Urinary cadmium and mammographic density in premenopausal women

PURPOSE: Mammographic density (MD), a strong marker of breast cancer risk, is influenced by genetic, environmental, and hormonal factors. Cadmium, a persistent and widespread environmental pollutant, has been associated with risk of breast cancer, and laboratory evidence suggests cadmium is a carcinogen in the breast. We investigated the hypothesis that cadmium exposure is associated with higher MD. METHODS: In a cross-sectional study of MD and urinary cadmium concentration, percentage MD (MD%) and Breast Imaging-Reporting and Data Systems (BI-RADS ®) density category were determined from screening mammograms of 190 premenopausal women ages 40–45 years. Women completed a health questionnaire, and the cadmium content of spot urine samples was measured with inductively-coupled plasma mass spectrometry and corrected for urine creatinine. Urinary cadmium concentrations are thought to reflect exposure to cadmium over a period of 20–30 years. Multivariable linear regression and logistic regression were used to estimate the strength of association between urinary cadmium and mammographic breast density. RESULTS: Adjusted mean MD% among women in the upper tertile of creatinine-corrected urine cadmium was 4.6% higher (95% confidence interval (CI): −2.3 to 11.6%) than in women in the lowest cadmium tertile. Each two-fold increase in urine cadmium was associated with higher odds of MD% in the upper tertile (odds ratio(OR): 1.29, 95% CI: 0.82–2.02) or a BI-RADS category rating of “extremely dense” (OR: 1.75, 95% CI: 1.14–2.70). Stronger associations were observed among nulliparous women, and current or former smokers. CONCLUSIONS: Exposure to cadmium may be associated with increased breast density in premenopausal women