Breast Imaging Reporting And Data System Breast Density Research Articles

An audit of clinically triaged women at low risk for breast cancer presenting to the Helen Joseph Mammography Unit.

The Helen Joseph Hospital (HJH) breast clinic utilises a clinical triage system to stratify patients based on their risk of breast cancer into high-, medium-, or low-risk profiles. This allows for timeous imaging and subsequent management of those patients at increased risk for breast cancer. The primary objective was to determine the cancer detection rate (CDR). The secondary objective was to correlate biopsy results with the Breast Imaging-Reporting and Data System (BI-RADS) risk assessment. A retrospective audit of the patients at low risk for breast cancer who were referred to the breast imaging unit (BIU) in 2019 at HJH. Patients were clinically assessed as low risk based on a triage form and were identified using the imaging files stored in the BIU. Results were recorded on Microsoft Excel and calculated as per the American College of Radiology guidelines. The total population sample consisted of 398 patients. Two patients were characterised as BI-RADS 4 and underwent breast biopsies. One patient was diagnosed with histologically proven breast cancer. The CDR was 2.51%. The most representative groups were the age group of 60-69 years, BI-RADS breast density B and BI-RADS risk assessment 2. Amongst the low-risk population, both the CDR and spectrum of disease was comparable to that of a screening population. This may be due to the use of a triage system prior to imaging, as well as an increase in clinical awareness of breast cancer within a tertiary institution.

Identifying women with dense breasts at high risk for interval cancer: a cohort study.

Twenty-one states have laws requiring that women be notified if they have dense breasts and that they be advised to discuss supplemental imaging with their provider. To better direct discussions of supplemental imaging by determining which combinations of breast cancer risk and Breast Imaging Reporting and Data System (BI-RADS) breast density categories are associated with high interval cancer rates. Prospective cohort. Breast Cancer Surveillance Consortium (BCSC) breast imaging facilities. 365,426 women aged 40 to 74 years who had 831,455 digital screening mammography examinations. BI-RADS breast density, BCSC 5-year breast cancer risk, and interval cancer rate (invasive cancer ≤12 months after a normal mammography result) per 1000 mammography examinations. High interval cancer rate was defined as more than 1 case per 1000 examinations. High interval cancer rates were observed for women with 5-year risk of 1.67% or greater and extremely dense breasts or 5-year risk of 2.50% or greater and heterogeneously dense breasts (24% of all women with dense breasts). The interval rate of advanced-stage disease was highest (>0.4 case per 1000 examinations) among women with 5-year risk of 2.50% or greater and heterogeneously or extremely dense breasts (21% of all women with dense breasts). Five-year risk was low to average (0% to 1.66%) for 51.0% of women with heterogeneously dense breasts and 52.5% with extremely dense breasts, with interval cancer rates of 0.58 to 0.63 and 0.72 to 0.89 case per 1000 examinations, respectively. The benefit of supplemental imaging was not assessed. Breast density should not be the sole criterion for deciding whether supplemental imaging is justified because not all women with dense breasts have high interval cancer rates. BCSC 5-year risk combined with BI-RADS breast density can identify women at high risk for interval cancer to inform patient-provider discussions about alternative screening strategies. National Cancer Institute.

Review of: Are breast density and bone mineral density independent risk factors for breast cancer?

Citation of original article:K. Kerlikowske, J. Shepherd, J. Creasman, J. A. Tice, E. Ziv, S. R. Cummings. Are breast density and bone mineral density independent risk factors for breast cancer. Journal of the National Cancer Institute 2005; 97(7): 368–74.Abstract of the original articleBackground: Mammographic breast density and bone mineral density (BMD) are markers of cumulative exposure to estrogen. Previous studies have suggested that women with high mammographic breast density or high BMD are at increased risk of breast cancer. We determined whether mammographic breast density and BMD of the hip and spine are correlated and independently associated with breast cancer risk. Methods: We conducted a cross-sectional study (N = 15 254) and a nested case-control study (of 208 women with breast cancer and 436 control subjects) among women aged 28 years or older who had a screening mammography examination and hip BMD measurement within 2 years. Breast density for 3105 of the women was classified using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, and percentage mammographic breast density among the case patients and control subjects was quantified with a computer-based threshold method. Spearman rank partial correlation coefficient and Pearson's correlation coefficient were used to examine correlations between BI-RADS breast density and BMD and between percentage mammographic breast density and BMD, respectively, in women without breast cancer. Logistic regression was used to examine the association of breast cancer with percentage mammographic breast density and BMD. All statistical tests were two-sided. Results: Neither BI-RADS breast density nor percentage breast density was correlated with hip or spine BMD (correlation coefficient = −.02 and −.01 for BI-RADS, respectively, and −2.06 and .01 for percentage breast density, respectively). Neither hip BMD nor spine BMD had a statistically significant relationship with breast cancer risk. Women with breast density in the highest sextile had an approximately threefold increased risk of breast cancer compared with women in the lowest sextile (odds ratio: 2.7; 95% confidence interval: 1.4–5.4); adjusting for hip or spine BMD did not change the association between breast density and breast cancer risk. Conclusion: Breast density is strongly associated with increased risk of breast cancer, even after taking into account reproductive and hormonal risk factors, whereas BMD, although a possible marker of lifetime exposure to estrogen, is not. Thus, a component of breast density that is independent of estrogen-mediated effects may contribute to breast cancer risk.

Clinical significance of categorisation of mammographic density for breast cancer prognosis

Mammographic density reflects comprehensive changes in the mammary gland. The condition of the tumour microenvironment is a possible factor affecting tumour progression, as well as a tumour risk factor. This study aimed to determine whether mammographic density correlates with tumour clinicopathological features and prognosis in breast cancer patients. The analysis involved 163 Japanese women who underwent surgery for breast cancer between 1999 and 2003 in the Nagasaki University Hospital, Japan. Mammographic density was classified according to the breast imaging reporting and data system (BI-RADS) categories 1-4. Age, tumour size, axillary lymph node involvement, steroid receptor (SR) status, histological grade and Nottingham prognostic index (NPI) were analysed by density category and tested for statistically significant differences across categories. A significant difference (P<0.05) by breast-density category was found only for age. SR-negative tumours had significantly worse NPI scores than SR-positive tumours in breast-density categories 2 (P=0.03) and 4 (P<0.001). A high distant-metastasis frequency was observed in category 4 SR negatives (44%) versus category 4 SR positives (4.3%). These findings reveal that although the BI-RADS breast-density category alone is not associated with prognosis in breast cancer, patients who are both category 4 and SR negative have an extremely poor prognosis.

Are Breast Density and Bone Mineral Density Independent Risk Factors for Breast Cancer?

Mammographic breast density and bone mineral density (BMD) are markers of cumulative exposure to estrogen. Previous studies have suggested that women with high mammographic breast density or high BMD are at increased risk of breast cancer. We determined whether mammographic breast density and BMD of the hip and spine are correlated and independently associated with breast cancer risk. We conducted a cross-sectional study (N = 15,254) and a nested case-control study (of 208 women with breast cancer and 436 control subjects) among women aged 28 years or older who had a screening mammography examination and hip BMD measurement within 2 years. Breast density for 3105 of the women was classified using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, and percentage mammographic breast density among the case patients and control subjects was quantified with a computer-based threshold method. Spearman rank partial correlation coefficient and Pearson's correlation coefficient were used to examine correlations between BI-RADS breast density and BMD and between percentage mammographic breast density and BMD, respectively, in women without breast cancer. Logistic regression was used to examine the association of breast cancer with percentage mammographic breast density and BMD. All statistical tests were two-sided. Neither BI-RADS breast density nor percentage breast density was correlated with hip or spine BMD (correlation coefficient = -.02 and -.01 for BI-RADS, respectively, and -.06 and .01 for percentage breast density, respectively). Neither hip BMD nor spine BMD had a statistically significant relationship with breast cancer risk. Women with breast density in the highest sextile had an approximately threefold increased risk of breast cancer compared with women in the lowest sextile (odds ratio = 2.7, 95% confidence interval = 1.4 to 5.4); adjusting for hip or spine BMD did not change the association between breast density and breast cancer risk. Breast density is strongly associated with increased risk of breast cancer, even after taking into account reproductive and hormonal risk factors, whereas BMD, although a possible marker of lifetime exposure to estrogen, is not. Thus, a component of breast density that is independent of estrogen-mediated effects may contribute to breast cancer risk.