Abstract
BackgroundAccurate breast cancer risk assessment for women attending routine screening is needed to guide screening and preventive interventions. We evaluated the accuracy of risk predictions from both visual and volumetric mammographic density combined with the Tyrer-Cuzick breast cancer risk model.MethodsA case-control study (474 patient participants and 2243 healthy control participants) of women aged 40–79 years was performed using self-reported classical risk factors. Breast density was measured by using automated volumetric software and Breast Imaging and Reporting Data System (BI-RADS) density categories. Odds ratios (95% CI) were estimated by using logistic regression, adjusted for age, demographic factors, and 10-year risk from the Tyrer-Cuzick model, for a change from the 25th to 75th percentile of the adjusted percent density distribution in control participants (IQ-OR).ResultsAfter adjustment for classical risk factors in the Tyrer-Cuzick model, age, and body mass index (BMI), BI-RADS density had an IQ-OR of 1.55 (95% CI = 1.33 to 1.80) compared with 1.40 (95% CI = 1.21 to 1.60) for volumetric percent density. Fibroglandular volume (IQ-OR = 1.28, 95% CI = 1.12 to 1.47) was a weaker predictor than was BI-RADS density (Pdiff = 0.014) or volumetric percent density (Pdiff = 0.065). In this setting, 4.8% of women were at high risk (8% + 10-year risk), using the Tyrer-Cuzick model without density, and 7.1% (BI-RADS) compared with 6.8% (volumetric) when combined with density.ConclusionThe addition of volumetric and visual mammographic density measures to classical risk factors improves risk stratification. A combined risk could be used to guide precision medicine, through risk-adapted screening and prevention strategies.
Highlights
Breast cancer mortality rates in the USA have fallen substantially since 1990 because of early detection of the disease and better treatment [1,2,3]
We evaluated the accuracy of risk predictions from both visual and volumetric mammographic density combined with the Tyrer-Cuzick breast cancer risk model
Mammographic density was incorporated into the Tyrer-Cuzick risk model by developing a measure of breast density independent from age at mammogram and body mass index (BMI) at the time the questionnaire was filled, and it was defined as the difference between observed and expected density
Summary
Breast cancer mortality rates in the USA have fallen substantially since 1990 because of early detection of the disease and better treatment [1,2,3]. A model developed within the breast cancer surveillance consortium includes clinical mammographic density (BI-RADS density), but not a comprehensive set of risk factors (including age of affected relative, second-degree relatives, and weight) [19, 20]. The analysis reported here aimed to extend the Tyrer-Cuzick model by determining the risk associated with 2 measures of mammographic density after adjustment for the other factors in the model. Both of the mammographic density methods considered are feasible for clinical practice (BI-RADS and fully automated volumetric density). The prespecified hypothesis was that both measures of breast density would add information for breast cancer risk assessment to classical risk factors
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