The relation of urinary estrogen metabolites with mammographic densities in premenopausal women

Background: Mammographic density is a strong predictor of breast cancer risk. The total amount and the metabolism of endogenous estrogens, e.g., the ratio of 2-hydroxyestrone (2-OHE1) and 16α-OHE1 may influence breast cancer risk. This study examined the association of urinary estrogen metabolites with breast density in premenopausal women. Methods: Urine samples were collected at baseline and after 2 years, analyzed for 11 estrogen metabolites plus progesterone and testosterone by liquid chromatography mass spectrometry, and adjusted for creatinine levels. Mixed-effects regression was applied to examine the association of estrogens with breast density. Results: Total estrogen metabolites (181 ± 113 vs. 247 ± 165 pmol/mg creatinine, p = 0.01) and the 2/16α-OH ratio (8.4 ± 10.4 vs. 13.0 ± 17.1, p = 0.02) were lower in the 74 Asian than in the 114 non-Asian women. In adjusted models, positive associations of total estrogen metabolites (p = 0.002) and the 2/16α-OHE1 ratio (p = 0.08) with percent density were detected in Asians only. In all women, mammographic density was positively associated with the 2-OH pathway (p = 0.01), inversely related to the 16α-OH pathway (p = 0.01), and not associated with the 4-OH pathway, testosterone, and progesterone. Results for the size of the dense area weakly reflected the findings for percent density, while associations with the non-dense area were in the opposite direction. Conclusions: The findings that the 2-OH pathway is associated with higher and the 16α-OH pathway with lower breast density contradicts the hypothesized risk profile of these metabolites, but, if a relation between estrogen metabolites and breast cancer risk exists, it may be mediated through pathways other than mammographic density.