Oskar Sabine, Engmann Natalie J, Azus Aisia R, Tehranifar Parisa
Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA.
Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Cancer Causes Control. 2018 Aug;29(8):731-736. doi: 10.1007/s10552-018-1048-6. Epub 2018 Jun 8.
Type II diabetes mellitus (T2DM) has consistently been associated with an increased risk of breast cancer, but the association of gestational diabetes mellitus (GDM) with breast cancer is less clear. T2DM and GDM may influence breast cancer risk through mammographic breast density, a strong risk factor for breast cancer. We examined whether T2DM and GDM are associated with higher mammographic breast density in a largely racial/ethnic minority sample.
We collected digital mammograms, anthropometric measures, and interview data from 511 racially diverse women recruited during screening mammography appointments between 2012 and 2016 (mean age 51 years; 70% Hispanic). We examined the associations of self-reported GDM, T2DM, and medication use (metformin and insulin) with mammographic breast density, measured as percent and area of dense tissue using Cumulus software.
In multivariable linear regression models, history of T2DM and/or GDM and length of time since diagnosis were not associated with percent density or dense breast area, either before or after adjustment for current BMI. Use of metformin in diabetic women was associated with lower percent density (β = - 5.73, 95% CI - 10.27, - 1.19), only before adjusting for BMI. These associations were not modified by menopausal status.
Our results do not support associations between T2DM and/or GDM and higher amount of mammographically dense breast tissue, suggesting that the mechanism linking diabetes with breast cancer risk may not include mammographic breast density in midlife.
2型糖尿病（T2DM）一直与乳腺癌风险增加相关，但妊娠期糖尿病（GDM）与乳腺癌的关联尚不清楚。T2DM和GDM可能通过乳腺X线摄影的乳房密度（乳腺癌的一个重要风险因素）影响乳腺癌风险。我们在一个主要为种族/族裔少数群体的样本中研究了T2DM和GDM是否与更高的乳腺X线摄影乳房密度相关。
我们收集了2012年至2016年间在乳腺X线筛查预约期间招募的511名种族多样的女性的数字化乳腺X线照片、人体测量数据和访谈数据（平均年龄51岁；70%为西班牙裔）。我们使用Cumulus软件，以致密组织的百分比和面积来衡量，研究了自我报告的GDM、T2DM以及药物使用（二甲双胍和胰岛素）与乳腺X线摄影乳房密度之间的关联。
在多变量线性回归模型中，T2DM和/或GDM病史以及诊断后的时间长度与密度百分比或致密乳腺面积均无关联，无论是否对当前体重指数（BMI）进行调整。仅在调整BMI之前，糖尿病女性使用二甲双胍与较低的密度百分比相关（β = -5.73，95%置信区间 -10.27，-1.19）。这些关联不受绝经状态的影响。
我们的结果不支持T2DM和/或GDM与更高量的乳腺X线摄影致密乳腺组织之间存在关联，这表明在中年时期，将糖尿病与乳腺癌风险联系起来的机制可能不包括乳腺X线摄影乳房密度。
