Localized mammographic density is associated with interval cancer and large breast cancer: a nested case-control study

Abstract

BackgroundHigh mammographic density is associated with breast cancer and with delayed detection. We have examined whether localized density, at the site of the subsequent cancer, is independently associated with being diagnosed with a large-sized or interval breast cancer.MethodsWithin a prospective cohort of 63,130 women, we examined 891 women who were diagnosed with incident breast cancer. For 386 women, retrospective localized density assessment was possible. The main outcomes were interval cancer vs. screen-detected cancer and large (> 2 cm) vs. small cancer. In negative screening mammograms, overall and localized density were classified reflecting the BI-RADS standard. Density concordance probabilities were estimated through multinomial regression. The associations between localized density and the two outcomes were modeled through logistic regression, adjusted for overall density, age, body mass index, and other characteristics.ResultsThe probabilities of concordant localized density were 0.35, 0.60, 0.38, and 0.32 for overall categories “A,” “B,” “C,” and “D.” Overall density was associated with large cancer, comparing density category D to A with OR 4.6 (95%CI 1.8–11.6) and with interval cancer OR 31.5 (95%CI 10.9–92) among all women. Localized density was associated with large cancer at diagnosis with OR 11.8 (95%CI 2.7–51.8) among all women and associated with first-year interval cancer with OR 6.4 (0.7 to 58.7) with a significant linear trend p = 0.027.ConclusionsOverall density often misrepresents localized density at the site where cancer subsequently arises. High localized density is associated with interval cancer and with large cancer. Our findings support the continued effort to develop and examine computer-based measures of localized density for use in personalized breast cancer screening.Electronic supplementary materialThe online version of this article (10.1186/s13058-019-1099-y) contains supplementary material, which is available to authorized users.

Average glandular dose in paired digital mammography and digital breast tomosynthesis acquisitions in a population based screening program: effects of measuring breast density, air kerma and beam quality

“…Dense patches of breast tissue can mask lesions, and thereby fulfilling the criteria for a dense breast, even without high volumetric density. This change is important as localized densities have been shown to be associated with interval-and large cancers (231).…”

AutoCumulus: an Automated Mammographic Density Measure Created Using Artificial Intelligence

“…There is a well-established association between mammographic density and risk of interval cancers that are diagnosed between regular mammographic screens (Kerlikowske et al, 2015; Strand et al, 2019), and there is a wide concern about ‘dense breasts’ per se (REF). Measurement of density has been problematic, however, and clinical practice has generally relied on the pathologists’ interpretation without any formal quality control; the risk predicting performance of the BI-RADS categorisations when used in practice by multiple readers across a period of time is far less than found by controlled research studies utilising one or a few radiologists (Hopper et al, 2020).…”

AI-based density prediction for breast cancer prevention: can we measure mammographic density in just one breast?

“…The percentage of the breast taken up by this denser tissue both increases the risk of breast cancer and makes it more difficult to identify on a mammogram 4 . The white appearance of both dense breast tissue and malignancy can result in the malignancy being 'masked' by the dense tissue 5 . This masking effect is thought to increase the likelihood of symptomatic interval cancers in women with dense breasts 6. Interval cancers are more likely to be aggressive, larger in size or have metastasised to lymph tissue 7 .…”