Breast Cancer Research and Treatment

, Volume 135, Issue 2, pp 571–580 | Cite as

Mammographic density and breast cancer risk in White and African American Women

  • Hilda Razzaghi
  • Melissa A. Troester
  • Gretchen L. Gierach
  • Andrew F. Olshan
  • Bonnie C. Yankaskas
  • Robert C. Millikan


Mammographic density is a strong risk factor for breast cancer, but limited data are available in African American (AA) women. We examined the association between mammographic density and breast cancer risk in AA and white women. Cases (n = 491) and controls (n = 528) were from the Carolina Breast Cancer Study (CBCS) who also had mammograms recorded in the Carolina Mammography Registry (CMR). Mammographic density was reported to CMR using Breast Imaging Reporting and Data System (BI-RADS) categories. Increasing mammographic density was associated with increased breast cancer risk among all women. After adjusting for potential confounders, a monotonically increasing risk of breast cancer was observed between the highest versus the lowest BI-RADS density categories [OR = 2.45, (95 % confidence interval: 0.99, 6.09)]. The association was stronger in whites, with ~40 % higher risk among those with extremely dense breasts compared to those with scattered fibroglandular densities [1.39, (0.75, 2.55)]. In AA women, the same comparison suggested lower risk [0.75, (0.30, 1.91)]. Because age, obesity, and exogenous hormones have strong associations with breast cancer risk, mammographic density, and race in the CBCS, effect measure modification by these factors was considered. Consistent with previous literature, density-associated risk was greatest among those with BMI > 30 and current hormone users (P value = 0.02 and 0.01, respectively). In the CBCS, mammographic density is associated with increased breast cancer risk, with some suggestion of effect measure modification by race, although results were not statistically significant. However, exposures such as BMI and hormone therapy may be important modifiers of this association and merit further investigation.


Mammographic breast density Breast cancer Race African American Epidemiology 

List of abbreviations


African American


Breast Imaging Reporting and Data System


Body mass index


Carolina Breast Cancer Study


Confidence interval


Carolina Mammography Registry


Hormone therapy


Likelihood ratio test


National Heart, Lung, and Blood Institute


Odds ratio


Waist-to-hip ratio



The authors are grateful to Jessica Tse and Robert Christopher Allis for their assistance with data management and data analysis for this manuscript. This research was supported [in part] by the Intramural Research Program of the NIH and the National Cancer Institute. M.A.T was supported by the National Institutes for Environmental Health Sciences and National Cancer Institute Breast Cancer and the Environment Research Program 5U01ES019472-02 and NCI grant 5R01CA138255. R.C.M. and M.A.T are supported by a SPORE in Breast Cancer 5P50CA058233.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10549_2012_2185_MOESM1_ESM.doc (40 kb)
Supplementary material 1 (DOC 40 kb)


  1. 1.
    Wolfe JN (1976) Breast patterns as an index of risk for developing breast cancer. AJR Am J Roentgenol 126:1130–1137PubMedGoogle Scholar
  2. 2.
    Wolfe JN (1976) Breast parenchymal patterns and their changes with age. Radiology 121:545–552PubMedGoogle Scholar
  3. 3.
    Tabar L, Dean P (1982) Mammographic parenchymal patterns. Risk indicator for breast cancer? JAMA 247:185–189PubMedCrossRefGoogle Scholar
  4. 4.
    D’Orsi C, Bassett L, Berg W et al (2003) Breast imaging reporting and data system: ACR BI-RADS-mammography, 4th edn. American College of Radiology, Reston, VAGoogle Scholar
  5. 5.
    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 15:1159–1169PubMedCrossRefGoogle Scholar
  6. 6.
    Warner E, Lockwood G, Math M, 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 Prevent 16:67–72PubMedGoogle Scholar
  7. 7.
    Vachon CM, Brandt KR, Ghosh K, Scott CG, Maloney SD, Carston MJ, Pankratz VS, Sellers TA (2007) Mammographic breast density as a general marker of breast cancer risk. Cancer Epidemiol Biomarkers Prev 16:43–49PubMedCrossRefGoogle Scholar
  8. 8.
    Boyd NF, Byng JW, Jong RA, Fishell EK, Little LE, Miller AB, Lockwood GA, Tritchler DL, Yaffe MJ (1995) Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. J Natl Cancer Inst 87:670–675PubMedCrossRefGoogle Scholar
  9. 9.
    Ziv E, Shepherd J, Smith-Bindman R, Kerlikowske K (2003) Mammographic breast density and family history of breast cancer. J Natl Cancer Inst 95:556–558PubMedCrossRefGoogle Scholar
  10. 10.
    Boyd NF, Lockwood GA, Byng JW (1998) Mammographic densities and breast cancer risk. Cancer Epidemiol Biomarkers Prev 7:1133–1144PubMedGoogle Scholar
  11. 11.
    Ursin G, Ma H, Wu AH, Bernstein L, Salane M, Parisky YR, Astrahan M, Siozon CC, Pike MC (2003) Mammographic density and breast cancer in three ethnic groups. Cancer Epidemiol Biomarkers Prev 12:332–338PubMedGoogle Scholar
  12. 12.
    Maskarinec G, Pagano I, Lurie G, Wilkens LR, Kolonel LN (2005) Mammographic density and breast cancer risk: the multiethnic cohort study. Am J Epidemiol 162:743–752PubMedCrossRefGoogle Scholar
  13. 13.
    Brisson J, Merletti F, Sadowsky NL, Twaddle JA, Morrison AS, Cole P (1982) Mammographic features of the breast and breast cancer risk. Am J Epidemiol 115:428–437PubMedGoogle Scholar
  14. 14.
    Chen Z, Wu A, Gauderman WJ (2004) Does mammographic density reflect ethnic differences in breast cancer incidence rates? Am J Epidemiol 159:140–147PubMedCrossRefGoogle Scholar
  15. 15.
    Habel LA, Capra AM, Oestreicher N, Greendale GA, Cauley JA, Bromberger J, Crandall CJ, Gold EB, Modugno F, Salane M et al (2007) Mammographic density in a multiethnic cohort. Menopause 14:891–899PubMedCrossRefGoogle Scholar
  16. 16.
    El-Bastawissi AY, White E, Mandelson MT, Taplin S (2001) Variation in mammographic breast density by race. Ann Epidemiol 11:257–263PubMedCrossRefGoogle Scholar
  17. 17.
    Tehranifar P, Reynolds D, Flom J, Fulton L, Liao Y, Kudadjie-Gyamfi E, Terry M (2011) Reproductive and menstrual factors and mammographic density in African American, Caribbean, and white women. Cancer Causes Control 22:599–610PubMedCrossRefGoogle Scholar
  18. 18.
    del Carmen MG, Halpern EF, Kopans DB, Moy B, Moore RH, Goss PE, Hughes KS (2007) Mammographic breast density and race. AJR Am J Roentgenol 188:1147–1150PubMedCrossRefGoogle Scholar
  19. 19.
    del Carmen MG, Hughes KS, Halpern E, Rafferty E, Kopans D, Parisky YR, Sardi A, Esserman L, Rust S, Michaelson J (2003) Racial differences in mammographic breast density. Cancer 98:590–596PubMedCrossRefGoogle Scholar
  20. 20.
    Wolfe JN, Saftlas AF, Salane M (1987) Mammographic parenchymal patterns and quantitative evaluation of mammographic densities: a case-control study. AJR Am J Roentgenol 148:1087–1092PubMedGoogle Scholar
  21. 21.
    O’Brien KM, Cole SR, Tse C-K, Perou CM, Carey LA, Foulkes WD, Dressler LG, Geradts J, Millikan RC (2010) Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res 16:6100–6110PubMedCrossRefGoogle Scholar
  22. 22.
    Millikan R, Newman B, Tse C-K, Moorman P, Conway K, Smith L, Labbok M, Geradts J, Bensen J, Jackson S et al (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109:123–139PubMedCrossRefGoogle Scholar
  23. 23.
    Hall IJ, Moorman PG, Millikan RC, Newman B (2005) Comparative analysis of breast cancer risk factors among African-American Women and White Women. Am J Epidemiol 161:40–51PubMedCrossRefGoogle Scholar
  24. 24.
    Newman B, Moorman PG, Millikan R, Qaqish BF, Geradts J, Aldrich TE, Liu ET (1995) The Carolina Breast Cancer Study: integrating population-based epidemiology and molecular biology. Breast Cancer Res Treat 35:51–60PubMedCrossRefGoogle Scholar
  25. 25.
    Weinberg CR, Sandler DP (1991) Randomized recruitment in case-control studies. Am J Epidemiol 134:421–432PubMedGoogle Scholar
  26. 26.
    Millikan R, Eaton A, Worley K, Biscocho L, Hodgson E, Huang W-Y, Geradts J, Iacocca M, Cowan D, Conway K, Dressler L (2003) HER2 codon 655 polymorphism and risk of breast cancer in African Americans and Whites. Breast Cancer Res Treat 79:355–364PubMedCrossRefGoogle Scholar
  27. 27.
    Moorman PG, Kuwabara H, Millikan RC, Newman B (2000) Menopausal hormones and breast cancer in a biracial population. Am J Public Health 90:966–971PubMedCrossRefGoogle Scholar
  28. 28.
    Yankaskas B, Jones M, Aldrich T (1996) The Carolina Mammography Registry: a population-based mammography and cancer surveillance project. J Regist Manag 23:173–178Google Scholar
  29. 29.
    Gomatam S, Carter R, Ariet M, Mitchell G (2002) An empirical comparison of record linkage procedures. Stat Med 21:1485–1496PubMedCrossRefGoogle Scholar
  30. 30.
    Jaro M (1995) Probabilistic linkage of large public health data files. Stat Med 14:491–498PubMedCrossRefGoogle Scholar
  31. 31.
    Quantin C, Binquet C, Bourquard K, Pattisina R, Gouyon-Cornet B, Ferdynus C, Gouyon J-B, Allaert FA (2004) Which are the best identifiers for record linkage? Med Inf Internet Med 29:221–227CrossRefGoogle Scholar
  32. 32.
    Vachon C, van Gils C, Sellers T, Ghosh K, Pruthi S, Brandt K, Pankratz VS (2007) Mammographic density, breast cancer risk and risk prediction. Breast Cancer Res 9:217PubMedCrossRefGoogle Scholar
  33. 33.
    Yaffe M, Boyd N, Byng J, Jong R, Fishell E, Lockwood G, Little L, Tritchler D (1998) Breast cancer risk and measured mammographic density. Eur J Cancer Prev Suppl 1:S47–S55CrossRefGoogle Scholar
  34. 34.
    Kerlikowske K, Grady D, Barclay J, Frankel SD, Ominsky SH, Sickles EA, Ernster V (1998) Variability and accuracy in mammographic interpretation using the American college of radiology breast imaging reporting and data system. J Natl Cancer Inst 90:1801–1809PubMedCrossRefGoogle Scholar
  35. 35.
    Byrne C, Schairer C, Wolfe J, Parekh N, Salane M, Brinton LA, Hoover R, Haile R (1995) Mammographic features and breast cancer risk: effects with time, age, and menopause status. J Natl Cancer Inst 87:1622–1629PubMedCrossRefGoogle Scholar
  36. 36.
    Kato I, Beinart C, Bleich A, Su S, Kim M, Toniolo PG (1995) A nested case-control study of mammographic patterns, breast volume, and breast cancer (New York City, NY, United States). Cancer Causes Control 6:431–438PubMedCrossRefGoogle Scholar
  37. 37.
    Thomas DB, Carter RA, Bush WH, Ray RM, Stanford JL, Lehman CD, Daling JR, Malone K, Davis S (2002) Risk of subsequent breast cancer in relation to characteristics of screening mammograms from women less than 50 years of age. Cancer Epidemiol Biomark Prev 11:565–571Google Scholar
  38. 38.
    Cuzick J, Warwick J, Pinney E, Warren RML, Duffy SW (2004) Tamoxifen and breast density in women at increased risk of breast cancer. J Natl Cancer Inst 96:621–628PubMedCrossRefGoogle Scholar
  39. 39.
    Mandelson M, Oestreicher N, Porter P, White D, Finder C, Taplin S, White E (2000) Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 92:1081–1087PubMedCrossRefGoogle Scholar
  40. 40.
    Greenland S, Pearl J, Robins J (1999) Causal diagrams for epidemiologic research. Epidemiology 10:37–48PubMedCrossRefGoogle Scholar
  41. 41.
    Ziv E, Tice J, Smith-Bindman R, Shepherd J, Cummings S, Kerlikowske K (2004) Mammographic density and estrogen receptor status of breast cancer. Cancer Epidemiol Biomark Prev 13:2090–2095Google Scholar
  42. 42.
    El-Bastawissi AY, White E, Mandelson MT, Taplin SH (2000) Reproductive and hormonal factors associated with mammographic breast density by age (United States). Cancer Causes Control 11:955–963PubMedCrossRefGoogle Scholar
  43. 43.
    Sung J, Song Y-M, Stone J, Lee K, Kim S-Y (2010) Association of body size measurements and mammographic density in Korean Women: the Healthy Twin Study. Cancer Epidemiol Biomark Prev 19:1523–1531CrossRefGoogle Scholar
  44. 44.
    Conroy SM, Woolcott CG, Koga KR, Byrne C, Nagata C, Ursin G, Vachon CM, Yaffe MJ, Pagano I, Maskarinec G (2011) Mammographic density and risk of breast cancer by adiposity: an analysis of four case-control studies. Int J Cancer 130(8):1915–1924PubMedCrossRefGoogle Scholar
  45. 45.
    Greendale GA, Reboussin BA, Slone S, Wasilauskas C, Pike MC, Ursin G (2003) Postmenopausal hormone therapy and change in mammographic density. J Natl Cancer Inst 95:30–37PubMedCrossRefGoogle Scholar
  46. 46.
    Harvey J, Scheurer C, Kawakami FT, Quebe-Fehling E, de Palacios PI, Ragavan VV (2005) Hormone replacement therapy and breast density changes. Climacteric 8:185–192PubMedCrossRefGoogle Scholar
  47. 47.
    Van Duijnhoven FJB, Peeters PHM, Warren RML, Bingham SA, van Noord PAH, Monninkhof EM, Grobbee DE, van Gils CH (2007) Postmenopausal hormone therapy and changes in mammographic density. J Clin Oncol 25:1323–1328PubMedCrossRefGoogle Scholar
  48. 48.
    Stomper PC, Van Voorhis BJ, Ravnika VA, Meyer JE (1990) Mammographic changes associated with postmenopausal hormone replacement therapy; a longitudinal study. Radiology 174:487–490PubMedGoogle Scholar
  49. 49.
    Rutter CM, Mandelson MT, Laya MB, Seger DJ, Taplin S (2001) Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy. JAMA 285:171–176PubMedCrossRefGoogle Scholar
  50. 50.
    Writing Group for the Women’s Health Initiative I (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333CrossRefGoogle Scholar
  51. 51.
    Kerlikowske K, Cook AJ, Buist DSM, Cummings SR, Vachon C, Vacek P, Miglioretti DL (2010) Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use. J Clin Oncol 28:3830–3837PubMedCrossRefGoogle Scholar
  52. 52.
    Ciatto S, Houssami N, Apruzzese A, Bassetti E, Brancato B, Carozzi F, Catarzi S, Lamberini MP, Marcelli G, Pellizzoni R, Pesce B, Risso G, Russo F, Scorsolini A (2005) Categorizing breast mammographic density intra- and interobserver reproducibility of BI-RADS density categories. The Breast 14:269–275PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Hilda Razzaghi
    • 1
  • Melissa A. Troester
    • 1
    • 2
  • Gretchen L. Gierach
    • 3
  • Andrew F. Olshan
    • 1
    • 2
  • Bonnie C. Yankaskas
    • 4
  • Robert C. Millikan
    • 1
    • 2
  1. 1.Department of EpidemiologyGillings Global School of Public Health, University of North CarolinaChapel HillUSA
  2. 2.Linberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillUSA
  3. 3.Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthRockvilleUSA
  4. 4.Department of Radiology, School of MedicineUniversity of North CarolinaChapel HillUSA

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