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Differences in mammographic density between Asian and Caucasian populations: a comparative analysis

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Mammographic density is a measurable and modifiable biomarker that is strongly and independently associated with breast cancer risk. Paradoxically, although Asian women have lower risk of breast cancer, studies of minority Asian women in predominantly Caucasian populations have found that Asian women have higher percent density. In this cross-sectional study, we compared the distribution of mammographic density for a matched cohort of Asian women from Malaysia and Caucasian women from Sweden, and determined if variations in mammographic density could be attributed to population differences in breast cancer risk factors.

Methods

Volumetric mammographic density was compared for 1501 Malaysian and 4501 Swedish healthy women, matched on age and body mass index. We used multivariable log-linear regression to determine the risk factors associated with mammographic density and mediation analysis to identify factors that account for differences in mammographic density between the two cohorts.

Results

Compared to Caucasian women, percent density was 2.0% higher among Asian women (p < 0.001), and dense volume was 5.7 cm3 higher among pre-menopausal Asian women (p < 0.001). Dense volume was 3.0 cm3 lower among post-menopausal Asian women (p = 0.009) compared to post-menopausal Caucasian women, and this difference was attributed to population differences in height, weight, and parity (p < 0.001).

Conclusions

Our analysis suggests that among post-menopausal women, population differences in mammographic density and risk to breast cancer may be accounted for by height, weight, and parity. Given that pre-menopausal Asian and Caucasian women have similar population risk to breast cancer but different dense volume, development of more appropriate biomarkers of risk in pre-menopausal women is required.

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Authors’ contributions

NR and WKH conducted statistical analysis; SM, KC, NA, FH and KR recruited patients; ME, JT, KPY, SM, and FH retrieved images and conducted image analysis; NR, PH, and ST conceived the study; NR and ST drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We thank participants for taking part in this study, all staff at the Health Screening Centre, and Imaging Department of Subang Jaya Medical Centre and Biomedical Imaging Department of University Malaya Medical Centre (particularly Dr Farhana Fadzil and Prof Ng Kwan Hoong) for assistance in mammographic screening and reporting, and patient recruitment.

Author information

Authors and Affiliations

  1. Cancer Research Malaysia, 1 Jalan SS12/1A, 47500, Subang Jaya, Selangor, Malaysia

    Nadia Rajaram, Shivaani Mariapun, Pui Yoke Kwan & Soo Hwang Teo

  2. Department of Applied Mathematics, Faculty of Engineering, University of Nottingham Malaysia Campus, Jalan Broga, 43500, Semenyih, Selangor, Malaysia

    Nadia Rajaram & Weang Kee Ho

  3. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77, Stockholm, Sweden

    Mikael Eriksson, Jose Tapia, Kamila Czene & Per Hall

  4. Breast Cancer Research Unit, Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Faizah Harun, Kartini Rahmat, Nur Aishah Mohd Taib & Soo Hwang Teo

  5. Biomedical Imaging Department, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia

    Kartini Rahmat

  6. Department of Radiology, South General Hospital, Stockholm, Sweden

    Per Hall

Authors
  1. Nadia Rajaram
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  2. Shivaani Mariapun
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  7. Faizah Harun
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  9. Kamila Czene
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  10. Nur Aishah Mohd Taib
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  11. Per Hall
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  12. Soo Hwang Teo
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Corresponding author

Correspondence to Soo Hwang Teo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

The MyMammo study is funded by the funds raised through the Sime Darby LPGA Tournament, the University Malaya Research Grant [RP046B-15HTM], and the High Impact Research Grant [UM.C/625/1/HIR-MOHE]. The KARMA Study is funded by the Märit and Hans Rausing’s Initiative Against Breast Cancer, the Kamprad Foundation, and Swedish Research Council [2014 -2271].

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Rajaram, N., Mariapun, S., Eriksson, M. et al. Differences in mammographic density between Asian and Caucasian populations: a comparative analysis. Breast Cancer Res Treat 161, 353–362 (2017). https://doi.org/10.1007/s10549-016-4054-y

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  • DOI: https://doi.org/10.1007/s10549-016-4054-y

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