title: Association between the Adherence to the International Guidelines for Cancer Prevention and Mammographic Density.
abstract: BACKGROUND
  Mammographic density (MD) is considered a strong predictor of Breast Cancer (BC). The objective of the present study is to explore the association between MD and the compliance with the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) recommendations for cancer prevention.
  
  
  METHODS
  Data of 3584 women attending screening from a population-based multicenter cross-sectional study (DDM-Spain) collected from October 7, 2007 through July 14, 2008, was used to calculate a score that measures the level of compliance with the WCRF/AICR recommendations: R1)Maintain adequate body weight; R2)Be physically active; 3R)Limit the intake of high density foods; R4)Eat mostly plant foods; R5)Limit the intake of animal foods; R6)Limit alcohol intake; R7)Limit salt and salt preserved food intake; R8)Meet nutritional needs through diet. The association between the score and MD (assessed by a single radiologist using a semi-quantitative scale) was evaluated using ordinal logistic models with random center-specific intercepts adjusted for the main determinants of MD. Stratified analyses by menopausal status and smoking status were also carried out.
  
  
  RESULTS
  A higher compliance with the WCRF/AICR recommendations was associated with lower MD (OR1-unit increase = 0.93 95%CI:0.86;0.99). The association was stronger in postmenopausal women (OR = 0.91 95%CI:0.84;0.99) and nonsmokers (OR = 0.87;95%CI:0.80;0.96 for nonsmokers, OR = 1.01 95%CI:0.91;1.12 for smokers, P-interaction = 0.042). Among nonsmokers, maintaining adequate body weight (OR = 0.81 95%CI:0.65;1.01), practicing physical activity (OR = 0.68 95%CI:0.48;0.96) and moderating the intake of high-density foods (OR = 0.58 95%CI:0.40;0.86) and alcoholic beverages (OR = 0.76 95%CI:0.55;1.05) were the recommendations showing the strongest associations with MD.
  
  
  CONCLUSIONS
  postmenopausal women and non-smokers with greater compliance with the WCRF/AICR guidelines have lower MD. These results may provide guidance to design specific recommendations for screening attendants with high MD and therefore at higher risk of developing BC.
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain.
authors.forename: Adela
authors.initials: A
authors.lastname: Castelló
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Leandro
authors.initials: L
authors.lastname: Prieto
authors.affiliation: Navarre Breast Cancer Screening Program, Public Health Institute, Pamplona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Ederra
authors.affiliation: Valencian Breast Cancer Screening Program, General Directorate of Public Health, Valencia, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas-Trejo
authors.affiliation: Cancer Prevention and Control Unit, Catalonian Institute of Oncology (ICO. Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vidal
authors.affiliation: Balearic Islands Breast Cancer Screening Program, Regional Authority for Health & Consumer Affairs, Palma de Mallorca, Islas Baleares.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sánchez-Contador
authors.affiliation: Galician Breast Cancer Screening Program, Galician Regional Health Authority, A Coruña, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Santamariña
authors.affiliation: Castile-León Breast Cancer Screening Program, General Directorate of Public Health, Burgos, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Pedraz
authors.affiliation: Aragón Breast Cancer Screening Program, Aragon Health Service, Zaragoza, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Moreo
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Aragonés
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pérez-Gómez
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Lope
authors.affiliation: Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Universidad Miguel Hernandez, Sant Joan D'Alacant, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Vioque
authors.affiliation: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
mesh_terms: D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008403:Mass Screening; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017698:Postmenopause; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology