The Relationship between Body Mass Index and Mammographic Density during a Premenopausal Weight Loss Intervention Study

SIMPLE SUMMARY: This study assessed the association between short-term weight change and mammographic density in premenopausal women losing weight through diet and exercise to reduce their risk of postmenopausal breast cancer. We aimed to understand whether a reduction in body mass index affects various components of the breast, which could indicate a potential pathway for the reduction in postmenopausal breast cancer risk seen with premenopausal weight loss. Understanding this pathway is useful for monitoring the effectiveness of prevention strategies based on lifestyle advice. We found that a short-term reduction in premenopausal body mass index through diet and exercise is associated with a reduction in breast fat, but it is unlikely to have a significant effect on the quantity of breast glandular tissue. Breast cancer risk determined by changes in breast density might not capture potential weight loss-induced breast cancer risk reduction, instead falsely ascribing an increased risk due to increased percent density. ABSTRACT: We evaluated the association between short-term change in body mass index (BMI) and breast density during a 1 year weight-loss intervention (Manchester, UK). We included 65 premenopausal women (35–45 years, ≥7 kg adult weight gain, family history of breast cancer). BMI and breast density (semi-automated area-based, automated volume-based) were measured at baseline, 1 year, and 2 years after study entry (1 year post intervention). Cross-sectional (between-women) and short-term change (within-women) associations between BMI and breast density were measured using repeated-measures correlation coefficients and multivariable linear mixed models. BMI was positively correlated with dense volume between-women (r = 0.41, 95%CI: 0.17, 0.61), but less so within-women (r = 0.08, 95%CI: −0.16, 0.28). There was little association with dense area (between-women r = −0.12, 95%CI: −0.38, 0.16; within-women r = 0.01, 95%CI: −0.24, 0.25). BMI and breast fat were positively correlated (volume: between r = 0.77, 95%CI: 0.69, 0.84, within r = 0.58, 95%CI: 0.36, 0.75; area: between r = 0.74, 95%CI: 0.63, 0.82, within r = 0.45, 95%CI: 0.23, 0.63). Multivariable models reported similar associations. Exploratory analysis suggested associations between BMI gain from 20 years and density measures (standard deviation change per +5 kg/m(2) BMI: dense area: +0.61 (95%CI: 0.12, 1.09); fat volume: −0.31 (95%CI: −0.62, 0.00)). Short-term BMI change is likely to be positively associated with breast fat, but we found little association with dense tissue, although power was limited by small sample size.