Breast Cancer Population Attributable Risk Proportions Associated with Body Mass Index and Breast Density by Race/Ethnicity and Menopausal Status
Menée à partir de données d'examens mammographiques réalisés auprès de plus d'1 million d'Américaines sur la période 1994-2016 (âge : 35-84 ans ; durée médiane de suivi : 5,2 ans), cette étude estime la part des cancers du sein attribuable à l'indice de masse corporelle et à la densité mammaire, en fonction de l'origine ethnique et du statut ménopausique
Background: Overweight/obesity and dense breasts are strong breast cancer risk factors whose prevalences vary by race/ethnicity. The breast cancer population attributable risk proportions (PARPs) explained by these factors across racial/ethnic groups are unknown. Methods: We analyzed data collected from 3,786,802 mammography examinations (1,071,653 women) in the Breast Cancer Surveillance Consortium, associated with 21,253 invasive breast cancers during a median of 5.2 years follow-up. Hazard ratios (HRs) for body mass index (BMI) and breast density, adjusted for age and registry were estimated using separate Cox regression models by race/ethnicity (white, black, Hispanic/Latina, Asian) and menopausal status. HRs were combined with observed risk-factor proportions to calculate PARPs for shifting overweight/obese to normal BMI and shifting heterogeneously/extremely dense to scattered fibroglandular densities. Results: The prevalences and HRs for overweight/obesity and heterogeneously/extremely dense breasts varied across races/ethnicities and menopausal status. BMI PARPs were larger for post- vs. premenopausal women (12.0-28.3% vs. 1.0-9.9%) and nearly double among postmenopausal black women (28.3%) than other races/ethnicities (12.0-15.4%). Breast density PARPs were larger for pre- vs. postmenopausal women (23.9-35.0% vs. 13.0-16.7%) and lower among premenopausal black women (23.9%) than other races/ethnicities (30.4-35.0%). Postmenopausal density PARPs were similar across races/ethnicities (13.0-16.7%). Conclusions: Overweight/obesity and dense breasts account for large proportions of breast cancers in white, black, Hispanic, and Asian women despite large differences in risk-factor distributions. Impact: Risk prediction models should consider how race/ethnicity interacts with BMI and breast density. Efforts to reduce BMI could have a large impact on breast cancer risk reduction, particularly among postmenopausal black women.