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Objectives: There are several breast cancer (BC) risk factors-many related to body composition, hormonal status, and fertility patterns. However, it is not known if risk factors in healthy women are associated with specific mammographic features at the time of BC diagnosis. Our aim was to assess the potential association between pre-diagnostic body composition and mammographic features in the diagnostic BC image., Materials and Methods: The prospective Malmö Diet and Cancer Study includes women with invasive BC from 1991 to 2014 (n = 1116). BC risk factors at baseline were registered (anthropometric measures, menopausal status, and parity) along with mammography data from BC diagnosis (breast density, mammographic tumor appearance, and mode of detection). We investigated associations between anthropometric measures and mammographic features via logistic regression analyses, yielding odds ratios (OR) with 95% confidence intervals (CI)., Results: There was an association between high body mass index (BMI) (≥ 30) at baseline and spiculated tumor appearance (OR 1.370 (95% CI: 0.941-2.010)), primarily in women with clinically detected cancers (OR 2.240 (95% CI: 1.280-3.940)), and in postmenopausal women (OR 1.580 (95% CI: 1.030-2.440)). Furthermore, an inverse association between high BMI (≥ 30) and high breast density (OR 0.270 (95% CI: 0.166-0.438)) was found., Conclusion: This study demonstrated an association between obesity and a spiculated mass on mammography-especially in women with clinically detected cancers and in postmenopausal women. These findings offer insights on the relationship between risk factors in healthy women and related mammographic features in subsequent BC., Clinical Relevance Statement: With increasing numbers of both BC incidence and women with obesity, it is important to highlight mammographic findings in women with an unhealthy weight., Key Points: Women with obesity and BC may present with certain mammographic features. Spiculated masses were more common in women with obesity, especially postmenopausal women, and those with clinically detected BCs. Insights on the relationship between obesity and related mammographic features will aid mammographic interpretation., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Professor Sophia Zackrisson. Conflict of interest: The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Statistics and biometry: Anna Åkesson statistician kindly provided statistical advice for this manuscript. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: The MDCS is a large prospective study with several publications over the years. More specifically on image data and BC, the latest research was published by Sturesdotter et al [20]. There has been no previous publication on image data and baseline anthropometric data, so there is no overlap with the current study. Methodology: Prospective Observational Performed at one institution, (© 2024. The Author(s).)