kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.4.168 kjhp-15-168 Original Article Associations between Metabolic Syndrome and Three-dimensional Breast Density Using Digital Mammography BhangSeon-yong LeeHyo-jin KangJee-hyun YuByung-yeon 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 122015 19122015 154 168174 31102014 15102015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 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. 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.

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Study population characteristics by metabolic syndrome status

Characteristics (N＝166) Totala (N＝166) Without MSa (N＝131) With MSa (N＝35) Pb
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.

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

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.

Mean percentage of dense breast volume by prevalence of metabolic abnormalities

Characteristics Total (N＝166) Without MS (N＝131) With MS (N＝35)
N (%) Mean PD (SD) Pa N (%) Mean PD (SD) Pa N (%) Mean PD (SD) Pa
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.

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

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).