Cancer Causes & Control

, Volume 11, Issue 7, pp 653–662 | Cite as

Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States)

  • Celine M. Vachon
  • Christopher C. Kuni
  • Kristin Anderson
  • V. Elving Anderson
  • Thomas A. Sellers


Objective: Mammographically defined percent breast density is an important risk factor for breast cancer, but the epidemiology of this trait is poorly understood. Although several studies have investigated the associations between reproductive factors and density, few data are available on the associations of breast density and waist-to-hip ratio (WHR), physical activity, education, alcohol and smoking.

Methods: We investigated the associations of known and suspected breast cancer risk factors with breast density in a large breast cancer family study. Information was collected on members of 426 families through telephone interviews, mailed questionnaires and mammography. Mammographic films on 1900 women were digitized and breast density was estimated in discrete five-unit increments by one radiologist. Analysis of covariance techniques were used and all analyses were performed stratified by menopausal status.

Results: Similar to other reports, nulliparity, late age at first birth, younger age and lower body mass index were associated with increased percent density in both premenopausal and postmenopausal women, and hormone replacement therapy among postmenopausal women. Higher levels of alcohol consumption and low WHR were associated with increased percent density among both premenopausal and postmenopausal women (differences of 3–11% between high and low categories). However, smoking and education were inversely associated with percent density among premenopausal (p = 0.004 and p = 0.003, respectively) but not postmenopausal women (p = 0.52 and p = 0.90). Physical activity was not associated with percent density in either stratum (p values > 0.25). Combined, these factors explained approximately 37% of the variability in the percent density measure in premenopausal women and 19% in postmenopausal women.

Conclusions: Many of these factors may potentially affect breast cancer risk through their effect on percent breast density.

breast cancer breast density mammographic density risk factors 


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  1. 1.
    Warner E, Lockwood G, Tritchler D, Boyd NF (1992) The risk of breast cancer associated with mammographic parenchymal patterns: a meta-analysis of the published literature to examine the effect of method of classification. Cancer Detect Prev 16: 67–72.Google Scholar
  2. 2.
    Boyd NF, Byng JW, Jong RA, 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: 670–675.Google Scholar
  3. 3.
    Boyd NF, Lockwood GA, Byng JW, Tritchler DL, Yaffe MJ (1998) Mammographic densities and breast cancer risk. Cancer Epidemiol Biomarkers Prev 7: 1133–1144.Google Scholar
  4. 4.
    Byrne C, Schairer C, Wolfe J, et al. (1995) Mammographic features and breast cancer risk: effects with time, age, and menopause status. J Natl Cancer Inst 87: 1622–1629.Google Scholar
  5. 5.
    Oza AM, Boyd NF (1993) Mammographic parenchymal patterns: a marker of breast cancer risk. Epidemiol Rev 15: 196–208.Google Scholar
  6. 6.
    Brisson J, Verreault R, Morrison AS, Tennina S, Meyer F (1989) Diet, mammographic features of breast tissue, and breast cancer risk. Am J Epidemiol 130: 14–24.Google Scholar
  7. 7.
    Brisson J, Merletti F, Sadowsky NL, Twaddle JA, Morrison AS, Cole P (1982) Mammographic features of the breast and breast cancer rusk. Am J Epidemiol 115: 428–437.Google Scholar
  8. 8.
    Stomper PC, D'Souza DJ, DiNitto PA, Arredonda MA (1996) Analysis of parenchymal density on mammograms in 1353 women 25–79 years old. Am J Roentgenol 167: 1261–1265.Google Scholar
  9. 9.
    Kaufman Z, Garstin WI, Hayes R, Michell MJ, Baum M (1991) The mammographic parenchymal patterns of women on hormonal replacement therapy. Clin Radiol 43: 389–392.Google Scholar
  10. 10.
    McNicholas M, Heneghan JP, Milner MH, Tunney T, Hourihane JB, MacErlaine DP (1994) Pain and increased mammographic density in women receiving hormone replacement therapy: a prospective study. Am J Roentgenol 163: 311–315.Google Scholar
  11. 11.
    Leung W, Goldberg F, Zee B, Sterns E (1997) Mammographic density in women on postmenopausal hormone replacement therapy. Surgery 122: 669–674.Google Scholar
  12. 12.
    Cyrlak D, Wong CH (1993) Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. Am J Roentgenol 161: 1177–1183.Google Scholar
  13. 13.
    Stomper PC, van Voorhis BJ, Ravnikar VA, Meyer JE (1990) Mammographic changes associated with postmenopausal hormone replacement therapy: a longitudinal study. Radiology 174: 487–490.Google Scholar
  14. 14.
    Greendale GA, Reboussin BA, Sie A, et al. (1999) Effects of estrogen and estrogen–progestin on mammographic parenchymal density. Ann Intern Med 130: 262–269.Google Scholar
  15. 15.
    Hunter DJ, Willett WC (1993) Diet, body size and breast cancer. Epidemiol Rev 15: 110–132.Google Scholar
  16. 16.
    Schatzhin A, Carter CL, Green SB, et al. (1989) Is alcohol consumption related to breast cancer? Results from the Framingham Heart Study. J Natl Cancer Inst 81: 31–35.Google Scholar
  17. 17.
    Byers T, Graham S, Rzepka T, Marchall J (1985) Lactation and breast cancer: evidence for a negative association in premenopausal women. Am J Epidemiol 121: 664–674.Google Scholar
  18. 18.
    Franchesi S, Favero A, LaVecchia C, et al. (1996) Body size indices and breast cancer risk before and after menopause. Int J Cancer 67: 181–186.Google Scholar
  19. 19.
    De Waard F (1979) Premenopausal and postmenopausal breast cancer: one disease or two? J Natl Cancer Inst 63: 549–552.Google Scholar
  20. 20.
    Sellers TA, Anderson VE, Potter JD, et al. (1995) Epidemiologic and genetic follow-up study of 544 Minnesota breast cancer families: design and methods. Genet Epidemiol 12: 417–429.Google Scholar
  21. 21.
    Sellers TA, Kïng RA, Cerhan JR, et al. (1999) Fifty-year follow-up of cancer incidence in a historical cohort of Minnesota breast cancer families. Cancer Epidemiol Biomarkers Prev 12: 1051–1058.Google Scholar
  22. 22.
    Weaver TW, Kushi LH, McGovern PG, et al. (1996) Validation study of self-reported measures of fat distribution. Int J Obes Relat Metab Disord 20: 644–650.Google Scholar
  23. 23.
    Lee-Han H, Cooke G, Boyd NF (1995) Quantitative evaluation of mammographic densities: a comparison of methods of assessment. Eur J Cancer Prev 4: 285–292.Google Scholar
  24. 24.
    Jong R, Fishell E, Little L, Lockwood G, Boyd NF (1996) Mammographic signs of potential relevance to breast cancer risk: the agreement of radiologists' classification. Eur J Cancer Prev 5: 281–286.Google Scholar
  25. 25.
    SAS Institute Inc. (1989) SAS/STAT User's Guide. Cary (NC): SAS Institute Inc.Google Scholar
  26. 26.
    The Gallop Poll (1988) Public Opinion 1987. Wilmington, DE: Scholarly Resources, Inc., p. 316.Google Scholar
  27. 27.
    Cramer DW, Xu H, Harlow BL (1995) Does “incessant” ovulation increase risk for early menopause? Am J Obstet Gynecol 172: 568–573.Google Scholar
  28. 28.
    Efron B, Tibshirani RJ (1993) An Introduction to the Bootstrap. New York: Chapman & Hall.Google Scholar
  29. 29.
    Madigan MP, Ziegler RG, Benichou J, Byrne C, Hoover RN, (1995) Proportion of breast cancer cases in the United States explained by well-established risk factors. J Natl Cancer Inst 87: 1681–1685.Google Scholar
  30. 30.
    Pankow JS, Vachon CM, Kuni CC, et al. (1997) Genetic analysis of mammographic breast density in adult women: evidence of a gene effect. J Natl Cancer Inst 89: 549–556.Google Scholar
  31. 31.
    Salminen T, Hakama M, Heikkila M, Saarenmaa I (1988) Favourable change in mammographic parenchymal patterns and breast cancer risk factors. Int J Cancer 78: 410–414.Google Scholar
  32. 32.
    Boyd NF, Greenber C, Lockwood G, et al. (1997) Effects at two years of low-fat, high carbohydrate diet on radiologic features of the breast: results from a randomized trial. J Natl Cancer Inst 89: 488–496.Google Scholar
  33. 33.
    Persson I, Thurfjell E, Holmberg L (1997) Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density. J Clin Oncol 15: 3201–3207.Google Scholar
  34. 34.
    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: 433–437.Google Scholar
  35. 35.
    Berkowitz JE, Gatewood OMB, Goldblum LE, Gayler BW (1990) Hormonal replacement therapy; mammographic manifestations. Radiology 174: 199–201.Google Scholar
  36. 36.
    Spicer UV, Ursin G, Parisky YR, et al. (1994) Changes in mammographic densities induced by a hormonal contraceptive designed to reduce breast cancer risk. J Natl Cancer Inst 86: 431–436.Google Scholar
  37. 37.
    Ursin G, Pike MC, Spicer DV, Porrath SA, Reitherman RW (1996) Can mammographic densities predict effects of Tamoxifen on the breast? J Natl Cancer Inst 88: 128–129.Google Scholar
  38. 38.
    Ursin G, Longnecker MP, Haile RW, Greenland S (1995) A meta-analysis of body mass index and risk of premenopausal breast cancer. Epidemiology 6: 137–141.Google Scholar
  39. 39.
    Kelsey JL (1993) Breast cancer epidemiology: summary and future directions. Epidemiol Rev 15: 256–263.Google Scholar
  40. 40.
    Brisson J, Morrison AS, Kopans DB, Sadowsky NL, Kalisher L, Twaddle JA (1984) Height and weight, mammographic features of breast tissue and breast cancer risk. Am J Epidemiol 119: 374–381.Google Scholar
  41. 41.
    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: 1233–1238.Google Scholar
  42. 42.
    Baron JA, Newcomb PA, Longnecker MP, et al. (1996) Cigarette smoking and breast cancer. Cancer Epidemiol Biomarkers Prev 3: 399–403.Google Scholar
  43. 43.
    Seybolt LM, Vachon C, Potter K, et al. (1997) Evaluation of potential sources of bias in a genetic epidemiologic study of breast cancer. Genet Epidemiol 14: 85–95.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Celine M. Vachon
    • 1
    • 2
  • Christopher C. Kuni
    • 3
  • Kristin Anderson
    • 4
  • V. Elving Anderson
    • 4
  • Thomas A. Sellers
    • 1
    • 2
  1. 1.Department of Health Sciences Research, Mayo FoundationMayo FoundationRochesterUSA
  2. 2.Mayo Clinic Cancer CenterRochesterUSA
  3. 3.Department of RadiologyUniversity of ColoradoDenverUSA
  4. 4.Division of Epidemiology, School of Public HealthUniversity of MinnesotaMinneapolisUSA

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