Reproductive factors associated with mammographic density: a Korean co-twin control study

To determine the mechanism by which menstrual and reproductive factors are associated with the risk of breast cancer, we examined the relationships between mammographic density and known menstrual and reproductive risk factors for breast cancer. A co-twin control study was conducted with 122 pairs of monozygotic Korean female twins selected from the Healthy Twin study. Mammographic density was measured from digital mammograms using a computer-assisted method. Information on selected menstrual and reproductive factors was collected through a self-administered questionnaire. Within-pair differences for each mammographic measure were regressed against within-pair differences for each menstrual and reproductive risk factor with an adjustment for body mass index and other menstrual and reproductive factors. The percent dense area was inversely associated with the age at the first full-term childbirth (FFTB) and the number of live births, although the associations were marginally significant with an adjustment for BMI and other reproductive factors. The non-dense area was positively associated with the age at the FFTB and the number of live births. The absolute dense area was positively associated with the duration of breast feeding. The age at menarche was not associated with any component of the mammographic measures. This finding suggests that mammographic density can mediate the protective effect of greater parity against breast cancer, at least in part while age at menarche, age at the FFTB, and breast feeding do not exert their effects through mammographic density.