Korean Journal of Family Medicine (가정의학회지)

The Korean Academy of Family Medicine (대한가정의학회)
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Mammographic Breast Density and Risk Factors of Breast Cancer in Korean Women Using Multicenter Study

다기관 연구를 통해 살펴본 한국여성에서 유방밀도와 유방암 위험요인

Cho, Jung-Jin;Song, Hong-Ji;Koh, En-Young;Song, Yun-Mi;Han, Bu-Kyung;Yun, Young-Sook;Park, Hyun-Ah;Lee, Sung-Hee;Yang, Jeong-Hee;Han, Heon;Seo, Young-Ran
조정진;송홍지;고은영;송윤미;한부경;윤영숙;박현아;이성희;양정희;한헌;서영란

  • Published : 20060100
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Abstract

Background: Density patterns on mammography have been related to the risk factors for breast cancer in the western countries. High mammographic density appears to confer a 4-fold risk of breast cancer. While the proportion of high-density mammography is higher in Korean women than in Caucasian women, the incidence of breast cancer in Korean women is considerably lower. Therefore, we examined if the mammographic breast density pattern correlates with the risk factors for breast cancer in Korean women. Methods: In a cross-sectional design, we recruited 1,758 pre- and post-menopause women without prior history of breast cancer and breast surgery who underwent screening mammogram and completed a self-administered questionnaire in 6 general hospitals. On the basis of ACR BI RADS breast composition, four density patterns were classified in caudocranial and mediolateral mammography by a designated radiologist in each hospital. Multiple linear logistic regression was used for statistical analyses. Results: Inter-rater reliability between the initial report and the report made by another blinded radiologist was high (Pearson's co-efficient=0.81). Overall, the age, body mass index, family history of breast cancer, and duration of hormone replacement therapy correlated with the mammographic density patterns. In pre-menopausal women, the high body mass index and parity (=2) were associated with low mammographic density. In post- menopausal women, older age, high body mass index, negative family history of breast cancer, and duration of hormone replacement therapy were associated with low mammographic density. Conclusion: Our data showed that the mammographic breast density patterns correlated with risk factors for breast cancer in Korean women. While the proportion of high-density mammography is higher in Korean women, the incidence of breast cancer is lower than in the western population. This maybe dependent on other unknown factors.

연구배경: 서구에서 유방밀도는 유방암 위험요인과 관련성이 높을 뿐만 아니라 유방밀도가 유방암의 독립적인 위험요인이라고 한다. 그런데 한국 여성은 서구여성에 비해 고밀도 유방비율이 높은데도 불구하고 유방암 비율은 낮다. 따라서 일차적으로 한국여성에서 유방밀도와 유방암 위험요인과의 관련성이 서구와 차이가 있는지 살펴보는 것이 필요하다. 방법: 2002년 2월부터 8월까지 서울, 경기, 강원 지역 6개의 병원에서 유방암 선별검사로 유방촬영술을 받고 이전에 유방암, 유방수술의 병력이 없는 1,758명을 대상으로 유방암 위험요인에 대한 자기기입식 설문조사를 실시하였다. 유방촬영 판독은 해당 병원 방사선과 전문의 1인이 설문에 대한 정보 없이 유방촬영술 판독규약(ACR BI RADS)에 따라 유방밀도를 분류하였으며 병원별 판독자간의 오차를 평가하기 위해 각 병원별 6개씩 유방촬영사진을 수거하여 다른 방사선과 전문의에게 재판독하였다. 결과: 유방밀도에 대한 판독자간의 신뢰도는 높았다(Pearson's co-efficient=0.81). 유방밀도를 BI RAD 3, 4형인 고밀도 유방과 1, 2형인 저밀도 유방으로 나누어 다변량 분석을 해보면 연령이 낮을수록, 체질량지수가 낮을수록, 유방암 가족력이 있는 경우, 호르몬 대체 요법기간이 길수록 유의하게 유방 밀도가 높은 것으로 나타났다. 폐경 전후로 나누어 분석해보면 폐경 전에는 체질량지수가 높을수록 출산횟수가 2회인 경우 유의하게 유방밀도가 낮았다. 폐경 후에는 연령이 높을수록, 체질량지수가 높을수록, 유방암 가족력이 없는 경우, 호르몬 대체 요법기간이 짧을수록 유방밀도가 유의하게 낮았다. 결론: 한국 여성에서도 서구와 유사하게 유방암 위험요인들과 유방밀도와의 관련성이 있으며 특히 유방암가족력이 있는 경우 폐경 후에도 유방밀도가 계속 높은 것으로 나타났다. 한국에서 유방밀도가 높은데도 유방암 발생률이 낮은 것은 유방밀도와 유방암 위험요인과의 관련성 차이가 아닌 다른 요인에 의한 것일 가능성이 높음을 시사한다.

Keywords

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