한국여성에서 체질량지수(Body Mass Index)에 따른 유방치밀도의 차이
Breast Density in Mammography According to Body MassIndex(BMI) in Korean Women
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초록
연구배경 유방촬영술상 치밀유방은 유방암의 위험요소일 뿐 아니라 검사의 민감도를 감소시켜 위음성의 중요한 요소가 된다. 한국여성에서 비만도와 유방치밀도와의 관계는 알려진 바가 적다. 본 연구에서는 한국여성에서 체질량지수와 치밀유방과의 연관성을 파악하고 이를 바탕으로 적절한 유방암검진방법을 모색해보고자 하였다. 방 법 2000년 2월부터 2006년 3월까지 건강검진센터에서 유방촬영술을 시행한 무증상의 여성 16482명을 대상으로 연령과 체질량지수에 따른 유방실질의 밀도분포를 분석하였으며 추가적인 유방초음파 촬영을 권유 받은 경우를 분석하였다. 유방촬영술상 유방실질의 밀도는 ACR BI-RADS의 유방실질분류를 따랐다. 결 과 치밀유방의 빈도는 4275명으로 25.9%였으며 연령과 체질량지수가 증가할수록 각각 감소하는 경향을 보였다. 연령으로 보정한 후의 치밀유방의 위험도는 정상체중에 비하여 저체중의 경우 1.381배 높았고 과체중의 경우 0.792배, 비만의 경우 0.540배, 고도비만의 경우 0.298배로 감소하는 경향을 보였다. 결 론 한국여성에서 체질량지수는 연령으로 보정한 후에도 치밀유방과 음의 상관관계를 갖는다.
Abstract
Background It is well known that low BMI and younger age are associated with high breast density in western women, but there is a lack of researchin Korean women. Mammographic dense breast has been reported both as a cause of false-negative findings on mammography and as an indicator of increased breast cancer risk. The purpose of this study was to evaluate the relationship between breast density and BMI. Furthermore, we considered proper screening method of breast cancer in Korean women. Methods From February 2000 to March 2006, 16,482 asymptomatic women who underwent screening mammography in the health promotion center were included. Those with prior history of breast cancer or breast surgery were excluded. Breast density distribution and further breast sonography recommendation rate were evaluated. Results 25.9% of women (n=4,275) had dense breasts. Both Age and BMI were negatively associated with breast density respectively (P<0.001, P<0.001). BMI after adjusting for age was negatively associated with breast density (OR of underweight 1.381, 95% CI 1.139-1.674; OR of overweight 0.792, 95% CI 0.723-0.868; OR of obesity 0.540, 95% CI 0.488-0.597; OR of severe obesity 0.298, 95% CI 0.217-0.409). 17.8% (n=2,939) of women were recommended further breast sonography due to low sensitivity of mammography. Young age and low BMI were associated with sonography recommendation rate (P<0.001, P<0.001). Conclusions BMI is negatively associated with breast density after adjusting for age. Mammography combined with breast sonography may increase sensitivity of breast cancer screening in especially young and thin women in Korea.
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