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Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN)

  • Epidemiology
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Abstract

Menstrual and reproductive factors may increase breast cancer risk through a pathway that includes increased mammographic density. We assessed whether known or suspected menstrual and reproductive breast cancer risk factors were cross-sectionally associated with mammographic density, by measuring area of radiographic density and total breast area on mammograms from 801 participants in the Study of Women’s Health Across the Nation (SWAN), a multi-ethnic cohort of pre- and early perimenopausal women. From multivariable linear regression, the following menstrual or reproductive factors were independently associated with percent mammographic density (area of dense breast/breast area): older age at menarche (β = 10.3, P < 0.01, for >13 vs. <12 years), premenstrual cravings and bloating (β = −3.36, P = 0.02), younger age at first full-term birth (β = −8.12, P < 0.01 for ≤23 years versus no births), greater number of births (β = −6.80, P < 0.01 for ≥3 births versus no births), and premenopausal status (β = 3.78, P < 0.01 versus early perimenopausal). Only number of births remained associated with percent density after adjustment for age, race/ethnicity, study site, body mass index (BMI), and smoking. In addition, stratified analyses revealed that the association with number of births was confined to women within the lowest BMI tertile (β = −12.2, P < 0.01 for ≥3 births versus no births). Our data support a mechanism for parity and breast cancer that involves mammographic density among pre- and early perimenopausal women that may be modified by body size.

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Acknowledgements

We would like to thank SWAN participants, study staff, and personnel at contributing mammography facilities. This ancillary study was supported by National Cancer Institute Grant R01CA89552. Dr. Butler was supported by National Institute of Child Health and Human Development (NICHD), the Office of Research on Women’s Health (ORWH), the Office of Dietary Supplements (ODS), and the National Institute of Aging (NIA) (5K12HD051958). Dr. Crandall was supported by National Institute of Health Research Grant 5K12AG01004 from the National Institute on Aging. Dr. Modugno was supported by the National Cancer Institute Grant K07CA80668. The SWAN has grant support from the National Institutes of Health, DHHS, through the National Institute on Aging, the National Institute of Nursing Research and the NIH Office of Research on Women’s Health (Grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). Clinical Centers: University of Michigan, Ann Arbor—MaryFran Sowers, PI; Massachusetts General Hospital, Boston, MA—Robert Neer, PI 1994–1999; Joel Finkelstein, PI 1999–present; Rush University, Rush University Medical Center, Chicago, IL—Lynda Powell, PI; University of California, Davis/Kaiser—Ellen Gold, PI; University of California, Los Angeles—Gail Greendale, PI; University of Medicine and Dentistry—New Jersey Medical School, Newark—Gerson Weiss, PI 1994–2004; Nanette Santoro, PI 2004–present; and the University of Pittsburgh, Pittsburgh, PA—Karen Matthews, PI. NIH Program Office: National Institute on Aging, Bethesda, MD—Marcia Ory 1994–2001; Sherry Sherman 1994–present; National Institute of Nursing Research, Bethesda, MD—Program Officers. Central Laboratory: University of Michigan, Ann Arbor—Daniel McConnell; (Central Ligand Assay Satellite Services). Coordinating Center: New England Research Institutes, Watertown, MA—Sonja McKinlay, PI 1995–2001; University of Pittsburgh, Pittsburgh, PA—Kim Sutton-Tyrrell, PI 2001–present.

Steering Committee: Chris Gallagher, Chair; Susan Johnson, Chair.

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Authors and Affiliations

  1. Division of Epidemiology, Department of Public Health Sciences, University of California at Davis, One Shields Avenue, 1616 DaVinci Court, Davis, CA, 95616, USA

    Lesley M. Butler & Ellen B. Gold

  2. Divisions of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Gail A. Greendale

  3. Division of General Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Carolyn J. Crandall

  4. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Francesmary Modugno

  5. Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA

    Nina Oestreicher, Charles P. Quesenberry Jr. & Laurel A. Habel

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  1. Lesley M. Butler
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  2. Ellen B. Gold
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  8. Laurel A. Habel
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Correspondence to Lesley M. Butler.

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Butler, L.M., Gold, E.B., Greendale, G.A. et al. Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN). Breast Cancer Res Treat 112, 165–174 (2008). https://doi.org/10.1007/s10549-007-9840-0

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