Background Well-tolerated and commonly used medications are increasingly assessed for reducing breast cancer risk. These include metformin and statins, both linked to reduced hormone availability and cell proliferation or growth and sometimes prescribed concurrently. We investigated independent and joint associations of these medications with mammographic breast density (MBD), a useful biomarker for the effect of chemopreventive agents on breast cancer risk. Methods Using data from a cross-sectional study of 770 women (78% Hispanic, aged 40–61 years, in a mammography cohort with high cardiometabolic burden), we examined the association of self-reported “ever” use of statins and metformin with MBD measured via clinical Breast Imaging Reporting and Data System (BI-RADS) density classifications (relative risk regression) and continuous semi-automated percent and size of dense area (Cumulus) (linear regression), adjusted for age, body mass index, education, race, menopausal status, age at first birth, and insulin use. Results We observed high statin (27%), metformin (13%), and combination (9%) use, and most participants were overweight/obese (83%) and parous (87%). Statin use was associated with a lower likelihood of high density BI-RADS (RR = 0.60, 95% CI = 0.45 to 0.80), percent dense area (PD) (β = − 6.56, 95% CI = − 9.05 to − 4.06), and dense area (DA) (β = − 9.05, 95% CI = − 14.89 to − 3.22). Metformin use was associated with lower PD and higher non-dense area (NDA), but associations were attenuated by co-medication with statins. Compared to non-use of either medication, statin use alone or with metformin were associated with lower PD and DA (e.g., β = − 6.86, 95% CI: − 9.67, − 4.05 and β = − 7.07, 95% CI: − 10.97, − 3.17, respectively, for PD) and higher NDA (β = 25.05, 95% CI: 14.06, 36.03; β = 29.76, 95% CI: 14.55, 44.96, respectively). Conclusions Statin use was consistently associated with lower MBD, measured both through clinical radiologist assessment and continuous relative and absolute measures, including dense area. Metformin use was associated with lower PD and higher NDA, but this may be driven by co-medication with statins. These results support that statins may lower MBD but need confirmation with prospective and clinical data to distinguish the results of medication use from that of disease.
Migration to the U.S. has been associated with increased body size and obesity risk in Latinas, but results for Caribbean immigrant women are limited and inconclusive. Emerging evidence also suggests that early-life environment associations with women’s midlife body mass index (BMI) may be different for larger and smaller women, but this has not been tested within migration life-course history. We examined the associations of nativity and migration timing with midlife body size in a sample of majority Caribbean Latinas and whether these associations varied across the body size distribution. We used interview data from 787 self-identified Latinas (ages 40–65 years) and assessed overall obesity using BMI (kg/m2) and central obesity based on waist circumference (WC, cm). We used linear and quantile regression to examine the association of migration history with BMI and WC and logistic regression for the probability of obesity. Foreign birthplace, later migration age, and lower percent of life in the U.S. were associated with lower BMI and WC means and lower odds of overall and central obesity. Quantile regression showed only inverse associations in the upper quantiles of BMI and WC. For example, relative to U.S.-born women, women living <50% of their lives in the U.S. had lower BMI in the 75th BMI percentile (β = −4.10, 95% CI: −6.75, −0.81), with minimal differences in the 25th (β = 0.04, 95% CI: −1.01, 0.96) and 50th BMI percentiles (β = −1.54, 95% CI: −2.90, 0.30). Our results support that migration to and increasing time in the U.S. are associated with greater body size in midlife Latina women, with stronger influences at higher body size distribution.
Heavy childhood body size is associated with lower mammographic density, consistent with its associations with breast cancer risk. Suggestive findings by nativity require confirmation in larger samples.
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General and central obesity, excess weight and body fat constitute potentially modifiable risk factors for several cancer sites and are important targets for cancer prevention efforts. The prevalence of obesity continues to increase in the United States (U.S.) and many parts of the world. In Latino populations, immigration to the U.S. and subsequent acculturation are accompanied by an increase in body size and obesity risk; however, evidence for Latinos of non-Mexican origin is limited. We examined the associations of birthplace, migration age, and percent of life in the U.S. with body size measures in a sample of 787 self-identified Latina women of predominantly Caribbean heritage (79% born in the Dominican Republic or Puerto Rico), recruited from a mammography clinic in New York City (ages 40-65 years, 53% monolingual Spanish speakers, 31% immigrated to the U.S. before age 20). We collected in-person interview data and measured women’s height, weight and waist circumference, which were used both as continuous and categorical variables to assess general obesity/body size using BMI (kg/m2, general obesity ≥ 30 vs. < 30) and central body fat composition/central obesity using waist circumference (in cm, ≥ 88 vs. < 88). We conducted multivariable regression analysis using linear regression and quantile regression methods for continuous body size measures and relative risk regression for risk of obesity. The results of linear and relative risk regression models showed lower BMI and waist circumference as well as lower risk of general and central obesity associated with foreign birthplace, later age at migration and less time in the U.S. Results from quantile regression revealed differences by percentiles with statistically significant inverse associations that were limited to the upper quantiles (≥ 75th percentile) of BMI and waist circumference. For instance, as compared with U.S.-born Latina women, BMI was lower for women who had spent < 50 % of life in the U.S., migrated to the U.S. at ages ≥ 30 years and were born in the Dominican Republic at the 75th percentile of BMI (β= -4.10, 95% CI: -6.75, -0.81; β= -4.34, 95% CI: -7.07, -0.88; β= -3.72, 95% CI: -6.41, -0.43, respectively), but no BMI differences by migration history were observed at the 25th percentile of BMI (β= 0.04, 95% CI: -1.01, 0.96; β= 0.04, 95% CI: -0.87, 1.08; β= 0.08, 95% CI: - 0.94, 1.14, respectively). In conclusion, our results using different modeling approaches provide support that migration to the U.S. is associated with larger body size and risk of obesity in midlife Latina women from Caribbean heritage, as observed for other Latina subgroups. Through the use of quantile regression methods, we provide new data highlighting that migration influences on body size may be stronger and most consistent at the higher distribution of BMI and waist circumference. Citation Format: Carmen B Rodriguez, Shweta Athilat, Parisa Tehranifar. What do different modeling approaches tell us about the association between migration history and midlife body size and obesity in Latina women? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C077.
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