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. 2023 Nov 1;32(11):1524-1530.
doi: 10.1158/1055-9965.EPI-23-0049.

Impact of BMI on Prevalence of Dense Breasts by Race and Ethnicity

Karla Kerlikowske #  1   2 , Michael C S Bissell #  3 , Brian L Sprague  4 , Jeffrey A Tice  5 , Katherine Y Tossas  6 , Erin J A Bowles  7 , Thao-Quyen H Ho  8   9 , Theresa H M Keegan  10 , Diana L Miglioretti  3   7
Affiliations

Impact of BMI on Prevalence of Dense Breasts by Race and Ethnicity

Karla Kerlikowske et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: Density notification laws require notifying women of dense breasts with dense breast prevalence varying by race/ethnicity. We evaluated whether differences in body mass index (BMI) account for differences in dense breasts prevalence by race/ethnicity.

Methods: Prevalence of dense breasts (heterogeneously or extremely dense) according to Breast Imaging Reporting and Data System and obesity (BMI > 30 kg/m2) were estimated from 2,667,207 mammography examinations among 866,033 women in the Breast Cancer Surveillance Consortium (BCSC) from January 2005 through April 2021. Prevalence ratios (PR) for dense breasts relative to overall prevalence by race/ethnicity were estimated by standardizing race/ethnicity prevalence in the BCSC to the 2020 U.S. population, and adjusting for age, menopausal status, and BMI using logistic regression.

Results: Dense breasts were most prevalent among Asian women (66.0%) followed by non-Hispanic/Latina (NH) White (45.5%), Hispanic/Latina (45.3%), and NH Black (37.0%) women. Obesity was most prevalent in Black women (58.4%) followed by Hispanic/Latina (39.3%), NH White (30.6%), and Asian (8.5%) women. The adjusted prevalence of dense breasts was 19% higher [PR = 1.19; 95% confidence interval (CI), 1.19-1.20] in Asian women, 8% higher (PR = 1.08; 95% CI, 1.07-1.08) in Black women, the same in Hispanic/Latina women (PR = 1.00; 95% CI, 0.99-1.01), and 4% lower (PR = 0.96; 95% CI, 0.96-0.97) in NH White women relative to the overall prevalence.

Conclusions: Clinically important differences in breast density prevalence are present across racial/ethnic groups after accounting for age, menopausal status, and BMI.

Impact: If breast density is the sole criterion used to notify women of dense breasts and discuss supplemental screening it may result in implementing inequitable screening strategies across racial/ethnic groups. See related In the Spotlight, p. 1479.

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Conflict of interest statement

Disclosures and Conflicts of Interest

Diana Miglioretti, PhD, has textbook royalties from Elsevier outside the submitted work. All other authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:
Distribution of Breast Imaging Reporting and Data System breast density categories within body mass index categories by race and ethnicity age-adjusted and inversely weighted for the number of mammograms per woman. Panels according to race and ethnicity.
Figure 2:
Figure 2:
Prevalence ratios and 95% bootstrap confidence intervals for polytomous BI-RADS breast density category by race and ethnicity. Graph A is unadjusted, Graph B is adjusted for age (linear and quadratic) and menopausal status, and Graph C is adjusted for age (linear and quadratic) and menopausal status, and body mass index (linear and quadratic).
See this image and copyright information in PMC

Comment in

References

    1. Bissell MCS, Kerlikowske K, Sprague BL, Tice JA, Gard CC, Tossas KY, et al.; Breast Cancer Surveillance Consortium. Breast cancer population attributable risk proportions associated with body mass index and breast density by race/ethnicity and menopausal status. Cancer Epidemiol, Biomarkers, & Prev. 2020;29(10):2048–2056. - PMC - PubMed
    1. Engmann NJ, Golmakani MK, Miglioretti DL, Sprague BL, Kerlikowske K, Breast Cancer Surveillance C. Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA Oncol. 2017;3(9):1228–1236. - PMC - PubMed
    1. Henderson LM, Miglioretti DL, Kerlikowske K, Wernli KJ, Sprague BL, Lehman CM. Breast cancer characteristics associated with digital versus screen-film mammography for screen-detected and interval cancers. Am J Roentgenol. 2015;205(3):676–684. - PMC - PubMed
    1. Kerlikowske K, Scott CG, Mahmoudzadeh AP, Ma L, Winham S, Jensen MR, et al. Automated and clinical Breast Imaging Reporting and Data System density measures predict risk for screen-detected and interval cancers: A case-control study. Ann Intern Med. 2018;168(11):757–765. - PMC - PubMed
    1. Kerlikowske K, Zhu W, Tosteson AN, Sprague BL, Tice JA, Lehman CD, et al. Identifying women with dense breasts at high risk for interval cancer: a cohort study. Ann Intern Med. 2015;162(10):673–681. - PMC - PubMed

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