Department of Surgery, University of California, San Diego, San Diego, CA.
Department of Surgery, University of California, San Francisco, San Francisco, CA.
Surg Obes Relat Dis. 2019 Jun;15(6):964-968. doi: 10.1016/j.soard.2019.03.037. Epub 2019 Mar 23.
Obesity and high breast density both increase breast cancer risk but paradoxically are inversely related. Bariatric surgery decreases breast cancer risk, but its impact on mammographic breast density is not well understood.
We investigated how mammographic density changes after bariatric surgery and whether this change is related to weight loss.
University of California, San Francisco Medical Center.
We reviewed records from 349 prospectively collected patients who underwent bariatric surgery between 2013 and 2015 and identified 42 women with pre- and postoperative screening mammograms within 1.5 years of surgery. We recorded body mass index (BMI), height and Breast Imaging Reporting and Data System density and calculated BMI loss and total weight loss. Data were analyzed in Stata 14.2.
Average age was 54.2 years, mean preoperative BMI was 43.8 kg/m, mean BMI lost was 30.9%, and total weight loss was 31.1% at 1.3 years. Over one-third had a change in mammographic breast density, which increased 93.3% of the time (P < .001). Amount of weight loss was not associated with a density change. Patients with the lowest mammographic density preoperatively were most likely to have a density change (P = .02).
Most women with a mammographic change had an increase in breast density, despite bariatric surgery being associated with reduced breast cancer risk. Baseline breast density was associated with a density change, but amount of weight loss was not. These findings suggest the metabolic effects of bariatric surgery have an effect on breast parenchyma independent of absolute BMI reduction or weight loss.
肥胖和高乳腺密度均会增加乳腺癌风险，但二者呈负相关。减重手术可降低乳腺癌风险，但对乳腺 X 线摄影密度的影响尚不清楚。
我们研究了减重手术后乳腺密度的变化情况，以及这种变化是否与体重减轻有关。
美国加利福尼亚大学旧金山医疗中心。
我们查阅了 2013 年至 2015 年间接受减重手术的 349 例前瞻性收集的患者记录，从中确定了 42 例手术前后 1.5 年内接受过筛查性乳腺 X 线摄影的患者。我们记录了体重指数（BMI）、身高和乳腺影像报告和数据系统密度，并计算了 BMI 减轻量和总减重。数据采用 Stata 14.2 进行分析。
平均年龄为 54.2 岁，术前平均 BMI 为 43.8 kg/m2，术后 1.3 年 BMI 减轻 30.9%，总减重 31.1%。超过三分之一的患者乳腺 X 线摄影密度发生变化，其中 93.3%的患者密度增加（P<0.001）。体重减轻量与密度变化无关。术前乳腺密度最低的患者最有可能发生密度变化（P=0.02）。
尽管减重手术与降低乳腺癌风险相关，但大多数乳腺 X 线摄影密度发生变化的患者其乳腺密度增加。术前乳腺密度与密度变化相关，而体重减轻量无关。这些发现表明，减重手术的代谢效应对乳腺实质的影响独立于绝对 BMI 降低或体重减轻。
