The association between breast density and breast cancer pathological response to neoadjuvant chemotherapy

Abstract

Purpose Mammographic Density (MD) refers to the amount of fibroglandular breast tissue present in the breast and is an established risk factor for developing breast cancer. The ability to evaluate treatment response dynamically renders neoadjuvant chemotherapy (NACT) the preferred treatment option in many clinical scenarios. Previous studies have suggested that MD can predict patients likely to achieve a pathological complete response (pCR) to NACT. We aimed to determine whether there is a causal relationship between BI-RADS breast composition categories for breast density at diagnosis and the pCR rate and residual cancer burden score (RCB) by performing a retrospective review on consecutive breast cancer patients who received NACT in a tertiary referral centre from 2015 to 2021. Methods The Mann–Whitney U Test was used to test for differences between two independent groups (i.e. those who achieved pCR and those who did not). A binary logistic regression model was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI) for an association between the independent variables of molecular subtype, MD, histological grade and FNA positivity and the dependant variable of pCR. Statistical analysis was conducted with SPSS (IBM SPSS for Mac, Version 26.0; IBM Corp). Results 292 patients were included in the current study. There were 124, 155 and 13 patients in the BI-RADS MD category b, c and d, respectively. There were no patients in the BI-RADS MD category a. The patients with less dense breast composition (MD category b) were significantly older than patients with denser breast composition (MD category c, d) (p = 0.001) and patients who had a denser breast composition (MD category d) were more likely to have ER+ tumours. There was no significant difference in PgR status, HER2 status, pathological complete response (pCR), FNA positivity, or RCB class dependent upon the three MD categories. A binary logistic regression revealed that patients with HER2-enriched breast cancer and triple-negative breast cancer are more likely to achieve pCR with an OR of 3.630 (95% CI 1.360–9.691, p = 0.010) and 2.445 (95% CI 1.131–5.288, p = 0.023), respectively. Conclusion Whilst dense MD was associated with ER positivity and these women were less likely to achieve a pCR, MD did not appear to independently predict pCR post-NACT.

Histo-Pathological Evaluation of Breast Cancer after Neo-Adjuvant Chemotherapy

“…Average age of the patients for abrasion's presentation was fifty years which is consistent with the findings of other research works [9,10] displaying the average ages as 50.60 and 48.90 years correspondingly. All the participants of this research work were females, which is similar to many other research studies [10,11,12,13]. In current research work, among forty-four patients, 55.0% (N: 24) females are pre-menopausal and 45.0% (N: 20) females are post-menopausal which is consistent with one other research study [14].…”

Mammographic assessment of breast density as a tool for predicting the response to neoadjuvant therapy in breast cancer patients

“…In our study, according to both MP and RCB systems, MD was a predictor for pCR as lower odds of reaching pCR were noticed in patients with higher MD. Some studies [29][30][31] did not find any association between MD and pCR to NAT-in a prospective study on 200 BC patients, even if a decrease in MD was noticed during NAT, it was not found to be associated with pCR in the neoadjuvant setting [30].…”