THE IMPACT OF LIFESTYLE AND ENVIRONMENTAL FACTORS ON THE DETECTABILITY OF BREAST CANCER BY MAMMOGRAPHY: IMPLICATIONS FOR THE PERSONALIZATION OF SCREENING TESTS - LITERATURE REVIEW
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5181Keywords:
Breast Cancer; Mammography; Breast Density; BI-RADS; Lifestyle Factors; Environmental Exposure; Screening Sensitivity; Early DetectionAbstract
Introduction and objective: Breast cancer remains the most commonly diagnosed cancer in women worldwide and one of the leading causes of cancer deaths in the female population (Sung et al., 2021). Despite advances in diagnosis and treatment, early detection of the disease remains a key factor in improving prognosis. Mammography is the primary screening method, but its diagnostic effectiveness varies and depends on many biological, hormonal, environmental, and lifestyle factors. Particular importance is attached to mammographic breast density, which simultaneously increases the risk of disease and reduces the sensitivity of the test by masking cancerous changes. A growing body of evidence suggests that lifestyle and environmental exposure can modify the structure of fibro-glandular tissue, affect its quantitative composition and radiological properties, and thus influence the detectability of cancerous changes.
The aim of this review was to comprehensively analyze the impact of lifestyle factors and environmental exposures on the detectability of breast cancer in mammography, with a particular focus on potential biological mechanisms and clinical implications.
Methods: A literature review was conducted in the PubMed database covering English-language publications from 2000 to 2025. Cohort studies, case-control studies, meta-analyses, and systematic reviews on the relationship between lifestyle, environmental factors, breast density, and mammography effectiveness were analyzed. Publications discussing radiological assessment standards, including the BI-RADS classification, were also included.
Conclusions: Available data indicate that lifestyle and environmental factors may influence the structure and composition of breast glandular tissue, modulating mammographic density and thus the sensitivity of screening. Incorporating these factors into personalized screening strategies may improve breast cancer detection, particularly in high-risk populations and women with high breast density.
References
Bagnardi, V., Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V., et al. (2015). Alcohol consumption and site-specific cancer risk: A comprehensive dose–response meta-analysis. British Journal of Cancer, 112(3), 580–593. https://doi.org/10.1038/bjc.2014.579
Boyd, N. F., Guo, H., Martin, L. J., Sun, L., Stone, J., Fishell, E., et al. (2007). Mammographic density and the risk and detection of breast cancer. New England Journal of Medicine, 356(3), 227–236. https://doi.org/10.1056/NEJMoa062790
Chlebowski, R. T., Hendrix, S. L., Langer, R. D., Stefanick, M. L., Gass, M., Lane, D., et al. (2003). Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women’s Health Initiative randomized trial. JAMA, 289(24), 3243–3253. https://doi.org/10.1001/jama.289.24.3243
Ciatto, S., Houssami, N., Apruzzese, A., Bassetti, E., Brancato, B., Cariddi, A., et al. (2004). Categorizing breast mammographic density: Intra- and interobserver reproducibility of BI-RADS density categories. Breast, 13(4), 269–275. https://doi.org/10.1016/j.breast.2003.10.005
Diamanti-Kandarakis, E., Bourguignon, J. P., Giudice, L. C., Hauser, R., Prins, G. S., Soto, A. M., et al. (2009). Endocrine-disrupting chemicals: An Endocrine Society scientific statement. Endocrine Reviews, 30(4), 293–342. https://doi.org/10.1210/er.2009-0002
Friedenreich, C. M., Cust, A. E., Lahmann, P. H., Steindorf, K., Boutron-Ruault, M. C., Clavel-Chapelon, F., et al. (2010). Physical activity and risk of breast cancer: The European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiology, Biomarkers & Prevention, 19(5), 1197–1210. https://doi.org/10.1158/1055-9965.EPI-09-1258
Huang, Y. T., Huang, C. J., Li, C. Y., Tsai, C. H., & Wu, C. H. (2025). Long-term exposure to air pollution and breast cancer risk: A nationwide cohort study. Scientific Reports, 15, Article 88765. https://doi.org/10.1038/s41598-025-88765-z
Independent UK Panel on Breast Cancer Screening. (2012). The benefits and harms of breast cancer screening: An independent review. The Lancet, 380(9855), 1778–1786. https://doi.org/10.1016/S0140-6736(12)61611-0
Iyengar, N. M., Hudis, C. A., & Dannenberg, A. J. (2015). Obesity and cancer: Local and systemic mechanisms. Annual Review of Medicine, 66, 297–309. https://doi.org/10.1146/annurev-med-050913-022228
Liu, Y., Chen, H., Zhou, X., Li, J., & Wang, Q. (2025). Breast density and interval cancer risk: A meta-analysis. European Journal of Cancer, 198, 113–124. https://doi.org/10.1016/j.ejca.2024.11.012
Maskarinec, G., Pagano, I., Lurie, G., & Kolonel, L. N. (2006). A longitudinal investigation of mammographic density: The multiethnic cohort. Cancer Epidemiology, Biomarkers & Prevention, 15(4), 732–739. https://doi.org/10.1158/1055-9965.EPI-05-0860
Maskarinec, G., Pagano, I., Lurie, G., Kolonel, L. N., & Henderson, B. E. (2006). Mammographic density and body mass index in women of different ethnic groups. Cancer Epidemiology, Biomarkers & Prevention, 15(4), 765–769. https://doi.org/10.1158/1055-9965.EPI-05-0879
McCormack, V. A., & dos Santos Silva, I. (2006). Breast density and parenchymal patterns as markers of breast cancer risk: A meta-analysis. Cancer Epidemiology, Biomarkers & Prevention, 15(6), 1159–1169. https://doi.org/10.1158/1055-9965.EPI-06-0034
Miglioretti, D. L., Zhu, W., Kerlikowske, K., Sprague, B. L., Onega, T., Buist, D. S. M., et al. (2016). Breast tumor prognostic characteristics and biennial vs annual mammography, by age and breast density. JAMA Oncology, 2(11), 1420–1428. https://doi.org/10.1001/jamaoncol.2016.3036
Morgan, W. F., & Bair, W. J. (2015). Radiation-induced genomic instability and bystander effects: A historical perspective. Oncogene, 34(7), 847–855. https://doi.org/10.1038/onc.2014.49
Pauwels, E. K. J., Foray, N., Bourguignon, M., & Luttun, A. (2021). Ionizing radiation and breast cancer: Mechanisms and risk. Cancers, 13(2), Article 275. https://doi.org/10.3390/cancers13020275
Pepłońska, B., Bukowska, A., & Sobala, W. (2022). Occupational exposure to ionizing radiation and breast cancer risk. International Journal of Occupational Medicine and Environmental Health, 35(3), 305–316. https://doi.org/10.13075/ijomeh.1896.01820
Preston, D. L., Ron, E., Tokuoka, S., Funamoto, S., Nishi, N., Soda, M., et al. (2007). Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiation Research, 168(1), 1–64. https://doi.org/10.1667/RR0763.1
Sánchez-Ocaña, M., & Ruiz de Porras, V. (2025). Environmental endocrine disruptors and breast cancer: The role of bisphenols, polychlorinated biphenyls, parabens, and dioxins. Environmental Toxicology and Pharmacology, 119, Article 104834. https://doi.org/10.1016/j.etap.2025.104834
Sickles, E. A., D’Orsi, C. J., Bassett, L. W., et al. (2013). ACR BI-RADS mammography. In ACR BI-RADS® atlas: Breast imaging reporting and data system. American College of Radiology.
Sprague, B. L., Trentham-Dietz, A., Hedman, C. J., Wang, J., Hemming, J. D., Hampton, J. M., et al. (2013). Circulating serum xenoestrogens and mammographic breast density. Breast Cancer Research, 15(3), Article R45. https://doi.org/10.1186/bcr3432
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
Tabár, L., Vitak, B., Chen, T. H. H., Yen, A. M. F., Cohen, A., Tot, T., et al. (2011). Swedish two-county trial: Impact of mammographic screening on breast cancer mortality during 3 decades. Radiology, 260(3), 658–663. https://doi.org/10.1148/radiol.11110469
Turner, M. C., Cohen, A., Burnett, R. T., Jerrett, M., Diver, W. R., & Gapstur, S. M. (2011). Interactions between cigarette smoking and ambient PM2.5 for cardiovascular mortality. Environmental Research, 111(6), 797–803. https://doi.org/10.1016/j.envres.2011.05.004
Vachon, C. M., Kuni, C. C., Anderson, K., Anderson, V. E., & Sellers, T. A. (2007). Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer. Cancer Causes & Control, 18(6), 653–662. https://doi.org/10.1007/s10552-007-8991-9
White, A. J., Nichols, H. B., Bradshaw, P. T., & Sandler, D. P. (2017). Overall and source-specific particulate matter air pollution and breast cancer risk in the Sister Study. Environmental Health Perspectives, 125(4), 697–703. https://doi.org/10.1289/EHP132
White, A. J., Teitelbaum, S. L., Stellman, S. D., Beyea, J., Steck, S. E., Mordukhovich, I., et al. (2023). Air pollution and breast cancer risk: Updated evidence from prospective cohorts. Environment International, 178, Article 107997. https://doi.org/10.1016/j.envint.2023.107997
Wu, Y., Zhang, D., & Kang, S. (2021). Physical activity and risk of breast cancer: A meta-analysis of prospective studies. Breast Cancer Research and Treatment, 185(2), 251–262. https://doi.org/10.1007/s10549-020-05964-8
Yaghjyan, L., Colditz, G. A., Rosner, B., & Tamimi, R. M. (2012). Mammographic breast density and subsequent risk of breast cancer in postmenopausal women. Breast Cancer Research and Treatment, 134(3), 1273–1281. https://doi.org/10.1007/s10549-012-2078-3
Yao, S., Sucheston, L. E., Millen, A. E., Johnson, C. S., Trump, D. L., & Nesline, M. K. (2011). Pretreatment serum concentrations of 25-hydroxyvitamin D and breast cancer prognostic characteristics. Cancer Epidemiology, Biomarkers & Prevention, 20(4), 718–724. https://doi.org/10.1158/1055-9965.EPI-10-1065
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Angelika Jankowska, Anna Wawrzeczko, Magdalena Gostół, Maciej Jakubiec, Natalia Górska, Katarzyna Wójtowicz, Gabriela Deska, Emilia Gąsiorowska, Aleksandra Lewczuk

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

