Abstract
BackgroundOur aim is to study if mammographic density (MD) prior to neoadjuvant chemotherapy is a predictive factor in accomplishing a pathological complete response (pCR) in neoadjuvant-treated breast cancer patients.MethodsData on all neoadjuvant treated breast cancer patients in Southern Sweden (2005–2016) were retrospectively identified, with patient and tumor characteristics retrieved from their medical charts. Diagnostic mammograms were used to evaluate and score MD as categorized by breast composition with the Breast Imaging-Reporting and Data System (BI-RADS) 5th edition. Logistic regression was used in complete cases to assess the odds ratios (OR) for pCR compared to BI-RADS categories (a vs b-d), adjusting for patient and pre-treatment tumor characteristics.ResultsA total of 302 patients were included in the study population, of which 57 (18.9%) patients accomplished pCR following neoadjuvant chemotherapy. The number of patients in the BI-RADS category a, b, c, and d were separately 16, 120, 140, and 26, respectively. In comparison to patients with BI-RADS breast composition a, patients with denser breasts had a lower OR of accomplishing pCR: BI-RADS b 0.32 (95%CI 0.07–0.1.5), BI-RADS c 0.30 (95%CI 0.06–1.45), and BI-RADS d 0.06 (95%CI 0.01–0.56). These associations were measured with lower point estimates, but wider confidence interval, in premenopausal patients; OR of accomplishing pCR for BI-RADS d in comparison to BI-RADS a: 0.03 (95%CI 0.00–0.76).ConclusionsThe likelihood of accomplishing pCR is indicated to be lower in breast cancer patients with higher MD, which need to be analysed in future studies for improved clinical decision-making regarding neoadjuvant treatment.
Highlights
Our aim is to study if mammographic density (MD) prior to neoadjuvant chemotherapy is a predictive factor in accomplishing a pathological complete response in neoadjuvant-treated breast cancer patients
Studies aiming at elucidating the role of MD in the adjuvant breast cancer (BC) setting have shown that a temporal decrease in MD after a primary BC lowers the risk of future contralateral BC [3]
We aim to investigate the association between the established Breast Imaging-Reporting and Data System (BI-RADS) breast composition categories for breast density at diagnosis and the pathological complete response (pCR) rate after neoadjuvant chemotherapy (NACT) in a Swedish consecutive cohort of 302 BC patients
Summary
Our aim is to study if mammographic density (MD) prior to neoadjuvant chemotherapy is a predictive factor in accomplishing a pathological complete response (pCR) in neoadjuvant-treated breast cancer patients. Accomplished pathological complete response (pCR) after NACT is considered to be a surrogate marker for improved long-term survival [13, 14]. Established predictors of response to NACT include younger age, triple negative phenotype or grade III tumors [15], and high tumor proliferation (Ki67) [16]. Additional biomarkers, such as imaging biomarkers, are needed to give each patient tailored cancer treatment
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