Associations between Metabolic Syndrome and Three-dimensional Breast Density Using Digital Mammography

Seon-yong Bhang; Hyo-jin Lee; Jee-hyun Kang; Byung-yeon Yu

doi:10.15384/kjhp.2015.15.4.168

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Bhang, Lee, Kang, and Yu: Associations between Metabolic Syndrome and Three-dimensional Breast Density Using Digital Mammography

Original Article

Korean J Health Promot 2015;15(4):168-174.

Published online: 19 December 2015

DOI: https://doi.org/10.15384/kjhp.2015.15.4.168

Associations between Metabolic Syndrome and Three-dimensional Breast Density Using Digital Mammography

Seon-yong Bhang, Hyo-jin Lee, Jee-hyun Kang, Byung-yeon Yu

Department of Family Medicine, College of Medicine, Konyang University, Daejeon, Korea

Corresponding author：Jee-hyun Kang, MD, PhD Department of Family Medicine, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea Tel: +82-42-600-8970, Fax: +82-42-600-9095 E-mail: jeehyunkang@yahoo.co.kr

Received 31 October 2014 Accepted 15 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Metabolic syndrome is associated with increased risk of breast cancer, but little is known about the association between metabolic syndrome and mammographic density as an independent predictor of breast cancer. In this study, we investigated the association between metabolic syndrome or its components and three-dimensional breast density using digital mammography.

Methods

We analyzed cross-sectional data of 166 women, aged 20 or over (61 premenopausal and 105 postmenopausal women) in a district hospital. Metabolic syndrome was defined according to the modified National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATP III) guideline. We measured volume percentage of dense breast tissue using digital mammography. Stepwise multiple regression analysis was used to estimate the association between mammographic density and metabolic syndrome, as well as its components.

Results

The Mean mammographic density was lower in the group with metabolic syndrome compared with the group without it. After adjusting for age and menopausal status, multiple regression analysis showed waist circumference (β＝-3.112, S.E.＝0.927, P＝0.001) and low HDL-cholesterol (β＝-2.967, S.E.＝1.109, P＝0.008) were independent variables for the percentage of mammographic density, although metabolic syndrome itself was not. After additional adjustment for body mass index, only low HDL-cholesterol was associated with percentage of mammographic density (β＝-2.953, S.E.＝0.882, P＝0.001).

Conclusions

In this study, only low HDL cholesterol was associated with three-dimensional mammographic density independently after adjusting for age, menopausal status and body mass index. These findings need to be confirmed in further larger prospective studies.

Keywords: Metabolic syndrome, Mammographic density, High density lipoprotein cholesterol, Breast cancer

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Table 1.

Study population characteristics by metabolic syndrome status

Characteristics (N＝166)	Total^a (N＝166)	Without MS^a (N＝131)	With MS^a (N＝35)	P^b
Mean age, y (SD)	54.63 (10.61)	53.22 (10.69)	59.91 (8.50)	0.001
BMI, kg/m² (SD)	24.18 (3.20)	23.57 (2.89)	26.41 (3.34)	＜0.001
Menopause (%)				0.002
Premenopause	61 (36.7)	56 (42.7)	5 (14.3)
Postmenopause	105 (63.3)	75 (57.3)	30 (85.7)
Smoking (%)				0.760
Non-smoker	164 (98.8)	129 (98.5)	35 (100.0)
Ex-smoker	1 (0.6)	1 (0.8)	0 (0.0)
Current smoker	1 (0.6)	1 (0.8)	0 (0.0)
Alcohol drinking (%)				0.130
No drinking	125 (75.3)	98 (74.8)	27 (77.1)
Past drinking	1 (0.6)	0 (0)	1 (2.9)
Current drinking	40 (24.1)	33 (25.2)	7 (20.0)
Parity (%)				0.780
No	8 (4.8)	6 (4.6)	2 (5.7)
Yes	158 (95.2)	125 (95.4)	33 (94.3)
Number of live births (%)				0.730
0	8 (4.8)	6 (4.6)	2 (5.7)
1-2	120 (72.3)	97 (74.0)	23 (65.7)
3-4	29 (17.5)	22 (16.8)	7 (20.0)
5 or more	9 (5.4)	6 (4.6)	3 (8.6)
Use of Contraceptive (%)				0.530
No	143 (86.1)	114 (87.0)	29 (82.9)
Yes	23 (13.9)	17 (13.0)	6 (17.1)

Abbreviations: MS, metabolic syndrome; SD, standard deviation; BMI, body mass index.

^a Data shown is mean (SD) for continuous variables and number (percentage) for categorical variables.

^b P value is based on student t-test for continuous variables and Pearson’s chi-square test for categorical variables. All statistical tests are two-sided.

Table 2.

Mean percentage of dense breast volume by prevalence of metabolic abnormalities

Characteristics	Total (N＝166)			Without MS (N＝131)			With MS (N＝35)
Characteristics	N (%)	Mean PD (SD)	P^a	N (%)	Mean PD (SD)	P^a	N (%)	Mean PD (SD)	P^a
MS
No	131 (78.9)	23.34 (7.55)		-	-	-	-	-	-
Yes	35 (21.1)	18.09 (3.66)	＜0.001	-	-	-	-	-	-
Components of the MS
Waist circumference (≥85 cm)
No	132 (79.5)	23.35 (7.44)		115 (87.8)	24.13 (7.59)		17 (48.6)	18.11 (2.93)
Yes	34 (20.5)	17.91 (4.18)	＜0.001	16 (12.2)	17.71 (4.13)	0.001	18 (51.4)	18.08 (4.33)	0.980
Raised blood pressure (SBP≥130 mmHg, DBP≥85 mmHg or taking antihypertensive agent)
No	78 (47.0)	24.74 (7.76)		73 (55.7)	25.13 (7.64)		5 (14.3)	19.07 (8.07)
Yes	88 (53.0)	20.02 (5.94)	＜0.001	58 (44.3)	21.10 (6.86)	0.002	30 (85.7)	17.93 (2.56)	0.530
Raised fasting plasma glucose (≥100mg/dL or taking hypoglycemic agent)
No	128 (77.1)	23.45 (7.59)		116 (88.5)	23.91 (7.77)		12 (34.3)	18.95 (2.97)
Yes	38 (22.9)	18.16 (3.67)	＜0.001	15 (11.5)	18.94 (3.12)	0.016	23 (65.7)	17.65 (3.97)	0.330
Raised triglyceride (≥150mg/dL)
No	128 (77.1)	22.74 (7.54)		117 (89.3)	23.28 (7.65)		11 (31.4)	16.94 (1.63)
Yes	38 (22.9)	20.55 (5.85)	0.100	14 (10.7)	23.86 (6.89)	0.790	24 (68.8)	18.62 (4.21)	0.210
Reduced HDL-cholesterol (≤50mg/dL)
No	112 (67.5)	23.42 (7.70)		101 (77.1)	23.93 (7.79)		11 (31.4)	18.82 (5.07)
Yes	54 (32.5)	19.78 (5.42)	0.002	30 (22.9)	21.39 (6.41)	0.110	24 (68.8)	17.76 (2.88)	0.430

Abbreviations: MS, metabolic syndrome; PD, percentage of dense volume; SD, standard deviation; HDL, high-density lipoprotein.

^a P value is based on student t-test. All statistical tests are two-sided.

Table 3.

Stepwise multiple linear regression of metabolic syndrome components and percentage of dense breast volume

Model 1 (without BMI adjustment)
	β	S.E	P value
Reduced HDL-C	-3.112	0.927	0.001
Waist Circumference	-2.967	1.109	0.008
Model 2 (with BMI adjustment)
	β	S.E	P value
Reduced HDL-C	-2.953	0.882	0.001

Abbreviations: BMI, body mass index; HDL-C, high-density lipoprotein cholesterol; S.E, standard error. Model 1 represents the adjusted model including age, smoking, menopausal status, oral contraceptive use. Model 2 represents Model 1 with an additional adjustment for BMI (kg/m²).

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