Abstract
IntroductionMammographic breast density is one of the strongest known risk factors for breast cancer. We present a novel technique for estimating breast density based on 3D T1-weighted Magnetic Resonance Imaging (MRI) and evaluate its performance, including for breast cancer risk prediction, relative to two standard mammographic density-estimation methods.MethodsThe analyses were based on MRI (n = 655) and mammography (n = 607) images obtained in the course of the UK multicentre magnetic resonance imaging breast screening (MARIBS) study of asymptomatic women aged 31 to 49 years who were at high genetic risk of breast cancer. The MRI percent and absolute dense volumes were estimated using our novel algorithm (MRIBview) while mammographic percent and absolute dense area were estimated using the Cumulus thresholding algorithm and also using a 21-point Visual Assessment scale for one medio-lateral oblique image per woman. We assessed the relationships of the MRI and mammographic measures to one another, to standard anthropometric and hormonal factors, to BRCA1/2 genetic status, and to breast cancer risk (60 cases) using linear and Poisson regression.ResultsMRI percent dense volume is well correlated with mammographic percent dense area (R = 0.76) but overall gives estimates 8.1 percentage points lower (P < 0.0001). Both show strong associations with established anthropometric and hormonal factors. Mammographic percent dense area, and to a lesser extent MRI percent dense volume were lower in BRCA1 carriers (P = 0.001, P = 0.010 respectively) but there was no association with BRCA2 carrier status. The study was underpowered to detect expected associations between percent density and breast cancer, but women with absolute MRI dense volume in the upper half of the distribution had double the risk of those in the lower half (P = 0.009).ConclusionsThe MRIBview estimates of volumetric breast density are highly correlated with mammographic dense area but are not equivalent measures; the MRI absolute dense volume shows potential as a predictor of breast cancer risk that merits further investigation.
Highlights
Mammographic breast density is one of the strongest known risk factors for breast cancer
The MRIBview estimates of volumetric breast density are highly correlated with mammographic dense area but are not equivalent measures; the Magnetic Resonance Imaging (MRI) absolute dense volume shows potential as a predictor of breast cancer risk that merits further investigation
Using data from the UK magnetic resonance imaging breast screening (MARIBS) study, we have developed a novel technique based on three-dimensional T1-weighted Magnetic Resonance Imaging (MRI) for obtaining estimates of the absolute and proportional volumes of the breast occupied by dense tissue [3]
Summary
Mammographic breast density is one of the strongest known risk factors for breast cancer. The MRI density differs from that obtained from mammography in that it is based on a three-dimensional image of the breast and differentiates between dense and non-dense tissue on the basis of behaviour in response to a magnetic field rather than to x-ray radiation. We considered both the absolute volume occupied by dense material, and the dense volume as a proportion of the entire breast volume
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