Breast Cancer Research and Treatment

, Volume 129, Issue 1, pp 135–147 | Cite as

Alcohol, tobacco, and mammographic density: a population-based study

  • Anna Cabanes
  • Roberto Pastor-Barriuso
  • Milagros García-López
  • Carmen Pedraz-Pingarrón
  • Carmen Sánchez-Contador
  • Jose Antonio Vázquez Carrete
  • María Pilar Moreno
  • Carmen Vidal
  • Dolores Salas
  • Josefa Miranda-García
  • Mercé Peris
  • Pilar Moreo
  • María Carmen Santamariña
  • Francisca Collado-García
  • Isabel Gonzalez-Román
  • Nieves Ascunce
  • Marina PollanEmail author
  • DDM-Spain


Mammographic density (MD), or the proportion of the breast with respect to its overall area that is composed of dense tissue, is a strong risk factor for breast cancer. Studies support a positive association of mammographic density and alcohol drinking. This was a cross-sectional multicenter study based on 3584 women, aged 45–68 years, recruited from seven screening centers within the Spanish breast cancer screening program network. The association between MD, alcohol consumption and tobacco use was evaluated by using ordinal logistic models with random center-specific intercepts. We found a weak positive association between current alcohol intake and higher MD, with current alcohol consumption increasing the odds of high MD by 13% (OR = 1.13; 95% CI 0.99–1.28) and high daily grams of alcohol being positively associated with increased MD (P for trend = 0.045). There were no statistically significant differences in MD between smokers and non-smokers. Nevertheless, increased number of daily cigarettes and increased number of accumulated lifetime cigarettes were negatively associated with high MD (P for trend 0.017 and 0.021). The effect of alcohol on MD was modified by menopausal status and tobacco smoking: whereas, alcohol consumption and daily grams of alcohol were positively associated with higher MD in postmenopausal women and in women who were not currently smoking, alcohol consumption had no effect on MD in premenopausal women and current smokers. Our results support an association between recent alcohol consumption and high MD, characterized by a modest increase in risk at low levels of current consumption and a decrease in risk among heavier drinkers. Our study also shows how the effects of alcohol in the breast can be modified by other factors, such as smoking.


Mammographic density Alcohol Smoking Breast cancer Ordinal logistic models 

List of abbreviations


Mammographic density


Food frequency questionnaire


Body mass index


Hormone replacement therapy




Insulin-like growth factor 1



We should like to thank the participants in the DDM-Spain study for their contribution to breast cancer research. This study was supported by: Research Grant FIS PI060386 from Spain’s Health Research Fund (Fondo de Investigación Sanitaria); the EPY 1306/06 Collaboration Agreement between Astra-Zeneca and the Carlos III Institute of Health (Instituto de Salud Carlos III); and a grant from the Spanish Federation of Breast Cancer (FECMA).


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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Anna Cabanes
    • 1
    • 2
  • Roberto Pastor-Barriuso
    • 1
    • 2
  • Milagros García-López
    • 2
    • 3
  • Carmen Pedraz-Pingarrón
    • 4
  • Carmen Sánchez-Contador
    • 5
  • Jose Antonio Vázquez Carrete
    • 6
  • María Pilar Moreno
    • 7
  • Carmen Vidal
    • 8
  • Dolores Salas
    • 9
    • 10
  • Josefa Miranda-García
    • 9
    • 10
  • Mercé Peris
    • 8
  • Pilar Moreo
    • 7
  • María Carmen Santamariña
    • 6
  • Francisca Collado-García
    • 5
  • Isabel Gonzalez-Román
    • 11
  • Nieves Ascunce
    • 2
    • 3
  • Marina Pollan
    • 1
    • 2
    • 12
    Email author
  • DDM-Spain
  1. 1.National Center for EpidemiologyInstituto de Salud Carlos IIIMadridSpain
  2. 2.Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP)
  3. 3.Navarra Breast Cancer Screening ProgrammePublic Health InstitutePamplonaSpain
  4. 4.Castilla-Leon Breast Cancer Screening ProgrammeD.G. Salud Pública ID e ICastilla y LeónSpain
  5. 5.Balearic Islands Breast Cancer Screening ProgrammeHealth Promotion for women and childhood. General Directorate Public Health and Participation, Regional Authority of Health and Consumer AffairsBalearic IslandsSpain
  6. 6.Galicia Breast Cancer Screening ProgrammeRegional Authority of Health, Galicia Regional GovernmentA CoruñaSpain
  7. 7.Aragon Breast Cancer Screening ProgrammeHealth Service of AragonZaragozaSpain
  8. 8.Cancer Prevention and Control UnitCatalan Institute of Oncology (ICO)BarcelonaSpain
  9. 9.Valencia Breast Cancer Screening ProgrammeGeneral Directorate Public HealthValenciaSpain
  10. 10.Centro Superior de Investigación en Salud Pública (CSISP)ValenciaSpain
  11. 11.Castilla-Leon Breast Cancer Screening ProgrammeHealth and Social Welfare DepartmentCastilla y LeónSpain
  12. 12.Área de Epidemiología Ambiental y CáncerCentro Nacional de Epidemiología, Instituto de Salud Carlos IIIMadridSpain

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