6th International Workshop on Breast Densitometry and Breast ...

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6 th <strong>International</strong> <strong>Workshop</strong> on Breast Densitometry
and Breast Cancer Risk Assessment
MULTIPLE METABOLIC RISK FACTORS AND MAMMOGRAPHIC BREAST
DENSITY IN THE NEW YORK CITY MULTIETHNIC BREAST CANCER PROJECT
Parisa Tehranifar, 1,2,3 Diane Reynolds, 4 Xiaozhou Fan, 1 Bernadette Boden-Albala, 5 Natalie Engmann, 1
Julie D. Flom, 1 Mary Beth Terry 1,2
1 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY ;
2 Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY ;
3 The Center for the Study of Social Inequalities and Health, Columbia University Mailman School of
Public Health, New York,, NY; 4 School of Nursing, Long Island University, Brooklyn Campus, Brooklyn,
NY; 5 Division of Social Epidemiology, Department of Health Evidence and Policy, Department of
Neurology, ICAHN School of Medicine at Mount Sinai, New York, NY
Acknowledgement: We would like to thank the study participants for contributing data to this analysis and
the following research staff for assisting with data collection and recruitment activities: Diane Levy,
Wendy Lewis, Gladys Rivera, Zoe Quandt, Joy White, Jessica Cabildo and Renata Khanis. This research
was funded by grants from the National Cancer Institute (grant numbers: U54 CA101598; K07
CA151777), Susan B. Komen Foundation Career Catalyst award (grant number KG110331) and the
National Institute of Environmental Health Sciences Center Support (grant number ES009089).
Background: Metabolic abnormalities have been individually associated with breast cancer risk. More
recently, studies have also shown modest positive associations between the presence of multiple
metabolic conditions, as frequently defined by the metabolic syndrome (MetS), and breast cancer risk in
postmenopausal women. Few studies have examined whether the presence of multiple metabolic risk
factors are similarly associated with breast density, an intermediate marker of breast cancer risk. We
examined whether obesity, diabetes, hypertension, and elevated cholesterol, individually and in
combination, are associated with breast density.
Methods: We digitized film mammograms and measured percent density and dense area using a
computer-assisted method in a sample of 191 women, recruited from a single radiology facility during
their screening mammography appointment (age range=40-61 years; 42% African American, 22% African
Caribbean, 22% White, 11% Hispanic, 3% other ethnicities). We used in-person computer assisted
interviews to collect detailed epidemiologic data at the time of recruitment. We used linear regression
models to examine the associations of each metabolic condition and the number of co-occurring
metabolic conditions (0, 1, 2, and 3 or 4 conditions) with percent density and dense breast area.
ABSTRACTS
Results: In age adjusted models of individual metabolic conditions, hypertension and obese body mass
index (≥30 kg/m 2 ) were inversely associated with percent density, and high blood cholesterol was
inversely associated with dense area. The presence of multiple metabolic conditions was associated with
lower percent density and dense area in multivariable models (2 conditions and 3 or 4 conditions vs. 0
conditions were associated with 9.4% (95% CI:-13.2, -5.5) and 10.7% (95% CI:-15.2, -6.2) reduction in
percent density and with 5.5 cm 2 (95% CI: -10.8, -0.3) and 8.4 cm 2 (95% CI: -14.5, -2.4) smaller dense
area).
Conclusions: The presence of multiple metabolic conditions was associated with lower levels of relative
and absolute measures of breast density in a predominantly racial minority sample of women. The
reduction in breast density associated with multiple metabolic conditions was greater than the influence of
any single condition on breast density. Our results suggest that the positive association between
metabolic abnormalities and breast cancer may not involve pathways related to breast density, and may be
stronger after accounting for the influence of metabolic conditions on breast density.
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