had a mammogram. We found no associations with birth weight or maximum attained height. Body mass index (BMI) at age 53 years and breast size were independently and inversely associated with Wolfe grade (P-value for trend o0.001 for both). Women who reached puberty later were at a greater odds of a higher Wolfe grade than women who had an earlier puberty (odds ratio associated with a 1 year delay in menarche 1.14, 95% CI: 1.01 -1.27, adjusted for BMI and breast size at mammography). A higher BMI at any age during childhood or adult life was associated with a reduction in the odds of a higher Wolfe grade, after controlling for breast size and BMI at mammography, for example, standardised odds ratio for height at age 7 was 0.72 (95% CI: 0.64, 0.81). These findings reveal the importance of taking life-course changes in body size, and not just contemporaneous measures, into account when using mammographic density as an intermediate marker for risk of breast cancer.

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High-risk mammographic parenchymal patterns and anthropometric measures: A case–control study

Cited by 51 publications

References 20 publications

Interaction of dense breast patterns with other breast cancer risk factors in a case–control study

Interaction of dense breast patterns with other breast cancer risk factors in a case–control study

Dietary and lifestyle determinants of mammographic breast density. A longitudinal study in a Mediterranean population

Life-course body size and perimenopausal mammographic parenchymal patterns in the MRC 1946 British birth cohort

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