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The aim of this study is to perform a test object-based comparison of the imaging performance of digital mammography (DM), digital breast tomosynthesis (DBT), and synthetic mammography (SM). Methods: Two test objects were used, the CDMAM and the L1-structured phantom. Small-detail detectability was assessed using CDMAM and the microcalcification simulating specks in the L1-structured background. Detection of spiculated and non-spiculated mass-like objects was assessed using the L1 phantom. Six different systems were included: Amulet Innovality (Fujifilm), Senographe Pristina (GEHC), 3Dimensions (Hologic), Giotto Class (IMS), Clarity 2D/3D (Planmed), and Mammomat Revelation (Siemens). Images were acquired under automatic exposure control (AEC) and at adjusted levels of AEC/2 and 2 × AEC level. Threshold gold thickness (T tr ) was established for the 0.13-mm-diameter CDMAM discs. Threshold diameters for the calcifications (d tr_c ), the spiculated masses (d tr_sm ), and for the non-spiculated masses (d tr_nsm ) were established. The threshold condition was defined as the thickness or diameter for a 62.5% correct score. Results: T tr for DM was generally superior to DBT, which in turn was superior to SM, but for most systems, these differences between modes were not significant. For L1, no significant differences in d tr_c were found between DM and DBT. The increase in d tr_c from DM to SM at AEC dose was 1%, 19%, 11%, 14%, 46%, and 27% for the Fujifilm, GEHC, Hologic, IMS, Planmed, and Siemens, respectively, indicating significantly poorer performance for all vendors except for Fujifilm, Hologic, and IMS. For both mass types, DBT performed better than SM, while SM showed no significant difference with DM (except for Fujifilm spiculated masses). The dose had an impact on small-detail detectability for both phantoms but did not influence the detection of either mass type. Conclusions: Both phantoms indicated potentially reduced small-detail detectability for SM versus DM and DBT and should therefore not be used in stand-alone mode. The L1 phantom demonstrated no significant difference in microcalcification detection between DM and DBT and also demonstrated the superiority of DBT, compared to DM for mass detection, for all six systems.

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The objective of this study is to determine the role of age at first full term pregnancy (FFTP), and mammographic breast density (MBD) in postmenopausal women. For this purpose women, age 50-69y, participating in the Flemish (Belgium) population based breast cancer screening program were invited to participate in the study during their visit at the mammography department in the University Hospital Leuven (UZLeuven) or at the mobile unit of their hometown. A self-administered questionnaire providing detailed information on lifestyle and environmental exposure was completed by the participants. In this analysis 1,034 women were included (mean age of 59.1 years (range: 49.2 to 69.8). The three parameters of MBD were the percentage glandular tissue of the total breast volume (GLAND), the ratio of the glandular tissue volume compared to the whole breast volume or Volumetric Breast Density (VBD) and the BI-RADS density classification (VolparaDataManager®, USA). The first two parameters (GLAND and VBD) were transformed according to the natural logarithm to improve normality. These two parameters were linked with the FFTP via a piecewise linear regression (PLR) model using the NLIN procedure in SAS (version 9.4, SAS Institute, Cary, NC, USA). For the BI-RADS, we used ordinal logistic regression analysis. All models were corrected for a priori chosen variables: age at menarche, the ever use of oral contraceptive pill (OC), hormonal use at menopause, age at MBD measurement, and the body mass index at participation. Estimates are provided as a % change (95% confidence intervals [CI]).The average age at FFTP was 26.1 years (5th-95th percentile: 20 to 34). The PLR model estimated the breakpoint in our analysis at a FFTP of 25.7 years (95% CI: 22.3 to 29.1). For the woman with a FFTP younger than 25.7 years, the association between GLAND or VBD and FFTP is statistically not significant. For woman with a FFTP above 25.7 years, each year increase in FFTP was associated with 1.3% increase in GLAND (95% CI: 0.0% to 2.5%) and 1.5% increase in VBD (95% CI: 0.2% to 2.8%). Analysis of the BI-RADS showed similar results, the odds of belonging to a higher BI-RADS classification (e.g. from class 1 to class 2) increased with 5.4% (95% CI: 0.0% to 11.0%) for each year increase in FFTP age after the age of 25.7 years. Among other reproductive factors such as age at menarche, for every year delay there is 3.5% higher GLAND (95% CI: 1.4 % to 5.6%) and 2.5% higher VBD (95% CI: 0.5% to 4.6%) and the ever use of OC resulted in 10.0 % decrease in GLAND (95% CI: -18.8% to -0.2%) and 10.2% decrease in VBD (95%CI:-19.1% to -0.3%).In conclusion, this study is to our knowledge the first one to show that mammographic breast density is significantly increased when pregnancy takes place after 25.7 years of age. Later age at menarche is increasing and use of oral contraceptive is reducing mammographic breast density at postmenopause. (This study was supported by a Grant of the Breast Cancer Organization Think Pink of Belgium, the Department of Breast Radiology and Mobile Unit of the University Hospital Leuven, the Centre of Environmental Sciences and the Centre of Biostatistics of the Hasselt University, and NIH Grant CA06927 to FCCC, PA, USA). Citation Format: Magda Johanna Vandeloo, Kristof Y. Neven, Liesbeth M. Bruckers, Jose Russo, Liesbeth Vancoillie, Esmee M. Bijnens, Eliane Kellen, Tim S. Nawrot, Chantal Van Ongeval. Age of first full term pregnancy and other reproductive factors affect mammographic breast density in postmenopausal women [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-32.

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