Few studies have investigated the association of non-dense area or fatty breasts in conjunction with breast density and breast cancer risk. Two articles in a recent issue of Breast Cancer Research investigate the role of absolute non-dense breast area measured on mammograms and find conflicting results: one article finds that non-dense breast area has a modest positive association with breast cancer risk, whereas the other finds that non-dense breast area has a strong protective effect to reduce breast cancer risk. Understanding the interplay of body mass index, menopause status, and measurement of non-dense breast area would help to clarify the contribution of non-dense breast area to breast cancer risk.
In a recent issue of Breast Cancer Research, two articles investigate the role of the non-dense breast area (fatty breasts) in breast cancer risk [1, 2]. Each presents compelling results to show why non-dense breast area measured on mammograms is as informative as dense breast area in regard to future breast cancer risk. Both studies report a strong association with dense breast area and breast cancer risk. However, Pettersson and colleagues [1] report a significant and rather strong negative association of non-dense area and breast cancer risk, whereas Lokate and colleagues [2] report a modest positive association. The two primary results are graphically shown in Figure 1. Can both be right?
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Pettersson and colleagues [1] report that the greater the non-dense breast area (regardless of the dense breast area), the lower the breast cancer risk. In other words, fatty breasts have a protective effect on breast cancer risk. Two other studies have shown an inverse association with non-dense breast area though not as strong as that reported by Pettersson and colleagues [1]. Torres-Mejia and colleagues [8] report that non-dense area is inversely associated with breast cancer risk but did not report on its independence from dense breast area. Stone and colleagues [9] found a weaker inverse association with non-dense area than Pettersson and colleagues [1], and the association did not persist when dense breast area was controlled for.
Additional indirect evidence supports the hypothesis that fatty breasts have a protective influence on breast cancer risk. Compared with women with average breast density, women with fatty breasts assessed by Breast Imaging Reporting and Data System (BI-RADS) density categories are at decreased risk of breast cancer [10]. Moreover, women with fatty breasts are at low risk of breast cancer, regardless of age, menopausal status, family history of breast cancer, history of prior breast biopsy, and postmenopausal hormone therapy use [3, 11]. Lastly, women with low breast density are at reduced risk of advanced-stage disease [11]. Thus, the finding by Pettersson and colleagues [1] is consistent with that of prior breast density studies showing that fatty breasts confer a low risk of breast cancer and this beneficial effect appears to be permanent, regardless of the presence of other risk factors.
Chief Bromden, the son of a Native American father and a white mother, begins the novel by relating the real and imagined humiliations he suffers at the hands of the African-American hospital assistants. While their treatment of him is tolerated, despite the fact that he is physically much larger than they are, Chief expresses a greater fear of Big Nurse, Nurse Ratched. The Nurse is identified as a woman of great power and control, who is bitter because her ruthless, machine-like efficiency is thwarted by her naturally endowed large breasts. Despite her power, the paranoid-schizophrenic Chief believes her to be in service of the Combine, a large mechanized matrix that hums behind the walls and floors of the hospital, controlling everything from the environment to human behavior. 2ff7e9595c
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