Abstract
BackgroundIn the light of the breast density legislation in the USA, it is important to know a woman’s breast cancer risk, but particularly her risk of a tumor that is not detected through mammographic screening (interval cancer). Therefore, we examined the associations of automatically measured volumetric breast density with screen-detected and interval cancer risk, separately.MethodsVolumetric breast measures were assessed automatically using Volpara version 1.5.0 (Matakina, New Zealand) for the first available digital mammography (DM) examination of 52,814 women (age 50 − 75 years) participating in the Dutch biennial breast cancer screening program between 2003 and 2011. Breast cancer information was obtained from the screening registration system and through linkage with the Netherlands Cancer Registry. We excluded all screen-detected breast cancers diagnosed as a result of the first digital screening examination. During a median follow-up period of 4.2 (IQR 2.0–6.2) years, 523 women were diagnosed with breast cancer of which 299 were screen-detected and 224 were interval breast cancers. The associations between volumetric breast measures and breast cancer risk were determined using Cox proportional hazards analyses.ResultsPercentage dense volume was found to be positively associated with both interval and screen-detected breast cancers (hazard ratio (HR) 8.37 (95% CI 4.34–16.17) and HR 1.39 (95% CI 0.82–2.36), respectively, for Volpara density grade category (VDG) 4 compared to VDG1 (p for heterogeneity < 0.001)). Dense volume (DV) was also found to be positively associated with both interval and screen-detected breast cancers (HR 4.92 (95% CI 2.98–8.12) and HR 2.30 (95% CI 1.39–3.80), respectively, for VDG-like category (C)4 compared to C1 (p for heterogeneity = 0.041)). The association between percentage dense volume categories and interval breast cancer risk (HR 8.37) was not significantly stronger than the association between absolute dense volume categories and interval breast cancer risk (HR 4.92).ConclusionsOur results suggest that both absolute dense volume and percentage dense volume are strong markers of breast cancer risk, but that they are even stronger markers for predicting the occurrence of tumors that are not detected during mammography breast cancer screening.
Highlights
In the light of the breast density legislation in the USA, it is important to know a woman’s breast cancer risk, but her risk of a tumor that is not detected through mammographic screening
We examined the associations between the different breast density measures and breast cancer risk by calculating hazard ratios (HR) and their 95% confidence intervals using Cox proportional hazards analyses for quartiles and continuous measures (per standard deviation (SD) increase of the lntransformed measure) of dense volume (DV) and percentage dense volume (PDV)
52,291), 59 years (IQR 54–64) in women who were diagnosed with screen-detected breast cancer and 55 years (IQR 50–62) in women diagnosed with interval breast cancer during follow up
Summary
In the light of the breast density legislation in the USA, it is important to know a woman’s breast cancer risk, but her risk of a tumor that is not detected through mammographic screening (interval cancer). High breast density is known to hinder the detection of tumors during mammographic screening [4,5,6] These findings have led to legislation in the USA that mandates disclosure of breast density information to women undergoing mammography screening. When breast density measures are used as a tool to stratify women for different screening strategies, it is important that these measures are highly reproducible as it is undesirable that the likelihood of a woman being classified as having dense breasts is dependent on which radiologist she goes to Another prerequisite is that these measures can be obtained in the daily practice of highthroughput screening
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