Skip to main content

Advertisement

SpringerLink
Log in

Breast cancer risk factors and mammographic breast density in women over age 70

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

Summary

Background

Breast density is a strong risk factor for breast cancer, but little is known about factors associated with breast density in women over 70.

Methods

Percent breast density, sex hormone levels and breast cancer risk factor data were obtained on 239 women ages 70–92 recruited from 1986 to 1988 in the United States. Multivariable linear regression was used to develop a model to describe factors associated with percent density.

Results

Median (range) percent density among women was 23.7% (0–85%). Body mass index (β= −0.345, p<0.001 adjusted for age and parity) and parity (β= −0.277, p<0.001 adjusted for age and BMI) were significantly and inversely associated with percent breast density. After adjusting for parity and BMI, age was not associated with breast density (β=0.05, p=0.45). Parous women had lower percent density than nulliparous women (23.7 versus 34.7%, p=0.005). Women who had undergone surgical menopause had greater breast density than those who had had a natural menopause (33.4 versus 24.8%, p=0.048), as did women who were not current smokers (26.0 versus 17.3% for smokers, p=0.02). Breast density was not associated with age at menarche, age at menopause, age at first birth, breastfeeding, estrogen levels or androgen levels. In a multivariable model, 24% of the variance in percent breast density was explained by BMI (β= −0.35), parity (β=−0.29), surgical menopause (β=0.13) and current smoking (β= −0.12).

Conclusion

Factors associated with breast density in older, post-menopausal women differ from traditional breast cancer risk factors and from factors associated with breast density in pre-menopausal and younger post-menopausal women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Cancer Society: Facts and Figures. Washington, DC, 2005

  2. SEER Cancer Statistics Review, 1975–2001. National Cancer Institute, Bethesda, MD, 2004

  3. Yancik R, Cancer burden in the aged: an epidemiologic and demographic overview Cancer 1997;80(7):1273–1283

    Article  PubMed  CAS  Google Scholar 

  4. Boyd NF, Lockwood GA, Byng JW, Tritchler DL, Yaffe MJ, Mammographic densities and breast cancer risk Cancer Epidemiol Biomarkers Prev 1998;7(12):1133–1144

    PubMed  CAS  Google Scholar 

  5. Byrne C, Schairer C, Wolfe J, et al. Mammographic features and breast cancer risk: effects with time, age, and menopause status J Natl Cancer Inst 1995;87(21):1622–1629

    Article  PubMed  CAS  Google Scholar 

  6. Heine JJ, Malhotra P, Mammographic tissue, breast cancer risk, serial image analysis, and digital mammography. Part 1. Tissue and related risk factors Acad Radiol. 2002;9(3):298–316

    Article  PubMed  Google Scholar 

  7. Chlebowski RT, Hendrix SL, Langer RD, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial JAMA 2003;289(24):3243–3253

    Article  PubMed  CAS  Google Scholar 

  8. Greendale GA, Reboussin BA, Slone S, Wasilauskas C, Pike MC, Ursin G, Postmenopausal hormone therapy and change in mammographic density J Natl Cancer Inst 2003;95(1):30–37

    Article  PubMed  CAS  Google Scholar 

  9. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study J Natl Cancer Inst 1998;90(18):1371–1388

    Article  PubMed  CAS  Google Scholar 

  10. Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation JAMA 1999;281(23):2189–2197

    Article  PubMed  CAS  Google Scholar 

  11. Brisson J, Brisson B, Cote G, Maunsell E, Berube S, Robert J, Tamoxifen and mammographic breast densities Cancer Epidemiol Biomarkers Prev 2000;9(9):911–915

    PubMed  CAS  Google Scholar 

  12. Freedman M, San Martin J, O’Gorman J, et al. Digitized mammography: a clinical trial of postmenopausal women randomly assigned to receive raloxifene, estrogen, or placebo J Natl Cancer Inst 2001;93(1):51–56

    Article  PubMed  CAS  Google Scholar 

  13. van Gils CH, Hendriks JH, Holland R, et al. Changes in mammographic breast density and concomitant changes in breast cancer risk Eur J Cancer Prev 1999;8(6):509–515

    Article  PubMed  Google Scholar 

  14. Salminen TM, Saarenmaa IE, Heikkila MM, Hakama M, Risk of breast cancer and changes in mammographic parenchymal patterns over time Acta Oncol. 1998;37(6):547–551

    Article  PubMed  CAS  Google Scholar 

  15. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V, Effect of age, breast density, and family history on the sensitivity of first screening mammography JAMA 1996;276(1):33–38

    Article  PubMed  CAS  Google Scholar 

  16. Ma L, Fishell E, Wright B, Hanna W, Allan S, Boyd NF, Case–control study of factors associated with failure to detect breast cancer by mammography J Natl Cancer Inst 1992;84(10):781–785

    Article  PubMed  CAS  Google Scholar 

  17. Campbell PR: Population Projections for States by Age, Sex, Race, and Hispanic Origin: 1995–2025: US Bureau of the Census, Population Division, PPL-47, 1996

  18. Freid VM, Prager K, MacKay AP, Xia H, Chartbook on Trends in the Health of Americans. Health, United States, 2003 Hyattsville, MD National Center for Health Statistics 2003

    Google Scholar 

  19. Cummings SR, Black DM, Nevitt MC, et al. Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group JAMA 1990;263(5):665–668

    Article  PubMed  CAS  Google Scholar 

  20. Cummings SR, Browner WS, Bauer D, et al. Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group N Engl J Med 1998;339(11):733–738

    Article  PubMed  CAS  Google Scholar 

  21. Prentice RL, A case-cohort design for epidemiologic cohort studies and disease prevention trials Biometrika 1986;S2:1–11

    Article  Google Scholar 

  22. Haiman CA, Bernstein L, Berg D, Ingles SA, Salane M, Ursin G Genetic determinants of mammographic density Breast Cancer Res 2002;4(3):R5

    Article  PubMed  Google Scholar 

  23. Benichou J, Byrne C, Capece LA, et al. Secular stability and reliability of measurements of the percentage of dense tissue on mammograms Cancer Detection Prevention 2003;27(4):266–274

    Article  Google Scholar 

  24. Hassard TH, 1991 Understanding Biostatistics St. Louis Mosby-Year Book

    Google Scholar 

  25. Stomper PC, D’Souza DJ, DiNitto PA, Arredondo MA, Analysis of parenchymal density on mammograms in 1353 women 25–79 years old AJR Am J Roentgenol 1996;167(5):1261–1265

    PubMed  CAS  Google Scholar 

  26. Hutson SW, Cowen PN, Bird CC, Morphometric studies of age related changes in normal human breast and their significance for evolution of mammary cancer J Clin Pathol. 1985;38(3):281–287

    Article  PubMed  CAS  Google Scholar 

  27. Henson DE, Tarone RE, Involution and the etiology of breast cancer Cancer 1994;74(1 Suppl):424–429

    Article  PubMed  CAS  Google Scholar 

  28. Hart BL, Steinbock RT, Mettler FA, Jr., Pathak DR, Bartow SA, Age and race related changes in mammographic parenchymal patterns Cancer 1989;63(12):2537–2539

    Article  PubMed  CAS  Google Scholar 

  29. Gram IT, Funkhouser E, Tabar L Reproductive and menstrual factors in relation to mammographic parenchymal patterns among perimenopausal women Br J Cancer 1995;71(3):647–650

    PubMed  CAS  Google Scholar 

  30. Brisson J, Merletti F, Sadowsky NL, Twaddle JA, Morrison AS, Cole P, Mammographic features of the breast and breast cancer risk Am J Epidemiol 1982;115(3):428–437

    PubMed  CAS  Google Scholar 

  31. Grove JS, Goodman MJ, Gilbert FI, Jr., Mi MP, Factors associated with mammographic pattern Br J Radiol 1985;58(685):21–25

    PubMed  CAS  Google Scholar 

  32. Krook PM, Mammographic parenchymal patterns as risk indicators for incident cancer in a screening program: an extended analysis AJR Am J Roentgenol 1978;131(6):1031–1035

    PubMed  CAS  Google Scholar 

  33. El-Bastawissi AY, White E, Mandelson MT, Taplin SH, Reproductive and hormonal factors associated with mammographic breast density by age (United States) Cancer Causes Control 2000;11(10):955–963

    Article  PubMed  CAS  Google Scholar 

  34. Titus-Ernstoff L, Longnecker MP, Newcomb PA, et al. Menstrual factors in relation to breast cancer risk Cancer Epidemiol Biomarkers Prev 1998;7(9):783–789

    PubMed  CAS  Google Scholar 

  35. Cauley JA, Lucas FL, Kuller LH, Vogt MT, Browner WS, Cummings SR, Bone mineral density and risk of breast cancer in older women: the study of osteoporotic fractures. Study of Osteoporotic Fractures Research Group JAMA 1996;276(17):1404–1408

    Article  PubMed  CAS  Google Scholar 

  36. Zmuda JM, Cauley JA, Ljung BM, Bauer DC, Cummings SR, Kuller LH, Bone mass and breast cancer risk in older women: differences by stage at diagnosis J Natl Cancer Inst 2001;93(12):930–936

    Article  PubMed  CAS  Google Scholar 

  37. Gravelle IH, Bulstrode JC, Bulbrook RD, Wang DY, Allen D, Hayward JL, A prospective study of mammographic parenchymal patterns and risk of breast cancer Br J Radiol 1986;59(701):487–491

    PubMed  CAS  Google Scholar 

  38. Tabar L, Dean PB, Mammographic parenchymal patterns. Risk indicator for breast cancer? JAMA 1982;247(2):185–189

    Article  PubMed  CAS  Google Scholar 

  39. Andersson I, Andren L, Pettersson H, Influence of age at first pregnancy on breast parenchymal pattern: a preliminary report Radiology 1978;126(3):675–676

    PubMed  CAS  Google Scholar 

  40. Ernster VL, Sacks ST, Peterson CA, Schweitzer RJ, Mammographic parenchymal patterns and risk factors for breast cancer Radiology 1980;134(3):617–620

    PubMed  CAS  Google Scholar 

  41. Gravelle IH, Bulstrode JC, Wang DY, Bulbrook RD, Hayward JL, The relation between radiographic features and determinants of risk of breast cancer Br J Radiol 1980;53(626):107–113

    Article  PubMed  CAS  Google Scholar 

  42. Buchanan JB, Weisberg BF, Sandoz JP, Gray LA, Sr., Bland KI, Selected prognostic variables for mammographic parenchymal patterns Cancer 1981;47(9):2135–2137

    Article  PubMed  CAS  Google Scholar 

  43. Bergkvist L, Tabar L, Bergstrom R, Adami HO, Epidemiologic determinants of the mammographic parenchymal pattern. A population-based study within a mammographic screening program Am J Epidemiol 1987;126(6):1075–1081

    PubMed  CAS  Google Scholar 

  44. Leinster SJ, Walsh PV, Whitehouse GH, Al-Sumidaie AM, Factors associated with mammographic parenchymal patterns Clin Radiol. 1988;39(3):252–256

    Article  PubMed  CAS  Google Scholar 

  45. de Stavola BL, Gravelle IH, Wang DY, et al. Relationship of mammographic parenchymal patterns with breast cancer risk factors and risk of breast cancer in a prospective study Int J Epidemiol 1990;19(2):247–254

    Article  PubMed  Google Scholar 

  46. Andersson I, Janzon L, Pettersson H, Radiographic patterns of the mammary parenchyma: variation with age at examination and age at first birth Radiology 1981;138(1):59–62

    PubMed  CAS  Google Scholar 

  47. de Waard F, Rombach JJ, Collette HJ, Slotboom B, Breast cancer risk associated with reproductive factors and breast parenchymal patterns J Natl Cancer Inst 1984;72(6):1277–1282

    PubMed  Google Scholar 

  48. Beijerinck D, van Noord PA, Seidell JC, den Tonkelaar I, Rombach JJ, Bruning PF, Abdominal fat predominance in women is associated with a decreased prevalence of the high risk P2, DY mammographic breast patterns Int J Obes 1991;15(1):89–93

    PubMed  CAS  Google Scholar 

  49. Kaufman Z, Garstin WI, Hayes R, Michell MJ, Baum M, The mammographic parenchymal patterns of nulliparous women and women with a family history of breast cancer Clin Radiol 1991;43(6):385–388

    Article  PubMed  CAS  Google Scholar 

  50. Funkhouser E, Waterbor JW, Cole P, Rubin E, Mammographic patterns and breast cancer risk factors among women having elective screening South Med J 1993;86(2):177–180

    PubMed  CAS  Google Scholar 

  51. Vachon CM, Kushi LH, Cerhan JR, Kuni CC, Sellers TA, Association of diet and mammographic breast density in the Minnesota breast cancer family cohort Cancer Epidemiol Biomarkers Prev 2000;9(2):151–160

    PubMed  CAS  Google Scholar 

  52. Russo J, Rivera R, Russo IH, Influence of age and parity on the development of the human breast Breast Cancer Res Treat 1992;23(3):211–218

    Article  PubMed  CAS  Google Scholar 

  53. Oestreicher N, Habel LA, Bromberger J, et al.: Association of lifestyle factors and mammographic density in a pre/perimenopausal cohort. Paper presented at the Proceedings of Society for Epidemiologic Research, 2005

  54. Terry PD, Rohan TE, Cigarette smoking and the risk of breast cancer in women: a review of the literature Cancer Epidemiol Biomarkers Prev 2002;11(10 Pt 1):953–971

    PubMed  Google Scholar 

  55. Baron JA, La Vecchia C, Levi F, The antiestrogenic effect of cigarette smoking in women Am J Obstet Gynecol 1990;162(2):502–514

    PubMed  CAS  Google Scholar 

  56. Key T, Appleby P, Barnes I, Reeves G: Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst 94(8): 606-616, 2002

    Google Scholar 

  57. Cauley JA, Lucas FL, Kuller LH, Stone K, Browner W, Cummings SR, Elevated serum estradiol and testosterone concentrations are associated with a high risk for breast cancer. Study of Osteoporotic Fractures Research Group Ann Intern Med 1999;130(4 Pt 1):270–277

    PubMed  CAS  Google Scholar 

  58. Boyd NF, Stone J, Martin LJ, et al. The association of breast mitogens with mammographic densities Br J Cancer 2002;87(8):876–882

    Article  PubMed  CAS  Google Scholar 

  59. Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually J Natl Cancer Inst 1989;81(24):1879–1886

    Article  PubMed  CAS  Google Scholar 

  60. Yancik R, Ries LG, Yates JW, Breast cancer in aging women. A population-based study of contrasts in stage, surgery, and survival Cancer 1989;63(5):976–981

    Article  PubMed  CAS  Google Scholar 

  61. von Rosen A, Gardelin A, Auer G, Assessment of malignancy potential in mammary carcinoma in elderly patients Am J Clin Oncol 1987;10(1):61–64

    Article  Google Scholar 

  62. Diab SG, Elledge RM, Clark GM, Tumor characteristics and clinical outcome of elderly women with breast cancer J Natl Cancer Inst 2000;92(7):550–556

    Article  PubMed  CAS  Google Scholar 

  63. Ziv E, Tice J, Smith-Bindman R, Shepherd J, Cummings S, Kerlikowske K, Mammographic density and estrogen receptor status of breast cancer Cancer Epidemiol Biomarkers Prev 2004;13(12):2090–2095

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Chandra Marriott for her technical assistance with this manuscript and Dr. Jeffrey L. Eppinger for his comments on this work. Investigators in the Study of Osteoporotic Fractures Research Group: University of␣California, San Francisco (Coordinating Center:) SR␣Cummings (principal investigator), KL Stone (co-investigator), DC Bauer (co-investigator), MC Nevitt (co-investigator), W Browner, (co-investigator), DM Black (study statistician), H.K. Genant (director, central radiology laboratory), R. Benard, T. Blackwell, M. Dockrell, S. Ewing, C. Fox, R. Fullman, D. Kimmel, S. Litwack, LY. Lui, J. Maeda, P. Mannen, L. Nusgarten, L. Palermo, M. Rahorst, C. Schambach, J. Schneider, R. Scott, D. Tanaka, C. Yeung.

University of Maryland: M.C. Hochberg (principal investigator), L. Makell, (project director), R. Nichols, C. Boehm, L. Finazzo, T. Page, S. Trusty, B. Whitkop.

University of Minnesota: KE Ensrud (principal investigator), K. Margolis (co-investigator), P. Schreiner (co-investigator), K. Worzala (co-investigator), S. Love (clinical research director), E. Mitson (clinic coordinator), C. Bird, D. Blanks, F. Imker-Witte, K. Jacobson, K. Knauth, N. Nelson, E. Penland-Miller, G. Saecker.

University of Pittsburgh: J.A. Cauley (principal investigator), L.H. Kuller (co-principal investigator), M. Vogt (co-investigator), L. Harper (project director), L. Buck (clinic coordinator), C. Bashada, D. Cusick, G. Engleka, A. Flaugh, A. Githens, M. Gorecki, D. Medve, M. Nasim, C. Newman, S. Rudovsky, N. Watson, D. Lee.

The Kaiser Permanente Center for Health Research, Portland, Oregon: T. Hillier (principal investigator, E. Harris (co-principal investigator), E. Orwoll (co-investigator), H. Nelson (co-investigator), Mikel Aiken (biostatistician), Jan Van Marter (project administrator), Mary Rix (clinic coordinator), Jane Wallace, Kathy Snider, Kathy Canova, Kathy Pedula, JoAnne Rizzo. This work was financially supported in part by the National Institutes of Health grants CA80668, CA95113, CA57703, CA103730, AG05407, AR35582, AG05394, AR35584, AR35583, and AG000181.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Francesmary Modugno, Duyen L. Ngo, Glenn O. Allen, Lewis H. Kuller, Roberta B. Ness, Victor G. Vogel & Jane A. Cauley

  2. University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    Francesmary Modugno, Duyen L. Ngo, Glenn O. Allen, Lewis H. Kuller, Roberta B. Ness & Victor G. Vogel

  3. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Victor G. Vogel

  4. Department of Biostatics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Joseph P. Costantino

Authors
  1. Francesmary Modugno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Duyen L. Ngo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Glenn O. Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lewis H. Kuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberta B. Ness
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victor G. Vogel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joseph P. Costantino
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jane A. Cauley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesmary Modugno.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Modugno, F., Ngo, D.L., Allen, G.O. et al. Breast cancer risk factors and mammographic breast density in women over age 70. Breast Cancer Res Treat 97, 157–166 (2006). https://doi.org/10.1007/s10549-005-9105-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-005-9105-8

Key words:

Search

Navigation