Nondense mammographic area and risk of breast cancer

INTRODUCTION: The mechanisms underlying the strong association between percentage dense area on a mammogram and the risk of breast cancer are unknown. We investigated separately the absolute dense area and the absolute nondense area on mammograms in relation to breast cancer risk. METHODS: We conducted a nested case-control study on prediagnostic mammographic density measurements and risk of breast cancer in the Nurses' Health Study and the Nurses' Health Study II. Premenopausal mammograms were available from 464 cases and 998 controls, and postmenopausal mammograms were available from 960 cases and 1,662 controls. We used a computer-assisted thresholding technique to measure mammographic density, and we used unconditional logistic regression to calculate OR and 95% CI data. RESULTS: Higher absolute dense area was associated with a greater risk of breast cancer among premenopausal women (OR(tertile 3 vs 1 )= 2.01, 95% CI = 1.45 to 2.77) and among postmenopausal women (OR(quintile 5 vs 1 )= 2.19, 95% CI = 1.65 to 2.89). However, increasing absolute nondense area was associated with a decreased risk of breast cancer among premenopausal women (OR(tertile 3 vs 1 )= 0.51, 95% CI = 0.36 to 0.72) and among postmenopausal women (OR(quintile 5 vs 1 )= 0.46, 95% CI = 0.34 to 0.62). These associations changed minimally when we included both absolute dense area and absolute nondense area in the same statistical model. As expected, the percentage dense area was the strongest risk factor for breast cancer in both groups. CONCLUSIONS: Our results indicate that absolute dense area is independently and positively associated with breast cancer risk, whereas absolute nondense area is independently and inversely associated with breast cancer risk. Since adipose tissue is radiographically nondense, these results suggest that adipose breast tissue may have a protective role in breast carcinogenesis.