Cancer Causes & Control

, Volume 22, Issue 4, pp 599–610

Reproductive and menstrual factors and mammographic density in African American, Caribbean, and white women

  • Parisa Tehranifar
  • Diane Reynolds
  • Julie Flom
  • Loralee Fulton
  • Yuyan Liao
  • Elizabeth Kudadjie-Gyamfi
  • Mary Beth Terry
Original paper

Abstract

Objective

We investigated the associations between reproductive and menstrual risk factors for breast cancer and mammographic density, a strong risk factor for breast cancer, in a predominantly ethnic minority and immigrant sample.

Methods

We interviewed women (42% African American, 22% African Caribbean, 22% White, 9% Hispanic Caribbean, 5% other) without a history of breast cancer during their mammography appointment (n = 191, mean age = 50). We used a computer-assisted method to measure the area and percentage of dense breast tissue from cranio-caudal mammograms. We used multivariable linear regression analyses to estimate the associations between reproductive and menstrual risk factors and mammographic density.

Results

Age was inversely associated with percent density and dense area, and body mass index (BMI) was inversely associated with percent density. Adjusting for age, BMI, ethnicity and menopausal status, later age at menarche (e.g., β = −7.37, 95% CI: −12.29, −2.46 for age ≥13 years vs. ≤11 years), and any use of hormonal birth control (HBC) methods (β = −5.10, 95% CI: −9.37, −0.84) were associated with reduced dense area. Ethnicity and nativity (foreign- vs. US-born) were not directly associated with density despite variations in the distribution of several risk factors across ethnic and nativity groups.

Conclusions

The mean level of mammographic density did not differ across ethnic and nativity groups, but several risk factors for breast cancer were associated with density in ethnic minority and immigrant women.

Keywords

Breast cancer Mammographic density Risk factors Ethnicity Nativity status 

References

  1. 1.
    Boyd NF, Lockwood GA, Byng JW, Tritchler DL, Yaffe MJ (1998) Mammographic densities and breast cancer risk. Cancer Epidemiol Biom Prev 7:1133–1144Google Scholar
  2. 2.
    Boyd NF, Byng JW, Jong RA, Fishell EK, Little LE, Miller AB et al (1995) Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. J Natl Cancer Inst 87(9):670–675PubMedCrossRefGoogle Scholar
  3. 3.
    Oza AM, Boyd NF (1993) Mammographic parenchymal patterns: a marker of breast cancer risk. Epidemiol Rev 15(1):196–208PubMedGoogle Scholar
  4. 4.
    McCormack VA, dos Santos Silva I (2006) Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 15(6):1159–1169PubMedCrossRefGoogle Scholar
  5. 5.
    Li T, Sun L, Miller N, Nicklee T, Woo J, Hulse-Smith L et al (2005) The association of measured breast tissue characteristics with mammographic density and other risk factors for breast cancer. Cancer Epidemiol Biomarkers Prev 14(2):343–349PubMedCrossRefGoogle Scholar
  6. 6.
    Laya MB, Gallagher JC, Schreiman JS, Larson EB, Watson P, Weinstein L (1995) Effect of postmenopausal hormonal replacement therapy on mammographic density and parenchymal pattern. Radiology 196(2):433–437PubMedGoogle Scholar
  7. 7.
    Maskarinec G, Pagano I, Lurie G, Kolonel LN (2006) A longitudinal investigation of mammographic density: the multiethnic cohort. Cancer Epidemiol Biomarkers Prev 15(4):732–739PubMedCrossRefGoogle Scholar
  8. 8.
    Nordevang E, Azavedo E, Svane G, Nilsson B, Holm LE (1993) Dietary habits and mammographic patterns in patients with breast cancer. Breast Cancer Res Treat 26(3):207–215PubMedCrossRefGoogle Scholar
  9. 9.
    Butler LM, Gold EB, Greendale GA, Crandall CJ, Modugno F, Oestreicher N et al (2008) Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN). Breast Cancer Res Treat 112(1):165–174PubMedCrossRefGoogle Scholar
  10. 10.
    Martin LJ, Melnichouk O, Guo H, Chiarelli AM, Hislop TG, Yaffe MJ et al (2010) Family history, mammographic density, and risk of breast cancer. Cancer Epidemiol Biomarkers Prev 19(2):456–463PubMedCrossRefGoogle Scholar
  11. 11.
    Kerlikowske K, Ichikawa L, Miglioretti DL, Buist DS, Vacek PM, Smith-Bindman R et al (2007) Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst 99(5):386–395PubMedCrossRefGoogle Scholar
  12. 12.
    Ward E, Jemal A, Cokkinides V et al (2004) Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54:78–93PubMedCrossRefGoogle Scholar
  13. 13.
    Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K et al (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295(21):2492–2502PubMedCrossRefGoogle Scholar
  14. 14.
    Setiawan VW, Monroe KR, Wilkens LR, Kolonel LN, Pike MC, Henderson BE (2009) Breast cancer risk factors defined by estrogen and progesterone receptor status: the multiethnic cohort study. Am J Epidemiol 169(10):1251–1259PubMedCrossRefGoogle Scholar
  15. 15.
    del Carmen MG, Halpern EF, Kopans DB, Moy B, Moore RH, Goss PE et al (2007) Mammographic breast density and race. AJR Am J Roentgenol 188(4):1147–1150PubMedCrossRefGoogle Scholar
  16. 16.
    del Carmen MG, HE Hughes KS, Rafferty E, Kopans D, Parisky YR, Sardi A et al (2003) Racial differences in mammographic breast density. Cancer 198(3):590–596CrossRefGoogle Scholar
  17. 17.
    Habel LA, Capra AM, Oestreicher N, Greendale GA, Cauley JA, Bromberger J et al (2007) Mammographic density in a multiethnic cohort. Menopause 14(5):891–899PubMedCrossRefGoogle Scholar
  18. 18.
    El-Bastawissi AY, White E, Mandelson MT, Taplin S (2001) Variation in mammographic breast density by race. Ann Epidemiol 11:257–263PubMedCrossRefGoogle Scholar
  19. 19.
    Caire-Juvera G, Arendell LA, Maskarinec G, Thomson CA, Chen Z (2008) Associations between mammographic density and body composition in Hispanic and non-Hispanic white women by menopause status. Menopause 15(2):319–325PubMedCrossRefGoogle Scholar
  20. 20.
    Tseng M, Byrne C, Evers KA, London WT, Daly MB (2006) Acculturation and breast density in foreign-born, US Chinese women. Cancer Epidemiol Biomarkers Prev 15(7):1301–1305PubMedCrossRefGoogle Scholar
  21. 21.
    Maskarinec G, Pagano I, Lurie G, Wilkens LR, Kolonel LN (2005) Mammographic density and breast cancer risk: the multiethnic cohort study. Am J Epidemiol 162(8):743–752PubMedCrossRefGoogle Scholar
  22. 22.
    Maskarinec G, Pagano I, Chen Z, Nagata C, Gram IT (2007) Ethnic and geographic differences in mammographic density and their association with breast cancer incidence. Breast Cancer Res Treat 104(1):47–56PubMedCrossRefGoogle Scholar
  23. 23.
    Gans KM, Burkholder GJ, Upegui DI, Risica PM, Lasater TM, Fortunet R (2002) Comparison of baseline fat-related eating behaviors of Puerto Rican, Dominican, Colombian, and Guatemalan participants who joined a cholesterol education project. J Nutr Educ Behav 34(4):202–210PubMedCrossRefGoogle Scholar
  24. 24.
    John ES, Phipps AI, Davis A, Koo J (2005) Migration history, acculturation, and breast cancer risk in Hispanic women. Cancer Epidemiol Biomarkers Prev 14(12):2905–2913PubMedCrossRefGoogle Scholar
  25. 25.
    Stroup-Benham CA, Treviño FM (1991) Reproductive characteristics of Mexican-American, mainland Puerto Rican, and Cuban-American women Data from the Hispanic Health and Nutrition Examination Survey. JAMA 265(2):222–226PubMedCrossRefGoogle Scholar
  26. 26.
    Marks G, Garcia M, JM S (1990) Health risk behaviors of Hispanics in the United States: findings from HHANES, 1982–84. Am J Public Health 80(Suppl):20–26PubMedCrossRefGoogle Scholar
  27. 27.
    Bernal G, Enchautegui-de-Jesus N (1994) Latinos and Latinas in community psychology: a review of the literature. Am J Commun Psychol 22(4):531–557Google Scholar
  28. 28.
    Consedine NS, Magai C, Conway F, Neugut AI (2004) Obesity and awareness of obesity as risk factors for breast cancer in six ethnic groups. Obes Res 12(10):1680–1689PubMedCrossRefGoogle Scholar
  29. 29.
    Nazroo J, Jackson J, Karlsen S, Torres M (2007) The Black diaspora and health inequalities in the US and England: does where you go and how you get there make a difference? Sociol Health Illn 29(6):811–830PubMedCrossRefGoogle Scholar
  30. 30.
    McCormack VA, Perry N, Vinnicombe SJ, Silva Idos S (2008) Ethnic variations in mammographic density: a British multiethnic longitudinal study. Am J Epidemiol 168(4):412–421PubMedCrossRefGoogle Scholar
  31. 31.
    Byng JW, Boyd NF, Little L, Lockwood G, Fishell E, Jong RA et al (1996) Symmetry of projection in the quantitative analysis of mammographic images. Eur J Cancer Prev 5(5):319–327PubMedCrossRefGoogle Scholar
  32. 32.
    Stone J, Warren RM, Pinney E, Warwick J, Cuzick J (2009) Determinants of percentage and area measures of mammographic density. Am J Epidemiol 170(12):1571–1578PubMedCrossRefGoogle Scholar
  33. 33.
    Maskarinec G, Pagano I, Chen Z, Nagata C, Gram IT (2007) Ethnic and geographic differences in mammographic density and their association with breast cancer incidence. Breast Cancer Res Treat 104(1):47–56PubMedCrossRefGoogle Scholar
  34. 34.
    Reeves KW, Stone RA, Modugno F, Ness RB, Vogel VG, Weissfeld JL et al (2009) Longitudinal association of anthropometry with mammographic breast density in the Study of Women’s Health Across the Nation. Int J Cancer 124(5):1169–1177PubMedCrossRefGoogle Scholar
  35. 35.
    Haars G, van Noord PA, van Gils CH, Grobbee DE, Peeters PH (2005) Measurements of breast density: no ratio for a ratio. Cancer Epidemiol Biomarkers Prev 14(11 Pt 1):2634–2640PubMedCrossRefGoogle Scholar
  36. 36.
    McCormack VA, dos Santos Silva I, De Stavola BL, Perry N, Vinnicombe S, Swerdlow AJ et al (2003) Life-course body size and perimenopausal mammographic parenchymal patterns in the MRC 1946 British birth cohort. Br J Cancer 89(5):852–859PubMedCrossRefGoogle Scholar
  37. 37.
    Boyd NF, Lockwood GA, Byng JW, Little LE, Yaffe MJ, Tritchler DL (1998) The relationship of anthropometric measures to radiological features of the breast in premenopausal women. Br J Cancer 78(9):1233–1238PubMedCrossRefGoogle Scholar
  38. 38.
    Oestreicher N, Capra A, Bromberger J, Butler LM, Crandall CJ, Gold EB et al (2008) Physical activity and mammographic density in a cohort of midlife women. Med Sci Sports Exerc 40(3):451–456PubMedCrossRefGoogle Scholar
  39. 39.
    Chen Z, Wu AH, Gauderman WJ, Bernstein L, Ma H, Pike MC et al (2004) Does mammographic density reflect ethnic differences in breast cancer incidence rates? Am J Epidemiol 159(2):140–147PubMedCrossRefGoogle Scholar
  40. 40.
    Heng D, Gao F, Jong R, Fishell E, Yaffe M, Martin L et al (2004) Risk factors for breast cancer associated with mammographic features in Singaporean Chinese women. Cancer Epidemiol Biomarkers Prev 13(11 Pt 1):1751–1758PubMedGoogle Scholar
  41. 41.
    Dite GS, Gurrin LC, Byrnes GB, Stone J, Gunasekara A, McCredie MR et al (2008) Predictors of mammographic density: insights gained from a novel regression analysis of a twin study. Cancer Epidemiol Biomarkers Prev 17(12):3474–3481PubMedCrossRefGoogle Scholar
  42. 42.
    Boyd NF, Martin LJ, Yaffe MJ, Minkin S (2006) Mammographic density: a hormonally responsive risk factor for breast cancer. J Br Menopause Soc 12(4):186–193PubMedCrossRefGoogle Scholar
  43. 43.
    Gapstur SM, Lopez P, Colangelo LA, Wolfman J, Van Horn L, Hendrick RE (2003) Associations of breast cancer risk factors with breast density in Hispanic women. Cancer Epidemiol Biomarkers Prev 12(10):1074–1080PubMedGoogle Scholar
  44. 44.
    Vachon CM, Kuni CC, Anderson K, Anderson VE, Sellers TA (2000) Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States). Cancer Causes Control 11(7):653–662PubMedCrossRefGoogle Scholar
  45. 45.
    Warren R, Skinner J, Sala E, Denton E, Dowsett M, Folkerd E et al (2006) Associations among mammographic density, circulating sex hormones, and polymorphisms in sex hormone metabolism genes in postmenopausal women. Cancer Epidemiol Biomarkers Prev 15(8):1502–1508PubMedCrossRefGoogle Scholar
  46. 46.
    Pierce MB, Leon DA (2005) Age at menarche and adult BMI in the Aberdeen children of the 1950 s cohort study. Am J Clin Nutr 82(4):733–739PubMedGoogle Scholar
  47. 47.
    van Lenthe FJ, Kemper CG, van Mechelen W (1996) Rapid maturation in adolescence results in greater obesity in adulthood: the Amsterdam Growth and Health Study. Am J Clin Nutr 64(1):18–24PubMedGoogle Scholar
  48. 48.
    Okasha M, McCarron P, McEwen J, Smith GD (2001) Age at menarche: secular trends and association with adult anthropometric measures. Ann Hum Biol 28(1):68–78PubMedCrossRefGoogle Scholar
  49. 49.
    Collaborative Group on Hormonal Factors in Breast Cancer (1996) Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet 347(9017):1713–1727Google Scholar
  50. 50.
    Kahlenborn C, Modugno F, Potter DM, Severs WB (2006) Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis. Mayo Clin Proc 81(10):1290–1302PubMedCrossRefGoogle Scholar
  51. 51.
    Boyd NF, Martin LJ, Rommens JM, Paterson AD, Minkin S, Yaffe MJ et al (2009) Mammographic density: a heritable risk factor for breast cancer. Methods Mol Biol 472:343–360PubMedCrossRefGoogle Scholar
  52. 52.
    Phillips AA, Jacobson JS, Magai C, Consedine N, Horowicz-Mehler NC, Neugut AI (2007) Cancer incidence and mortality in the Caribbean. Cancer Invest 25(6):476–483PubMedCrossRefGoogle Scholar
  53. 53.
    Boyd NF, Rommens JM, Vogt K, Lee V, Hopper JL, Yaffe MJ et al (2005) Mammographic breast density as an intermediate phenotype for breast cancer. Lancet Oncol 6(10):798–808PubMedCrossRefGoogle Scholar
  54. 54.
    New York City Department of Health & Mental Hygiene (2008) Health Department Urges New York City Women to Stand Up to Breast Cancer; Press Release # 068-08 October 20, 2008Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Parisa Tehranifar
    • 1
    • 2
  • Diane Reynolds
    • 3
  • Julie Flom
    • 1
  • Loralee Fulton
    • 5
  • Yuyan Liao
    • 1
  • Elizabeth Kudadjie-Gyamfi
    • 4
  • Mary Beth Terry
    • 1
    • 2
  1. 1.Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkUSA
  2. 2.Herbert Irving Comprehensive Cancer CenterColumbia University Medical CenterNew YorkUSA
  3. 3.School of NursingLong Island UniversityBrooklynUSA
  4. 4.Department of PsychologyLong Island UniversityBrooklynUSA
  5. 5.Othmer Cancer CenterLong Island College HospitalBrooklynUSA

Personalised recommendations