Breast density in screening mammography in Indian population - Is it different from western population?

Abstract

Mammography is the only method presently considered appropriate for mass screening of breast cancer. However, higher breast density was strongly associated with lower mammographic sensitivity. Breast density is also identified as independent and strongest risk factors for breast cancer. Studies have shown women with high breast density have four to six times increased risk of breast cancer as compare to women with fatty breast. It varies between different age group it generally decreases with increasing age in postmenopausal women and it can be different in different ethnic groups and people from different geographical areas. This study evaluates the breast density in Indian population and its relationship with the age. We reviewed of all screening mammography examinations performed from May 2012 to January 2015 at our institute PGIMER, Chandigarh, INDIA. Descriptive analyses were used to examine the association between age and breast density. A total of 6132 screening mammograms were performed. Each subgroup categorized by decade of age. There was a significant inverse relationship between age and breast density (P < .001). Twenty-two percent of patients between 40 and 49 years old had dense breasts. This percentage decreased to 9% of women in their 50s. Only 7% of women in their 60s and 8% of women in their 70s had dense breasts. This data has been compared with the Western study done in New York University (NYU) shows there is significant difference (P value <.05) in the breast density in Indian and Western population with more Indians having ACR Grade 1 and 2 and Western population having 2 and 3. We found an inverse relationship between patient age and mammographic breast density. However, there were a large proportion of young women who had lower grades of mammographic density which could potentially benefit from the use of routine screening mammography in this subgroup of patients. Moreover, the breast density of Indian population is less when compared to the Western population. This might suggest that mammography is a good modality of choice for screening Indian population.

Mammographic Breast Density Profile of Jordanian Women With Normal and Breast Cancer Findings

“…If more equal numbers of women were recorded, the percentage differences in breast density patterns and the relationship of ACR BI-RADS category and age may change. Another limitation is the use of the subjective visual ACR BI-RADS classifying of MBD; however, it has been used in many studies, 17,23,25,26 and in the current study, almost perfect agreement was demonstrated between the 3 radiologists (kappa value of 0.93). It is more accurate to use automated methods for MBD measurement but semi-automated and automated methods are not currently available in Jordan.…”

“…The results revealed that 68.9% of women in the normal and 70.9% of breast cancer group reported high MBD – ACR BI-RADS c or d. This is higher than the recorded percentage for women in the United States (55.4%), 17 China (52.8%), 22 Lebanon (52.9%), 23 Uganda (39%), 24 United Arab Emirates (23.6%), 25 and India (16%). 26 This density difference emphasises both the increased risk of breast cancer in this population and the importance of local data informing screening policy rather than that of the US or other international data.…”

The implications of increased mammographic breast density for breast screening in Jordan

“…Decreased sensitivity can lead to higher rates of interval cancers and decrease the efficacy of breast screening programmes 7,8 . The overall percentage of Jordanian women with high‐dense breasts (69.3%), that is with breasts categorised as ACR BI‐RADS (c) or (d), is greater than the USA (55.4%), 19 Lebanon (52.9%) 23 and India (16%) 18 as shown in Fig. 2.…”

“…Mammographic breast density underlies many international differences in breast cancer prevalence and is known to vary amongst different ethnic groups and geographical regions. 18,19 . Knowledge related to mammographic breast density in a certain population is therefore crucial for planning an efficient screening programme especially where increased breast density is a known condition of the population.…”

“…Mammographic breast density underlies many international differences in breast cancer prevalence and is known to vary amongst different ethnic groups and geographical regions 18,19 …”