Longitudinal Changes in Volumetric Breast Density in Healthy Women across the Menopausal Transition

Abstract

Background: Mammographic breast density declines during menopause. We assessed changes in volumetric breast density across the menopausal transition and factors that influence these changes.

Methods: Women without a history of breast cancer, who had full field digital mammograms during both pre- and postmenopausal periods, at least 2 years apart, were sampled from four facilities within the San Francisco Mammography Registry from 2007 to 2013. Dense breast volume (DV) was assessed using Volpara on mammograms across the time period. Annualized change in DV from pre- to postmenopause was estimated using linear mixed models adjusted for covariates and per-woman random effects. Multiplicative interactions were evaluated between premenopausal risk factors and time to determine whether these covariates modified the annualized changes.

Results: Among the 2,586 eligible women, 1,802 had one premenopausal and one postmenopausal mammogram, 628 had an additional perimenopausal mammogram, and 156 had two perimenopausal mammograms. Women experienced an annualized decrease in DV [-2.2 cm³ (95% confidence interval, -2.7 to -1.7)] over the menopausal transition. Declines were greater among women with a premenopausal DV above the median (54 cm³) versus below (DV, -3.5 cm³ vs. -1.0 cm³; P < 0.0001). Other breast cancer risk factors, including race, body mass index, family history, alcohol, and postmenopausal hormone therapy, had no effect on change in DV over the menopausal transition.

Conclusions: High premenopausal DV was a strong predictor of greater reductions in DV across the menopausal transition.

Impact: We found that few factors other than premenopausal density influence changes in DV across the menopausal transition, limiting targeted prevention efforts.

Figure 1

Histogram of annualized change in dense volume (DV). DV: dense volume.

Figure 2

Annualized changes in dense volume (DV) across the menopausal transition according to premenopausal characteristics. Panel A: annualized changes in DV overall, Panel B: changes in DV according by premenopausal DV (above vs. below median DV), Panel C: changes in DV according to BMI; Panel D: changes by use of hormone replacement therapy. BMI: body mass index, HRT: hormone replacement therapy, Current E: current use of estrogen therapy, Current E+P: current use of combined estrogen & progesterone therapy.