title: Distribution of breast density in Iranian women and its association with breast cancer risk factors.
abstract: BACKGROUND
  Breast cancer is one of the most common cancers and the first-leading cause of cancer deaths among women in the world. Indeed, breast cancer is ranked as the first malignancy among Iranian women. Breast density, defined as the percentage of fibro glandular breast tissue in mammographic images, is one of the known risk factors for breast cancer. According to American college of radiology-Breast Imaging Reporting and Data System (ACR-BIRADS), mammographic density is divided into four categories. Studies have shown that increased breast density is associated with significant increase in breast cancer risk. Therefore, it is assumed that breast density should be associated with other breast cancer risk factors.
  
  
  OBJECTIVE
  The aim of this study was to assess the epidemiologic distribution of breast density of the patients in a referral center in Iran, and to evaluate the association of high breast density and breast cancer risk factors and other factors that may possibly affect the mammographic density according to previous studies.
  
  
  METHODS
  In an analytical cross-sectional study, 728 of those who had referred to Imam Khomeini Imaging Center either for diagnostic or screening purposes, participated in the study, after filling out the informed consent form, the survey questionnaire based survey assessing breast cancer risk factors affecting the breast density and related demographic features, was conducted. SPSS 11.5 software and chi-square, t-test and logistic regression tests were used to analyze the data.
  
  
  RESULTS
  Most of patients (75%) in categories 2 and 3 of mammographic density had a breast density of 51.9%, however, this amount was less (49.2%) in screening mammograms, while in diagnosing group it was more (51.6%). The Findings showed an increase in age, body mass index (BMI), duration of breast feeding, and also to be menopause e, unemployed and married, younger than 29 years old at first delivery, having children up to 8 and smoking are associated with less breast density. Diagnostic mammograms and symptomatic patients showed denser breasts. But density had no association with oral contraceptives pill (OCP) consumption or hormone replacement therapy or calcium and/or vitamin D consumption, age at menarche and menopause, menstruation cycle phase and family history of breast cancer. Age at the first delivery, menopausal status and parity were independently associated with breast density.
  
  
  CONCLUSIONS
  Density distribution and risk factors prevalence is different among symptomatic patients and the diagnostic mammograms of the screened persons, hence such information should be considered in the patient managements. In order to consider the effect of marriage and parity on decreasing the breast density, basic consultations should be performed. Smokers and obese women may falsely show low breast density while they may be in high-risk group. In this study no specific phase of menstrual cycle is suggested for mammographic examinations.
authors.affiliation: Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Tehran, IR Iran.
authors.forename: Nasrin
authors.initials: N
authors.lastname: Ahmadinejad
authors.affiliation: School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran.
authors.forename: Sajjadeh
authors.initials: S
authors.lastname: Movahedinia
authors.affiliation: School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Movahedinia
authors.affiliation: Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Holakouie Naieni
authors.affiliation: Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran.
authors.forename: Saharnaz
authors.initials: S
authors.lastname: Nedjat
keywords: Breast Neoplasms; Mammography; Mass Screening