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Abstract. Mammographic density (MD) is a significant risk factor for breast cancer and has been shown to reduce the sensitivity of mammography screening. Knowledge of a woman's density can be used to predict her risk of developing breast cancer and personalize her imaging pathway. However, measurement of breast density has proven to be troublesome with wide variations in density recorded using radiologists' visual Breast Imaging Reporting and Data System (BIRADS). Several automated methods for assessing breast density have been proposed, each with their own source of measurement error. The use of differing mammographic imaging systems further complicates MD measurement, especially for the same women imaged over time. The purpose of this study was to investigate whether having a mammogram on differing manufacturer's equipment affects a woman's MD measurement. Raw mammographic images were acquired on two mammography imaging systems (General Electric and Hologic) one year apart and processed using VolparaDensity™ to obtain the Volpara Density Grade (VDG) and average volumetric breast density percentage (AvBD%). Visual BIRADS scores were also obtained from 20 expert readers. BIRADS scores for both systems showed strong positive correlation (ρ ¼ 0.904; p < 0.001), while the VDG (ρ ¼ 0.978; p < 0.001) and AvBD% (ρ ¼ 0.973; p < 0.001) showed stronger positive correlations. Substantial agreement was shown between the systems for BIRADS (κ ¼ 0.692; p < 0.001), however, the systems demonstrated an almost perfect agreement for VDG (κ ¼ 0.933; p < 0.001).

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Purpose: Disagreement in mammographic breast density (MBD) assessment can impact breast cancer risk stratification, choices of further breast cancer screening intervals and pathways. This study examines whether inter-country MBD expectations and assessment approaches are associated with differences in MBD assessment. Methods