Mammographic density and prognosis in primary breast cancer patients

Abstract

Purpose Mammographic density (MD) is one of the strongest risk factors for breast cancer (BC). However, the influence of MD on the BC prognosis is unclear. The objective of this study was therefore to investigate whether percentage MD (PMD) is associated with a difference in disease-free or overall survival in primary BC patients. Methods A total of 2525 patients with primary, metastasis-free BC were followed up retrospectively for this analysis. For all patients, PMD was evaluated by two readers using a semi-automated method. The association between PMD and prognosis was evaluated using Cox regression models with disease-free survival (DFS) and overall survival (OS) as the outcome, and the following adjustments: age at diagnosis, year of diagnosis, body mass index, tumor stage, grading, lymph node status, hormone receptor and HER2 status. Results After median observation periods of 9.5 and 10.0 years, no influence of PMD on DFS ( p = 0.46, likelihood ratio test (LRT)) or OS ( p = 0.22, LRT), respectively, was found. In the initial unadjusted analysis higher PMD was associated with longer DFS and OS. The effect of PMD on DFS and OS disappeared after adjustment for age and was caused by the underlying age effect. Conclusions Although MD is one of the strongest independent risk factors for BC, in our collective PMD is not associated with disease-free and overall survival in patients with BC.

Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI)

“…Breast density is estimated to account for 26% of breast cancers in postmenopausal women [11]. Moreover, a higher breast density has also been associated with an increased breast cancerspecific mortality [12], albeit this data is not consistent among studies [13,14].…”

Breast Density Evaluation According to BI-RADS 5th Edition on Digital Breast Tomosynthesis: AI Automated Assessment Versus Human Visual Assessment

“…All these aspects are fundamental if breast density is universally recognized as an independent risk factor for the development of BC, as well as if breast density notification is introduced in some countries [36]. Furthermore, even though there is no clear association between breast density and breast cancer-specific survival [37,38], a high breast density might lead to missed detection and thus a later stage at diagnosis, when tumors are harder to treat. Consequently, a BC that is not screendetected in women with high-density breasts may present as an interval cancer during the time between routine screenings.…”

Mammographic breast density and survival in women with invasive breast cancer

“…A prospective analysis on the Breast Cancer Surveillance Consortium data of over 9000 women with invasive breast carcinoma showed that BI-RADS density (comparing BI-RADS 4 versus BI-RADS 2) was not related to the risk of death from BC (HR 0.92 95% CI 0.71-1.19) or any other cause (HR 0.83 95% CI 0.68-1.02), after accounting for some patient and tumor characteristics (site, age at and year of diagnosis, stage, BMI, mode of detection, treatment, and income) [12]. In a German study on 2525 patients diagnosed with primary metastasis-free BCs, no association was found between semi-automated MBD and overall survival (adjustments included: age and year at diagnosis, BMI, tumor stage, grading, lymph node status, hormone receptor and HER2 status) [13]. Pre-diagnostic MBD, assessed using a computer-assisted method, among 607 BC cases within the Hawaii component of the Multiethnic Cohort was not associated with death from BC (HR 0.95 per 10% 95% CI 0.79-1.15) and from other causes (HR 1.08 per 10% 95% CI 0.98-1.20); the model was adjusted for age at diagnosis, ethnicity, overweight, stage at diagnosis, and radiation treatment [14].…”