Breast cancer population attributable risk proportions associated with body mass index and breast density by race/ethnicity and menopausal status

Background: Overweight/obesity and dense breasts are strong breast cancer risk factors whose prevalences vary by race/ethnicity. The breast cancer population attributable risk proportions (PARP) explained by these factors across racial/ethnic groups are unknown. Methods: We analyzed data collected from 3,786,802 mammography examinations (1,071,653 women) in the Breast Cancer Surveillance Consortium, associated with 21,253 invasive breast cancers during a median of 5.2 years follow-up. HRs for body mass index (BMI) and breast density, adjusted for age and registry were estimated using separate Cox regression models by race/ethnicity (White, Black, Hispanic, Asian) and menopausal status. HRs were combined with observed risk-factor proportions to calculate PARPs for shifting overweight/obese to normal BMI and shifting heterogeneously/extremely dense to scattered fibroglandular densities. Results: The prevalences and HRs for overweight/obesity and heterogeneously/extremely dense breasts varied across races/ ethnicities and menopausal status. BMI PARPs were larger for postmenopausal versus premenopausal women (12.0%–28.3% vs. 1.0%–9.9%) and nearly double among postmenopausal Black women (28.3%) than other races/ethnicities (12.0%–15.4%). Breast density PARPs were larger for premenopausal versus postmenopausal women (23.9%–35.0% vs. 13.0%–16.7%) and lower among premenopausal Black women (23.9%) than other races/ethnicities (30.4%–35.0%). Postmenopausal density PARPs were similar across races/ethnicities (13.0%–16.7%). Conclusions: Overweight/obesity and dense breasts account for large proportions of breast cancers in White, Black, Hispanic, and Asian women despite large differences in risk-factor distributions. Impact: Risk prediction models should consider how race/ethnicity interacts with BMI and breast density. Efforts to reduce BMI could have a large impact on breast cancer risk reduction, particularly among postmenopausal Black women.