Breastfeeding and Mammographic Breast Density: A Cross-sectional Study

Breastfeeding is inversely associated with breast cancer risk but the associations of breastfeeding with mammographic breast density (MBD) are not clear. We investigated the association between breastfeeding and volumetric measures of MBD [volumetric percent density (VPD), dense volume (DV), and non-dense volume (NDV)] and evaluated whether it differs by race, menopausal status, and body mass index (BMI). The study population was comprised of 964 women (67% non-Hispanic White, 29% non-Hispanic Black) who had screening mammography at Washington University School of Medicine, St. Louis, MO. VPD, DV and NDV were log₁₀ transformed. We performed multivariable linear regression models adjusted for age, BMI, family history of breast cancer, race, and age at menarche among all participants and exclusively in parous women. Mean age was 50.7 years. VPD was 12% lower among women who breastfed 0–6 months, [10^b ¼ 0.88, 95% confidence interval (CI; 0.79–0.98)] compared with nulliparous women. Breastfeeding was not associated with VPD among women who breastfed >7 months. Breastfeeding was inversely associated with DV [parous never breastfed: 10^b ¼ 0.93; 95% CI (0.83–1.04), breastfed 0–6 months: 10^b ¼ 0.91, 95% CI (0.79–1.05), breastfed 7–12 months: 10^b ¼ 0.94; 95% CI (0.81–1.10), breastfed >12 months: 10^b ¼ 0.87, 95% CI (0.78–0.98), P_trend ¼ 0.03]. BMI modified the association between breastfeeding and VPD. Women who breastfed for 0–6 months and had a BMI < 25 kg/m² had lower VPD compared with nulliparous women, but among women with a BMI ≥ 25 kg/m² there was no association (P_interaction ¼ 0.04). In this diverse study population, the association of breastfeeding with VPD appears to be modified by BMI, but not by race or menopausal status. Future research exploring the associations of breastfeeding with other mammographic features are needed. Prevention Relevance: Breastfeeding for up to 6 months may be associated with lower VPD among women with a BMI < 25 kg/m². The potential role of MBD in mediating the associations of breastfeeding with breast cancer risk in a select group of women deserves further evaluation. See related Spotlight, p. 309.