The relationship between BMI, breast density, and cancer progression in breast cancer patients from Appalachian Kentucky

Purpose: Appalachian regions like Eastern Kentucky have high breast cancer mortality rates despite lower incidence rates compared to the rest of Kentucky. This area also experiences increased obesity rates. Previous studies have linked high breast density to a higher risk of breast cancer and obesity to poorer survival outcomes in other populations, but the relationship between BMI, breast density, and cancer progression in Appalachian Kentucky remains unclear. This retrospective study investigates these links in breast cancer patients from the region. Methods: We analyzed mammogram images of 1,405 women diagnosed with breast cancer at Markey Cancer Center between 2000-2018. Data on BMI, mammogram density, and cancer progression were collected. Mammograms were scored using the BI-RADS breast density scale. Additional data included age at diagnosis, BMI within a year of diagnosis, cancer stage, and treatment follow-up. Kaplan-Meier curves, log-rank tests, and Spearman correlation assessed the relationships among survival, BMI, and breast density. Results: A significant negative correlation between BMI and breast density was found (Spearman correlation=-0.34; P<0.0001). However, no significant associations were observed between breast density, obesity, and overall survival. The worst survival was seen in patients with BMI ≤18.5. Conclusion: In Appalachian Kentucky, BMI negatively correlates with breast density, but neither breast density nor obesity significantly impacts breast cancer prognosis. Underweight patients had poorer survival outcomes, suggesting factors other than obesity and breast density influence prognosis in this demographic.