Gestational diabetes, type II diabetes, and mammographic breast density in a US racially diverse population screened for breast cancer

Type II diabetes mellitus (T2DM) has consistently been associated with an increased risk of breast cancer, but the association of gestational diabetes mellitus (GDM) with breast cancer is less clear. T2DM and GDM may influence breast cancer risk through mammographic breast density, a strong risk factor for breast cancer. We examined whether T2DM and GDM are associated with higher mammographic breast density in a largely racial/ethnic minority sample. We collected digital mammograms, anthropometric measures, and interview data from 511 racially diverse women recruited during screening mammography appointments between 2012 and 2016 (mean age 51 years; 70% Hispanic). We examined the associations of self-reported GDM, T2DM, and medication use (metformin and insulin) with mammographic breast density, measured as percent and area of dense tissue using Cumulus software. In multivariable linear regression models, history of T2DM and/or GDM and length of time since diagnosis were not associated with percent density or dense breast area, either before or after adjustment for current BMI. Use of metformin in diabetic women was associated with lower percent density (beta = - 5.73, 95% CI - 10.27, - 1.19), only before adjusting for BMI. These associations were not modified by menopausal status. Our results do not support associations between T2DM and/or GDM and higher amount of mammographically dense breast tissue, suggesting that the mechanism linking diabetes with breast cancer risk may not include mammographic breast density in midlife.