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Mammographic Density and Breast Cancer in Three Ethnic Groups¹

Departments of Preventive Medicine [G. U., H. M., A. H. W., L. B., C. C. S., M. C. P.], Radiology [Y. R. P.], and Radiation Oncology [M. A.], University of California Keck School of Medicine, Los Angeles, California 90089; Institute for Nutrition Research University of Oslo, 0316 Oslo, Norway [G. U.]; and MSW Consulting, Bloomfield Hills, Michigan 48304 [M. S.]

The extent of radiodense tissue on a mammogram (mammographic densities) is strongly associated with breast cancer risk among (non-Latina) white women, but few data exist for African-American and Asian-American women. We collected prediagnostic mammograms from 622 breast cancer patients and 443 control subjects ages 35–64 years from three different ethnic groups (whites, African Americans, and Asian Americans) who participated as cases and controls in one of two ongoing breast cancer studies. Percent and absolute mammographic density were assessed using a previously validated computer-assisted method. In all three ethnic groups combined, breast cancer risk increased with increasing percent mammographic density. After adjustment for ethnicity, age, body mass index, age at menarche, breast cancer family history, age at and number of full-term pregnancies, menopausal status, and hormone replacement therapy use, women with the highest percent density had 5-fold greater breast cancer risk than women with no density (P_trend = 0.0001). The impact of percent density on risk was stronger for older than for younger women (50 versus <50 years; P = 0.05). Risk estimates did not differ significantly by ethnicity, with breast cancer risk (95% confidence interval) increasing 15% (4–27%) in whites, 30% (5–61%) in Asian Americans, and 11% (-2–26%) in African Americans for each 10% increase in density. The trends were similar for absolute density. Our results confirm that increases in computer-assisted mammographic density measurements are associated with a strong gradient in breast cancer risk. Furthermore, our findings suggest that mammographic density is as strong a predictor of risk for African-American and Asian-American women as for white women.

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