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American Journal of Epidemiology Advance Access originally published online on October 29, 2009
American Journal of Epidemiology 2009 170(11):1422-1432; doi:10.1093/aje/kwp304
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American Journal of Epidemiology © The Author 2009. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Mammographic Screening and Risk Factors for Breast Cancer

Nancy R. Cook*, Bernard A. Rosner, Susan E. Hankinson and Graham A. Colditz

* Correspondence to Dr. Nancy R. Cook, Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215 (e-mail: ncook{at}rics.bwh.harvard.edu).

Received for publication April 4, 2009. Accepted for publication August 26, 2009.

Screening mammography can distort estimated effects in breast cancer risk models due to associations with other risk factors. Mammography information was available in the Nurses’ Health Study from 1988, and 1,815 incident breast cancers were accrued through 2000 among 55,625 women with risk factor data. Logistic models were fit for screening mammography, and inverse probability weighting was used to adjust parameters in an established breast cancer risk model. Approximately 80% of women in each 2-year follow-up period had screening mammograms, which were positively associated with history of benign breast disease, family history of breast cancer, hormone therapy, alcohol use, physical activity, multivitamins, and calcium supplements, and negatively associated with postmenopause, current smoking, and body mass index. Markers of medical attention, including hypertension, high cholesterol, and osteoarthritis, were positively associated, while cardiovascular disease was negative. Inverse probability weighting led to small changes in effects of benign breast disease, family history, and hormone therapy. An apparent reduced risk associated with current smoking in unadjusted models was eliminated after weighting. Thus, several risk factors for breast cancer and cancer diagnosis are associated with mammographic screening. Adjustment for screening had some impact on breast cancer prediction in this cohort, especially for hormone therapy and smoking.

breast neoplasms; hormone replacement therapy; mammography; mass screening; probability weighting; risk factors

Abbreviations: CI, confidence interval; RR, incidence rate ratio


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