Nav: Home

Breast density assessment varies greatly by screening method and race

March 19, 2019

OAK BROOK, Ill. - Fewer women are assigned to a dense breast category when evaluated with advanced mammographic screening technologies compared to standard digital mammography, according to a new study published in the journal Radiology.

A woman's breast density, or the relative amount of glandular and connective tissue compared to fatty tissue, is assessed during a breast cancer screening with mammography. Women with the highest level of breast density have an increased risk for breast cancer and are advised to discuss supplemental screening with their physician. Most states in the U.S. have passed legislation mandating that women be notified of their breast density, and a federal law was just recently passed requiring the Food and Drug Administration (FDA) to oversee such notification.

Although digital mammography (DM) has long been the foundation of breast cancer screening, new imaging methods, or modalities, are increasingly being used, including digital breast tomosynthesis (DBT), also known as 3-D mammography, and synthetic mammography (SM).

In DM, two X-ray images are taken of the breast from top-to-bottom and from side-to-side while the breast is compressed against an imaging detector. In DBT, an X-ray tube moves in an arc over the compressed breast capturing multiple images from different angles. The DBT data can then be reconstructed into a quasi-3-D image stack that allows better lesion characterization and localization.

In 2011, the FDA approved the use of DBT in combination with DM imaging. In 2015, the FDA approved the use of synthesized 2-D images, which are reconstructed from the DBT data set to replace DM imaging, lowering the dose of DBT imaging.

In this retrospective study, researchers analyzed data from 24,736 women who underwent mammography screening at the Hospital of the University of Pennsylvania (HUP) between 2010 and 2017. Data collected included the breast density category assigned at the time of the screening using the standardized BI-RADS system, race, age and body mass index (BMI). The study population was 46 percent white and 54 percent African-American (mean age 56.3 years).

"Major strengths of our study were the size of our sample and the diverse patient population, which was approximately half white and half African-American," said Aimilia Gastounioti, Ph.D., lead author and research associate in the Radiology Department at HUP's Perelman School of Medicine.

Of the 60,766 imaging exams included in the study, 8,935 were conducted with DM (14.7 percent), 30,799 (50.7 percent) were performed with DM/DBT, and 21,052 (34.6 percent) used SM/DBT.

A statistical analysis of the study data showed breast density assignments varied greatly by the screening method used.

"We observed an overall trend of downgraded breast density when imaging was performed with either DM/DBT or SM/DBT compared with DM alone," Dr. Gastounioti said. "These effects were more prominent among African-American women and women with higher BMI."

Compared to standard DM imaging, the odds of a high-density assessment were reduced by 31 percent and 57 percent respectively when mammographic imaging was performed with DM/DBT or SM/DBT. The odds of receiving a high breast density assignment after SM replaced DM were reduced by 38 percent.

The density downgrade may be due to the perception of less fibroglandular tissue in the 3-D display of DBT imaging compared to DM's flat, 2-D display, as well as differences in the appearance of the denser glandular tissue and the fatty tissue in the reconstructed SM imaging.

"Our findings may have direct implications for personalized screening since breast density assignments, which often drive recommendations for supplemental screening, may vary greatly by modality, race and BMI," Dr. Gastounioti said.

She added that further research is needed to determine whether BI-RADS guidelines need to be adjusted for new imaging modalities.
-end-
"Effect of Mammographic Screening Modality on Breast Density Assessment: Digital Mammography versus Digital Breast Tomosynthesis." Collaborating with Dr. Gastounioti were Anne Marie McCarthy, Ph.D., Lauren Pantalone, B.S., Marie Synnestvedt, Ph.D., Despina Kontos, Ph.D., and Emily F. Conant, M.D.

The study was supported by the Susan G. Komen for the Cure Breast Cancer Foundation and the National Cancer Institute at the National Institutes of Health.

Radiology is edited by David A. Bluemke, M.D., Ph.D., University of Wisconsin School of Medicine and Public Health, Madison, Wis., and owned and published by the Radiological Society of North America, Inc. (https://pubs.rsna.org/journal/radiology)

RSNA is an association of over 53,400 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)

For patient-friendly information on breast imaging visit RadiologyInfo.org.

Radiological Society of North America

Related Breast Cancer Articles:

Breast cancer: AI predicts which pre-malignant breast lesions will progress to advanced cancer
New research at Case Western Reserve University in Cleveland, Ohio, could help better determine which patients diagnosed with the pre-malignant breast cancer commonly as stage 0 are likely to progress to invasive breast cancer and therefore might benefit from additional therapy over and above surgery alone.
Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.
Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.
More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.
Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.
Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.
Blood test can effectively rule out breast cancer, regardless of breast density
A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue.
Study shows influence of surgeons on likelihood of removal of healthy breast after breast cancer dia
Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published by JAMA Surgery.
Young breast cancer patients undergoing breast conserving surgery see improved prognosis
A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery.
Does MRI plus mammography improve detection of new breast cancer after breast conservation therapy?
A new article published by JAMA Oncology compares outcomes for combined mammography and MRI or ultrasonography screenings for new breast cancers in women who have previously undergone breast conservation surgery and radiotherapy for breast cancer initially diagnosed at 50 or younger.
More Breast Cancer News and Breast Cancer Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab