Environment and Breast Cancer: Science Review

Evidence From Humans
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The association between obesity and screening mammography accuracy
Elmore, J. G., Carney, P. A., Abraham, L. A., Barlow, W. E., Egger, J. R., Fosse, J. S., Cutter, G. R., Hendrick, R. E., D'Orsi, C. J., Paliwal, P., Taplin, S. H. Archives of Internal Medicine. 2004. 164:10, 1140-7.
Topic area
Body size
Funding agency
Study Participants
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Number in Cohort
Cohort:100,622 mammograms from 67,984 women
Cohort participation rate
Retention/participation exceeded 70% for exposed a
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: women who participated in a breast cancer screening program between 1/1/96 and 9/30/99; age 50 or older at recruitment; women with risk factors age 40 or older at recruitment; completed self-administered survey Ex: unilateral mammographies; women with a history of breast cancer; women who had radiologic breast examinations within 9 months of recruitment; women with a history of breast implants; missing Breast Imaging Reporting and Data System assessment; missing or improbable BMI data
Comment about participation selection
Strengths: high participation rate; large cohort; long-term prospectively collected data; included information on important covariates and compete ascertainment of subsequent breast cancer status fo participants when available; analyzed the need for women to be recalled for additional tests due to unclear mammography results by BMI; analyzed the association between a decrease in specificity of mammogram and increased BMI Limitations: anthropometric data self-reported; study conducted amongst a predominantly white population, therefore results cannot be generalized; likely overrepresentation of high risk women; small number of women diagnosed as having breast cancer
Exposure Investigated
How exposure was measured
Questionnaire, self-administered
Exposure assessment comment
Anthropometric data self-reported
Breast cancer outcome investigated
Other: women recalled for additional tests after mammograms and lower specificity of mammograms
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Adequately controlled, confounders: age, breast density, menopausal or HT status, breast symptoms, family history of breast cancer, history of breast biopsy or surgery and time since last mammogram
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Results Comments
Obese women (BMI 30-34) had more than a 20% increased risk of having a false-positive mammography results compared to underweight and normal weight women, although sensitivity was unchanged. Overweight women were more likely to be recalled for additional tests after mammograms and to have lower specificity.
Author address
Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104-2499, USA. jelmore@u.washington.edu