Using Mammographic Density to Improve Breast Cancer Screening Outcomes

Abstract

It is possible that the performance of mammographic screening would be improved if it is targeted at women at higher risk of breast cancer or who are more likely to have their cancer missed at screening, through more intensive screening or alternative screening modalities. We conducted a case-control study within a population-based Australian mammographic screening program (1,706 invasive breast cancers and 5,637 randomly selected controls). We used logistic regression to examine the effects of breast density, age, and hormone therapy use, all known to influence both breast cancer risk and the sensitivity of mammographic screening, on the risk of small (V15 mm) and large (>15 mm) screen-detected and interval breast cancers. The risk of small screen-detected cancers was not associated with density, but the risk of large screendetected cancers was nearly 3-fold for the second quintile and approximately 4-fold for the four highest density categories (third and fourth quintiles and the two highest deciles) compared with the lowest quintile. The risk of interval cancers increased monotonically across the density categories [highest decile odds ratio (OR), 4.65; 95% confidence interval (95% CI), 2.96-7.31]. The risk of small and large screen-detected cancers, but not interval cancers, increased with age.

Tumour Size at Detection According to Different Measures of Mammographic Breast Density

“…The flattening of the effect of breast density across the middle categories observed in this study and previous analyses of this data-set 8 has also been noted in studies of the association between breast density and breast cancer risk. 23,35 One possible explanation offered by Brisson et al 23 is that the degree of error in the breast density reading is higher in the middle values.…”

“…13,23,24 While studies have shown that increasing per cent density is associated with lower programme sensitivity 9 -12,22,25 and tumour size at detection 8 we could not find any studies that examined these associations for dense area.…”

Atrankinės Mamografinės Patikros Vykdymo Patirtis Nacionaliniame Vėžio Institute

“…Taigi liko neįvertinta radiologų darbo kokybė bei neatlikta detalesnė analizė, kodėl nebuvo nustatyta ryšio tarp intervalinių navikų skaičiaus ir krūties audinio tankumo. Turime neužmiršti, kad dauguma autorių kaip vieną svarbiausių mamografinio tyrimo jautrumą ribojančių veiksnių nurodo didelį krūties audinio tankumą, o tai tiesiogiai koreliuoja su intervalinių navikų dažniu [14][15][16][17][18][19]. Šis tyrimas -tai pirmas bandymas atlikti intervalinių navikų skaičiavimą AMPP vykdymo metu.…”

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“…Data from various screening programs suggest that interval cancers are more prevalent in women with mammographically dense breasts (16,17). Despite this, mammographic density is in general not used to guide screening intervals, or even as a criterion for additional exams in large screening programs.…”

“…Radiologists today use previous mammograms to compare with the current one for changes that could indicate the onset of a cancer. Although this improves detection rates for cancer, screening programs could probably improve their effectiveness even more by including mammographic density as a criterion for selecting women who need additional exams (17). Although additional exams such as ultrasound or magnetic resonance imaging are time consuming and costly, as they must be performed by trained radiologists, it is clear that they can improve detection rates of cancer substantially in women with dense breasts.…”