hwp

Original Article Korean J Health Promot 2017;17(1):1-8 pissn: 2234-2141 eissn: 2093-5676 http://dx.doi.org/10.15384/kjhp.2017.17.1.1 유방촬영술상의유방밀도와생활습관병과의관련성 황대연, 김유리, 황봉운, 김광현, 임지영 부산광역시의료원가정의학과 Associations between Breast Density on Mammography and Lifestyle Related Disease Dae Yeon Hwang, Yu Lee Kim, Bong Woon Hwang, Kwang Hyun Kim, Ji Young Lym Department of Family Medicine, Busan Medical Center, Busan, Korea Background: Dense breast reduced the sensitivity of mammography in breast cancer screening and known as an independent risk factor of breast cancer. The relationship between breast density and age, body mass index has studied. However, there are few studies on the relationship between breast density and lifestyle related disease. In this study, we investigated the relationship between mammographic breast density and lifestyle related disease. Methods: Retrospective cross sectional research was carried out from people who visited a single health screening center in Busan from January 2015 to December 2015. We investigated age, past history of the subjects and measured their height, weight, blood pressure and waist circumference. The biochemical test was carried out using their blood. All patients underwent mammography. The breast density on mammography determined by the basis of American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) breast composition and 996 people was recruited. Results: In the distribution of breast density, 16.3% of women (n=160) had dense breast. Age (under 49), body mass index (BMI) (underweight) were positively correlated with the BI-RADS composition category 3, 4 but the number of lifestyle related disease were negatively correlated (age =0.17, BMI =0.39, the number of lifestyle related disease =-0.21). The odds ratio (OR) of dense breast increased with decreasing lifestyle related disease severity (OR=3.06, 95% confidence interval: 1.13-8.22, P=0.027). Conclusions: This study showed that the number of lifestyle related disease was negatively correlated with mammographic density. The OR of dense breast increased with decreasing lifestyle related disease severity. Therefore, primary physicians should consider negative correlation between breast density and lifestyle related disease in breast cancer screening. Korean J Health Promot 2017;17(1):1-8 Keywords: Mammography, Breast density, Life Style Induced Illness, Breast cancer 서 론 유방암은갑상선암다음으로많이발생하는여성암으로 2012년현재유방암의연령표준화발생률은인구 10만명 Received: October 24, 2016 Accepted: February 9, 2017 Corresponding author : Yu Lee Kim, MD, MS Department of Family Medicine, Busan Medical Center, 359 World cup-daero, Yeonje-gu, Busan 47527, Korea Tel: +82-51-607-2179, Fax: +82-51-507-3001 E-mail: 07721052@hanmail.net 당 65.7명으로 1999년 24.5명에서매년 6.1% 증가하고있다. 국내유방암발생수준은서구에비해서는낮으나, 아시아평균보다는높다. 2012년 16,521명의유방암이발생하였으며, 이는여성암발생자의 14.8% (10만명당 65.7명 ) 를차지하고있다. 1) 이렇게증가하고있는유방암의위험요인으로는유방암의가족력, 빠른초경, 늦은출산, 폐경지연, 방사선노출, 호르몬보충요법, 비만, 고밀도유방등이있다. 2) 이중에서유방밀도는유방암의독립적인위험인자로유방밀도가높은여성군이유방밀도가낮은여성군에비해 Copyright c 2017 The Korean Society of Health Promotion and Disease Prevention This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 Korean J Health Promot Vol. 17, No. 1, 2017 유방암위험도가 4 배에서 6 배까지증가한다고보고되고있다. 3) 유방촬영술판독규약 (American College of Radiology Breast Imaging Reporting and Data System, ACR BI-RADS) 에따른분류상 3군과 4군을치밀유방또는고밀도유방이라하며, 고밀도유방은유방암선별검사인유방촬영술의민감도를낮추어위음성결과와재검사율을높이는요인으로알려져있다. 4,5) 이러한유방밀도에영향을주는다양한요인으로는인종, 연령, 체질량지수, 분만수유력, 폐경력, 호르몬제복용여부등이있다. 6-8) 이러한유방밀도에미치는요인에대한국내연구로는 Kim 등 9) 이한국여성의연령에따른유방밀도의분포를서양여성과비교하였으며, Goh 등 10) 과 Jung 등 11) 이연령, 체질량지수와유방밀도의관계를연구하였다. 그리고유방암가족력, 출산력, 폐경여부, 분만수유력, 호르몬제복용여부등과유방밀도의관계를알아본연구가있었다. 12) 그러나현재유방밀도와생활습관병 (lifestyle related disease) 과의관계에대한연구는부족하다. 따라서본연구에서는생활습관병중비만, 고혈압, 당뇨, 복부비만, 이상지질혈증을이용하여유방밀도와의관련성을알아보고자한다. 1. 연구대상 방 법 본연구는 2015년 1월부터 2015년 12월까지부산광역시에소재한일개종합병원건강증진센터에내원한 20세이상의여성 1,283명을대상으로의무기록을참조하여후향분석을하였다. 유방촬영술을시행하지않은 272명과혈액검사및신체계측을시행하지않은 15명을제외하여총 996명을대상으로하였으며, 연구기간동안 2회이상수진받은경우마지막결과를포함하였다. Seoul, Korea) 를이용하여측정하였다. 수축기혈압이 140 mmhg 미만그리고확장기혈압이혈압이 90 mmhg 미만을정상 (normal), 항고혈압약물을복용중이거나과거고혈압으로진단받은경우, 혹은측정된혈압결과에서수축기혈압이 140 mmhg 이상또는확장기혈압이 90 mmhg 이상인경우고혈압 (hypertension) 으로판정하였다. 그리고허리둘레 85 cm 미만을정상 (normal), 85 cm 이상을복부비만 (abdominal obesity) 으로분류하였다. 13) 2) 생화학검사생화학검사를위해수검자들은최소 12시간금식후정맥채혈을통하여혈장의공복혈당 (fasting blood glucose), 당화혈색소 (hemoglobin A1C), 고밀도지단백콜레스테롤 (high-density lipoprotein cholesterol), 저밀도지단백콜레스테롤 (low-density lipoprotein cholesterol), 중성지방 (triglyceride), 총콜레스테롤 (total cholesterol) 을측정하였다. 공복혈당이정상이더라도당뇨로진단받았거나당뇨약을복용중인경우는당뇨로판정하였고측정된공복혈당이 126 mg/dl 이상이거나당화혈색소가 6.5% 이상인경우에도당뇨로판정하였다. 14) 그리고총콜레스테롤 200 mg/dl 이상, 고밀도지단백콜레스테롤 60 mg/dl 미만, 저밀도지단백콜레스테롤 130 mg/dl 이상, 중성지방 150 mg/dl 이상중 1가지이상일때이상지질혈증으로정의하였다. 15) 3) 유방촬영유방촬영술은 Brestige (MEDI-FUTURE, Seongnam, Korea) 를이용하여내사위촬영과상하촬영을시행하였고, 유방촬영은해당병원의숙련된영상의학과전문의 2인이설문에대한정보없이유방촬영술판독규약 (ACR BI-RADS) 에따라유방밀도를판정하였다 (Table 1). 본연구에서는 BI-RADS 1, 2군을저밀도유방, BI-RADS 3, 4군을고밀도유방으로분류하였다. 2. 연구방법 1) 문진및신체계측대상자들에관한성별, 연령, 과거병력에대하여조사하였다. 키와몸무게는자동측정기 (DS-103, Dongsan Jenix, Seoul, Korea) 로측정하였으며, 체질량지수 (body mass index, BMI) 는체중 (kg) 을신장 (m) 의제곱으로나누어구하였다. 체질량지수가 18.5 kg/m 2 미만인경우를저체중 (underweight), 18.5 kg/m 2 이상 25 kg/m 2 미만인경우를정상 (normal), 25 kg/m 2 이상인경우는비만 (obesity) 으로정의하였다. 혈압은자동혈압계 (NEX 400R, Medison Jawon, Table 1. Breast composition categories according to ACR BI-RADS Breast composition categories 1 The breasts are almost entirely fatty 2 There are scattered areas of fibroglandular density 3 The breast are heterogeneously dense, which may obscure small masses 4 The breast are extremely dense, which lowers the sensitivity of mammography Abbreviation: ACR BI-RADS, American College of Radiology Breast Imaging Reporting and Data System.

Dae Yeon Hwang, et al. Associations between Breast Density on Mammography and Lifestyle Related Disease 3 4) 생활습관병생활습관병 (lifestyle related disease) 이란오랜기간동안여러가지생활습관이복합적으로관여하여발생하는심혈관계질환, 당뇨, 비만과같은만성퇴행성질환들을부르는명칭이다. 16) 본연구에서는비만, 고혈압, 당뇨, 복부비만, 이상지질혈증을생활습관병으로정의하여, 생활습관병의개수가 0개일때생활습관병의정도 (severity) 를낮음 (low), 개수가 1-2개일때보통 (moderate), 3개이상일때높음 (high) 으로분류하였다. 3. 통계분석 감소하였다 (Table 3). 3. 유방밀도와관련요인분석단변량분석에서유방밀도와관련있는요인은연령, 체질량지수, 비만, 고혈압, 복부비만, 이상지질혈증, 생활습관병개수였으며, 당뇨는관련이없었다. 또한연속형자료에서 BI-RADS 1, 2군과 3, 4군의연령, 체질량지수, 복부둘레, 총콜레스테롤, 중성지방, 고밀도지단백콜레스테롤, 저밀도지단백콜레스테롤의평균을비교하였을때모두통계적으로유의하였다 (Table 3). 수집된자료들에대한통계분석은 SPSS 21.0 for Windows (IBM Corp., Armonk, NY, USA) 를이용하였다. 유방밀도군의범주형자료에대한유의성검증에는카이제곱검정 (Chi-square test) 을사용하였으며, 연속형자료에대한유의성검증에는스튜던트 t 검정 (Student s t-test) 을실시하였다. 유방밀도와생활습관병의상관관계를알아보기위하여스피어만상관분석 (Spearman correlation analysis) 을사용하였다. 그리고생활습관병의정도에따른고밀도유방의위험도를알아보기위해로지스틱회귀분석을시행하였다. 본연구에서는 P값이 0.05 미만인경우를유의하다고판단하였다. 결과 1. 연구대상들의일반적인특성 연구대상자들의연령분포는 40대가 32.9% 로가장많았으며, 50대, 30대순으로나타났다. 생활습관병중비만은 20.1%, 당뇨 4.5%, 고혈압 15.7%, 복부비만 8.4%, 이상지질혈증 76.2% 로나타났다. 생활습관병의개수가 0개인군은 10.9%, 1-2개인군은 69.2%, 3-5개인군은 19.9% 였다. 그리고유방밀도분포는 BI-RADS 1군 8.7%, 2군 75.2%, 3군 13.5%, 4군 2.6% 로나타났다 (Table 2). 2. 요인별유방밀도분포유방밀도의분포를보면 BI-RADS 1, 2군 836명, 3, 4군이 160명이었다. BI-RADS 1, 2군의평균연령은 48세, BI-RADS 3, 4군의평균연령은 41세였으며, BI-RADS 1, 2군의평균체질량지수는 23.0 kg/m 2, BI-RADS 3, 4군의평균체질량지수는 20.8 kg/m 2 였다. 연령의증가, 체질량지수의증가, 생활습관병개수의증가에따라 BI-RADS 1, 2 군의비율은증가하고반대로 BI-RADS 3, 4군의비율은 Table 2. The general characteristics of study population Variable Category Total (996) Age <30 53 (5.3) 30-39 180 (18.1) 40-49 328 (32.9) 50-59 303 (30.4) 60-69 100 (10.0) 70< 32 (3.2) BMI (kg/m 2 ) <18.5 (underweight) 49 (4.9) 18.5 and <25 (normal) 747 (75.0) 25 (obesity) 200 (20.1) Diabetes Normal 951 (95.5) Diabetes mellitus 45 (4.5) Blood Pressure Normal 840 (84.3) Hypertension 156 (15.7) Abdominal obesity (cm) Waist circumference<85 912 (91.6) Waist circumference 85 84 (8.4) Dyslipidemia Normal 237 (23.8) Dyslipidemia 759 (76.2) Total cholesterol <200 630 (63.3) (mg/dl) 200 366 (36.7) LDL-C (mg/dl) <130 676 (67.9) 130 320 (32.1) HDL-C (mg/dl) 60 403 (40.5) <60 593 (59.5) Triglyceride (mg/dl) <150 891 (89.5) 150 105 (10.5) Number of Lifestyle 0 (low) 109 (10.9) related disease 1-2 (moderate) 689 (69.2) (severity) 3-5 (high) 198 (19.9) BI-RADS categories 1 87 (8.7) 2 749 (75.2) 3 134 (13.5) 4 26 (2.6) Abbreviations: BMI, body mass index; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; BI-RADS, Breast Imaging Reporting and Data System. Values are presented as number (%). Analyzed by frequency analysis.

4 Korean J Health Promot Vol. 17, No. 1, 2017 그리고유방밀도와생활습관병과의상관관계를알아보기위하여 Spearman 상관분석을시행한결과에서는 BI-RADS 1군은연령 (49세초과 ), 체질량지수 (18.5 BMI<25) 와생활습관병개수와양의상관관계를보였다. 그와반대로 BI-RADS 3, 4군은연령 (49세이하 ) 와체질량지수 (BMI<18.5) 에양의상관관계그리고생활습관병개수에서음의상관관계를보였다 (Table 4). 생활습관병의개수에따른유방밀도군의위험도 (odds Table 3. A comparison between BI-RADS 1, 2 and BI-RADS 3, 4 Variables BI-RADS 1, 2 (n=836) BI-RADS 3, 4 (n=160) Mean±SD n % n % Mean±SD P Age 48.90±10.60 41.07±9.41 <0.001 a <30 30 56.6 23 43.4 30-39 131 72.8 49 27.2 40-49 269 82.0 59 18.0 50-59 280 92.4 23 7.6 60-69 94 94.0 6 6.0 70< 32 100 0 0 BMI 23.03±2.95 20.83±2.67 <0.001 a Underweight (<18.5) 27 55.1 22 44.9 Normal (18.5 and <25) 618 82.7 129 17.3 Obesity (25 ) 191 95.5 9 4.5 Diabetes 0.079 b Normal 794 83.5 157 16.5 Diabetes mellitus 42 93.3 3 6.7 Blood Pressure Normal 686 81.7 154 18.3 Hypertension 150 96.2 6 3.8 Waist circumference (cm) 73.99±8.10 68.00±6.81 <0.001 a 0.001 b <85 755 82.8 157 17.2 85 81 96.4 3 3.6 Dyslipidemia 0.001 b Normal 182 76.8 55 23.2 Dyslipidemia 654 86.2 105 13.8 Total cholesterol (mg/dl) 193.09±34.82 185.58±52.99 0.023 a 0.003 b <200 512 81.3 118 18.7 200 324 88.5 42 11.5 LDL-C (mg/dl) 118.16±32.59 105.57±28.97 <0.001 a <130 546 80.8 130 19.2 130 290 90.6 30 9.4 HDL-C (mg/dl) 57.39±13.97 61.75±14.30 <0.001 a 0.007 b 60 323 80.1 80 19.9 <60 513 86.5 80 13.5 Triglyceride (mg/dl) 92.21±62.17 73.04±44.16 <0.001 a 0.034 b <150 740 83.1 151 16.9 150 96 91.4 9 8.6 Number of lifestyle related disease (severity) 0 (low) 144 72.7 54 27.3 1-2 (moderate) 588 85.3 101 14.7 3-5 (high) 104 95.4 5 4.6 Abbreviations: BI-RADS, Breast Imaging Reporting and Data System; SD, standard deviation; BMI, body mass index; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. a Calculated by Student s t-test. b Calculated by Chi-square test.

Dae Yeon Hwang, et al. Associations between Breast Density on Mammography and Lifestyle Related Disease 5 Table 4. Correlation between BI-RADS categories and lifestyle related disease BI-RADS 1 BI-RADS 1, 2 BI-RADS 2, 3, 4 BI-RADS 3, 4 ρ a P ρ P ρ P ρ P Age 49-0.06 0.130-0.17 <0.001 0.06 0.130 0.17 <0.001 49< 0.31 <0.001 0.07 0.107-0.31 <0.001-0.07 0.107 BMI <18.5-0.20 0.146-0.39 0.005 0.20 0.146 0.39 0.005 18.5 and <25 0.18 <0.001 0.20 <0.001-0.18 <0.001-0.20 <0.001 25 0.12 0.081 0.01 0.895-0.12 0.081-0.01 0.895 Number of lifestyle related disease 0.21 <0.001 0.21 < 0.001-0.21 <0.001-0.21 <0.001 Abbreviations: BI-RADS, Breast Imaging Reporting and Data System; BMI, body mass index. Calculated by Spearman correlation analysis. a Correlation coefficient. Table 5. Odds ratio for breast density in lifestyle related disease severity Lifestyle related disease severity High Moderate Low OR a 95% CI P OR a 95% CI P BI-RADS 1 1 0.53 (0.29-0.94) 0.032 0.34 (0.12-0.93) 0.037 BI-RADS 2 1 1.57 (0.98-2.50) 0.057 1.13 (0.65-1.96) 0.663 BI-RADS 1, 2 1 0.52 (0.20-1.33) 0.176 0.32 (0.12-0.87) 0.027 BI-RADS 3 1 1.82 (0.70-4.69) 0.214 2.31 (0.84-6.39) 0.101 BI-RADS 2, 3, 4 1 1.88 (1.05-3.35) 0.032 2.90 (1.06-7.90) 0.037 BI-RADS 3, 4 1 1.92 (0.74-4.94) 0.176 3.06 (1.13-8.22) 0.027 Abbreviations: OR, odds ratio; CI, confidence interval; BI-RADS, Breast Imaging Reporting and Data System. Calculated by logistic regression analysis. a Adjusted for age, body mass index. ratio, OR) 변화를확인하기위하여로지스틱회귀분석을시행하였으며, 생활습관병개수가적을수록 BI-RADS 1군의위험도는감소하였으나, 그와반대로 BI-RADS 3, 4군의위험도는증가하였다 (Table 5). 고 찰 현재유방밀도에영향을주는요인으로는인종, 연령, 체질량지수, 분만수유력, 폐경력, 호르몬제복용여부등이알려져있으나, 유방밀도와생활습관병과의관련성에대하여알려진바가없었다. 본연구에서는유방밀도와생활습관병의개수는음의상관관계가있으며, 생활습관병의개수가적을수록고밀도유방의위험도는증가하였다. 우리나라에서는유방암의조기발견을위해국립암센터에서제시한유방암검진권고안을따르고있으며, 40-69 세무증상여성을대상으로유방촬영술을이용한유방암검진을 2년마다시행하고있다. 1) 무증상여성에서유방촬영술은유방암조기발견에도움이되어사망률을낮춘다는국내외무작위대조비교임상시험연구가보고되어그효과를인정받고있다. 1,17) 유방촬영술에서판독되는유방의밀도는유방에서유방실질조직과상피조직이차지하는정도에따라결정되는데, 젊은연령대의여성의유방은유방실질조직이상대적으로많아서유방의밀도가높게되고, 연령이증가함에따라실질조직이지방조직으로대체되어유방의밀도가낮아지게된다. 18) 이러한유방촬영술은고밀도유방의검사민감도가감소하는것이가장큰문제로알려져있으며, 외국의경우고밀도유방은유방암선별검사의민감도를낮춘다고보고하고있다. 19) 현재유방밀도에영향을주는요인으로는연령, 체중, 체질량지수, 유방의크기, 월경주기, 폐경여부, 여성호르몬대체요법여부, 출산력및유전적요인등이알려져있다. 6-8) 유방밀도분포와관련하여국내여성의고밀도유방의비율이외국에비해높다는연구가있으며, 외국특히서구에서는 40대에고밀도유방의비율이높아진후 50대이후고밀도유방의비율이완만히감소하는데비해, 우리나라여성의고밀도유방의분포는 40대까지서구에비해비율이매우높고, 50대이후급격히감소한다고보고하고있다. 9,12) 국내외연구에서연령이증가할수록유방밀도가감소하는것으로보고하고있으며, 10,12,18) 본연구에서도연령

6 Korean J Health Promot Vol. 17, No. 1, 2017 이증가할수록고밀도유방군이감소하는것으로나타났다. 이는기존의국내외연구들의결과와일치하며, 연령이증가할수록유방밀도가감소하는것은인종의차이없이모든여성의일반적인특징이라고생각된다. 체질량지수또한유방밀도에영향을주는중요한인자로알려져있으며, 국내외연구에서체질량지수가감소할수록유방밀도가증가하는것으로보고하고있다. 10,20) 또한본연구에서도저체중일때고밀도유방의비율이더높게나타났다 (Table 3). 이것으로볼때연령이상대적으로젊은 40대이하여성및체질량지수가낮은저체중군여성에서는고밀도유방군의비율이증가하여, 유방촬영술의민감도가감소하는문제가발생할수있다. 이는통계적으로우리나라유방암의발생비율이외국과달리 40대에호발하는것과 40대이하여성의고밀도유방군의높은비율이관련이있을것으로생각된다. Bhang 등 21) 은혈당과유방밀도의관계를공복혈당이 100 mg/dl 이상이거나당뇨를진단받거나당뇨약을복용중인경우와아닌경우로나누어연구하였으며, 혈당과유방밀도는관련이없는것으로보고하고있다. 본연구에서도당뇨와유방밀도와의관계는통계적으로유의하지않았다 (Table 3). 앞의연구와본연구의결과를보면, 유방밀도와혈당또는당뇨는관련성이없는것으로생각된다. 현재유방밀도와혈압과의관련성을연구한논문은많지않지만, Bhang 등 21) 은항고혈압약물을복용중이거나수축기혈압이 130 mmhg 이상또는확장기혈압이 85 mmhg 이상인경우와아닌경우로나누어연구하였으며, 혈압과유방밀도는관련이없는것으로보고하고있다. 본연구에서는혈압요인을정상군과고혈압군으로나누어연구하였으며, 단변량분석에서는혈압과유방밀도는관계가있는것으로나타났지만, 다변량분석등을통한연구가앞으로더필요할것으로생각된다. 유방밀도와복부비만에관한국내의연구에서는체질량지수를보정하기전복부비만은유의한독립변수로나타났지만, 체질량지수를보정후에는통계적유의성이없는것으로나타났다. 21) 국외의한연구에서는복부비만과유방밀도와음의관계가있다고하였지만, 국내외다른연구에서는유의한관계가없거나, 양의상관관계가있다고보고하고있다. 22-24) 본연구의단변량분석에서는통계적으로유의하였지만, 여러연구간의결과가일치되지않고있으므로앞으로복부비만과유방밀도의관계에대한다양한연구가필요할것으로생각된다. 유방밀도와이상지질혈증에관한국내연구에서는체질량을보정한후낮은고밀도지단백콜레스테롤은유방밀도의감소와유의한관련성이있다고보고하고있으나, 일부국내외연구에서는유방밀도와증가된중성지방과낮은 고밀도지단백콜레스테롤은관계가없다고하였다. 21,22,25) 본연구의단변량분석에서는이상지질혈증요소들의평균의차이와집단분포의차이가통계적으로유의하였다. 그러나연구마다다른결과가나오는것은각연구집단의차이와각연구마다유방밀도에영향을주는요인들을다르게적용하였기때문이라고생각된다. 앞에서언급한국내외연구결과들과본연구의결과를통하여유방밀도와생활습관병에영향을줄수있는요인을고려해보면, 여성호르몬중에스트로겐 (estrogen) 을생각해볼수있다. 현재에스트로겐의감소는폐경기여성에서복부비만, 이상지질혈증, 심혈관계질환의증가와관련이있다고알려져있으며, 또한에스트로겐은유관세포의증식에양향을주며유방밀도를증가시키는중요한요인중하나로여겨지고있다. 26-28) 이로미루어볼때여성에서연령의증가에따른에스트로겐분비의감소는생활습관병의유병률증가와동시에유방밀도감소에영향을주는것으로생각된다. 따라서젊은여성들에서고밀도유방의비율이상대적으로높은것과생활습관병의유병률이낮은것은여성호르몬과관계가있는것으로추론해볼수있다. 이에대하여유방밀도와생활습관병과의관계에서에스트로겐의역할에대한향후전향적연구및메타분석등추가적인연구가필요할것이다. 마지막으로본연구에서는고밀도유방은 49세이하의연령, 저체중과양의상관관계를보였으며, 생활습관병개수에서음의상관관계를보였다. 또한생활습관병개수가많은군에비하여생활습관병개수가적은군에서 BI-RADS 1, 2군의위험도는감소하였으나, 반면에 BI-RADS 3, 4군의위험도는증가하였다. 따라서유방암검진권고안에따라무증상여성을대상으로유방촬영술을이용한유방암검진을시행할경우유방밀도와여성의연령, 체질량지수그리고생활습관병과음의상관관계가있음을고려해야하겠다. 본연구는몇가지제한점을가지고있다. 첫째, 국내일개지역병원에방문한환자를대상으로한단면적연구이기때문에지역간, 인종간의다양성을고려하지못하였다. 둘째, 현재유방밀도에영향을줄수있는요인으로는연령, 체질량지수, 유방의크기, 월경주기, 출산력, 폐경여부, 호르몬치료등이알려져있으나, 본연구에서는유방밀도에가장중요한요인중연령과체질량지수를제외한다른요인들을연구에포함시키지못하였다. 추후이와관련한연구에서는더많은유방밀도관련인자를포함한연구가시행되어야할것이다. 셋째, 생활습관병에영향을줄수있는흡연력, 음주력, 신체활동등을연구에포함시키지못하였다. 넷째, 본연구에서나타난비만, 당뇨병, 고혈압, 복부비만, 이상지질혈증의유병률은 2014년국민영양조사에서나타난유병률과차이가있다. 이러한차이는병원에

Dae Yeon Hwang, et al. Associations between Breast Density on Mammography and Lifestyle Related Disease 7 방문한건강검진대상자만을연구대상으로하였기때문인것으로생각되며, 추후우리나라다수의여성을대상으로하는연구가필요할것으로생각된다. 요 약 연구배경 : 유방암검진을위해시행하는유방촬영술에서고밀도유방은검사의민감도를감소시켜위음성의요인이될뿐만아니라유방암의독립적인위험인자로알려져있다. 현재유방밀도와연령, 체질량지수의관계는연구된바있으나, 유방밀도와생활습관병과의관계에대한연구는없었다. 본연구에서는유방밀도와생활습관병과의관련성에대해연구하고자한다. 방법 : 2015년 1월부터 2015년 12월까지부산에있는한종합병원내건강검진센터에내원하여유방촬영술을시행한수검자를후향적으로단면연구하였다. 대상자들의연령, 과거력등을조사하였고, 키, 체중, 허리둘레, 혈압을측정하였으며혈액검사를시행하였다. 모든대상자들은유방촬영술을시행하였다. 유방밀도는유방촬영술판독규약을통해결정하였으며, 연구는총 996명을대상으로하였다. 결과 : 유방밀도의분포를보면고밀도유방군이 160명 (16.3%) 이었다. BI-RADS 3, 4군는 49세이하의연령과저체중과양의상관관계가있었으며, 생활습관병의개수와는음의상관관계가있었다 ( 연령 ρ=0.17, 저체중 ρ=0.39, 생활습관병개수 ρ=-0.21). 그리고생활습관병개수가적을수록고밀도유방의위험도가증가하였다 (OR=3.06, 95% confidence interval: 1.13-8.22, P=0.027). 결론 : 생활습관병의개수와유방밀도는음의연관성을보였으며, 생활습관병의개수가적을수록고밀도유방의위험도는증가하였다. 따라서유방촬영술을시행할경우유방밀도와여성의연령, 체질량지수그리고생활습관병과음의상관관계가있음을고려해야하겠다. 중심단어 : 유방촬영술, 유방밀도, 생활습관병, 유방암 REFERENCES 1. National cancer center. Breast cancer screening guideline [Internet]. Goyang: National cancer information center; 2015. [Accessed Oct 1, 2016]. Available from: http://www.cancer.go.kr/ebook/146/webview/index.html. 2. McPherson K, Steel CM, Dixon JM. ABC of breast disease. Breast cancer-epidemiology, risk factors, and genetics. BMJ 2000;321(7261):624-8. 3. Boyd NF, Lockwood GA, Byng JW, Tritcher DL, Yaffe MJ. Mammographic densities and breast cancer risk. Cancer Epidemiol Biomarkers Prev 1998;7(12):1133-44. 4. American College of Radiology. ACR BI-RADS atlas: Breast imaging reporting and data system. 5th edition. Reston: American College of Radiology; 2013. 5. Carney PA, Kasales CJ, Tosteson AN, Weiss JE, Goodrich ME, Poplack SP, et al. Likelihood of additional work-up among women undergoing routine screening mammography: the impact of age, breast density, and hormone therapy use. Prev Med 2004;39(1):48-55. 6. Sellers TA, Vachon CM, Pankratz VS, Janney CA, Fredericksen Z, Brandt KR, et al. Association of childhood and adolescent anthropometric factors, physical activity, and diet with adult mammographic breast density. Am J Epidemiol 2007;166(4):456-64. 7. Jeon JH, Kang JH, Kim Y, Lee HY, Choi KS, Jun JK, et al. Reproductive and hormonal factors associated with fatty or dense breast patterns among Korean women. Cancer Res Treat 2011;43(1):42-8. 8. Jun JK, Kim MJ, Choi KS, Suh M, Jung KW. Development of a sampling strategy and sample size calculation to estimate the distribution of mammographic breast density in Korean women. Asian Pac J Cancer Prev 2012;13(9):4661-4. 9. Kim SH, Kim MH, Oh KK. Analysis and comparison of breast density according to age on mammogram between Korean and Western women. J Korean Radiol Soc 2000;42(6):1009-14. 10. Goh E, Shin KW, Seo YY, Ko JA, Park MS, Cho B, et al. Breast density in mammography according to body mass index(bmi) in Korean women. Korean J Health Promot Dis Prev 2008;8(4):281-6. 11. Jung JS, Kim JS, Park YM, Lee K, Park TJ. The relationship between body mass index and mammographic density in Korean women. J Korean Acad Fam Med 2008;29(11):831-7. 12. Cho JJ, Song HJ, Koh EY, Song YM, Han BK, Yun YS, et al. Mammographic breast density and risk factors of breast cancer in Korean women using multicenter study. J Korean Acad Fam Med 2006;27(1):33-41. 13. Lee S, Park HS, Kim SM, Kwon HS, Kim DY, Kim DJ, et al. Cut-off points of waist circumference for defining abdominal obesity in the Korean population. Korean J Obes 2006;15(1):1-9. 14. Basevi V, Di Mario S, Morciano C, Nonino F, Magrini N. Comment on: American diabetes association. Standards of medical care in diabetes--2011. Diabetes Care 2011;34(Suppl. 1):S11-S61. Diabetes Care 2011;34(5):e53; author relpy e54. 15. Korean Society of Lipidology and Atherosclerosis. Dyslipidemia treatment guideline. 3rd edition [Internet]. Seoul: Korean Society of Lipidology and Atherosclerosis; 2015. [Accessed Oct 1, 2016]. Available from: http://www.lipid.or.kr/bbs/skin/default/download.php?code=care&number=1100. 16. Kang JK. Concept of lifestyle-related disease. Korean J Med 2003;65(1):121-5. 17. Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med 2002;137(5 Part 1):347-60. 18. Grove JS, Goodman MJ, Gilbert FI Jr, Mi MP. Factors associated with mammographic pattern. Br J Radiol 1985;58(685):21-5. 19. Carney PA, Miglioretti DL, Yankaskas BC, Kerlikowske K, Rosenberg R, Rutter CM, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 2003;138(3):168-75. 20. Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M,

8 Korean J Health Promot Vol. 17, No. 1, 2017 et al. Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the million women study: cohort study. BMJ 2004;329(7464):477. 21. Bhang SY, Lee HJ, Kang JH, Yu BY. Associations between metabolic syndrome and three-dimensional breast density using digital mammography. Korean J Health Promot 2015;15(4):168-74. 22. Conroy SM, Butler LM, Harvey D, Gold EB, Sternfeld B, Greendale GA, et al. Metabolic syndrome and mammographic density: the study of women's health across the nation. Int J Cancer 2011;129(7):1699-707. 23. Boyd NF, Lockwood GA, Byng JW, Little LE, Yaffe MJ, Tritchler DL. The relationship of anthropometric measures to radiological features of the breast in premenopausal women. Br J Cancer 1998;78(9):1233-8. 24. Sung J, Song YM, Stone J, Lee K, Kim SY. Association of body size measurements and mammographic density in Korean women: the healthy twin study. Cancer Epidemiol Biomarkers Prev 2010;19(6):1523-31. 25. Sung J, Song YM, Stone J, Lee K, Kim SY. High-density lipoprotein cholesterol, obesity, and mammographic density in Korean women: the healthy twin study. J Epidemiol 2011;21(1):52-60. 26. Meyer MR, Barton M. Estrogens and coronary artery disease: new clinical perspectives. Adv Pharmacol. 2016;77:307-60. 27. Chlebowski RT, Anderson GL, Gass M, Lane DS, Aragaki AK, Kuller LH, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 2010;304(15):1684-92. 28. Han M. Metabolic syndrome emerging from menopause. J Korean Soc Menopause 2011;17(3):127-35.