Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program

Moshina, Nataliia; Ursin, Giske; Román, Marta; Sebuødegård, Sofie; Hofvind, Solveig

doi:10.1016/j.ejrad.2015.11.030

Cited by 8 publications

(6 citation statements)

References 152 publications

(229 reference statements)

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“…Results were essentially unchanged when we excluded the family history screenees, so they apply specifically to women recalled for assessment due to a suspicious screening mammogram. One would expect a smaller effect of density on risk in assessment cases as these would be likely to have higher levels of density on average than the general population, as women with denser breasts have mammography results harder to read and tend to be recalled more often [45] . Our results indicate that the effect in this group, while smaller than observed in the general screened population [2] , is by no means negligible.…”

Section: Discussionmentioning

confidence: 99%

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer

Duffy¹,

Morrish

Allgood³

et al. 2018

European Journal of Cancer

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BackgroundMammographic density has been shown to be a strong independent predictor of breast cancer and a causative factor in reducing the sensitivity of mammography. There remain questions as to the use of mammographic density information in the context of screening and risk management, and of the association with cancer in populations known to be at increased risk of breast cancer.AimTo assess the association of breast density with presence of cancer by measuring mammographic density visually as a percentage, and with two automated volumetric methods, Quantra™ and VolparaDensity™.MethodsThe TOMosynthesis with digital MammographY (TOMMY) study of digital breast tomosynthesis in the Breast Screening Programme of the National Health Service (NHS) of the United Kingdom (UK) included 6020 breast screening assessment cases (of whom 1158 had breast cancer) and 1040 screened women with a family history of breast cancer (of whom two had breast cancer). We assessed the association of each measure with breast cancer risk in these populations at enhanced risk, using logistic regression adjusted for age and total breast volume as a surrogate for body mass index (BMI).ResultsAll density measures showed a positive association with presence of cancer and all declined with age. The strongest effect was seen with Volpara absolute density, with a significant 3% (95% CI 1–5%) increase in risk per 10 cm3 of dense tissue. The effect of Volpara volumetric density on risk was stronger for large and grade 3 tumours.ConclusionsAutomated absolute breast density is a predictor of breast cancer risk in populations at enhanced risk due to either positive mammographic findings or family history. In the screening context, density could be a trigger for more intensive imaging.

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Section: Discussionmentioning

confidence: 99%

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer

Duffy¹,

Morrish

Allgood³

et al. 2018

European Journal of Cancer

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“…Furthermore, elevated MBD has been consistently associated with an increased risk of breast cancer (2)(3)(4). However, high MBD can "mask" an emerging tumor on standard mammography and therefore requires additional supplemental diagnostic tools (5,6). Ultrasound (US) screening is now receiving increased attention as a proven supplemental screening tool to differentiate between benign and malignant breast lesions.…”

Section: Introductionmentioning

confidence: 99%

“…The positive predictive values for BI-RADS 4a were defined as 2-10%, BI-RADS 4b as 10-50%, and BI-RADS 4c as 50-95% (7). BI-RADS 4 masses with dense breasts have a moderately increased risk of breast cancer, and dense breasts substantially reduced the sensitivity of mammography to detect malignancy (4,6). As we known, it is particularly difficult for radiologists to consistently distinguish the two most common and most variably assigned BI-RADS categories.…”

Section: Introductionmentioning

confidence: 99%

Mammography breast density: an effective supplemental modality for the precise grading of ultrasound BI-RADS 4 categories

Liu¹,

Sun²,

Fan³

et al. 2021

Gland Surg

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Background: High breast density is significantly associated with an increased risk of breast diseases.Presently, suspected breast masses assessed as Breast Imaging-Reporting and Data System (BI-RADS) grade 4 provide a wide range of positive predictive values. Moreover, subcategories (4a, 4b, and 4c) are still under consideration as the diagnostic criteria are neither comprehensive nor objective. However, whether mammography breast density (MBD) has any impact on the accurate grading of BI-RADS 4 assessed by ultrasound (US) remains unknown.Methods: A total of 1,086 women with 1,293 breast masses were included and assessed as BI-RADS 3-5 by US. The subcategories of MBD (from the ACR-a to the ACR-d group) were assessed by mammography according to the criteria of the American College of Radiology (ACR). The clinicopathological characteristics of these patients were reviewed retrospectively. The malignancy rates of breast masses among different subgroups assessed by BI-RADS were re-estimated with MBD.Results: Almost all BI-RADS 3 masses were classified as benign and nearly all BI-RADS 5 masses were identified as malignant. Significant inverse associations between MBD and malignancy rates were detected between the BI-RADS 4a and BI-RADS 4b groups. Moreover, malignancy rates decreased significantly from ACR-a to ACR-d for BI-RADS 4a and 4b breast lesions (P<0.001). However, this trend was not observed in BI-RADS 4c breast lesions.Conclusions: MBD could serve as a crucial factor for the accurate grading of BI-RADS 4 lesions assessed by US. We strongly recommend the adoption of the MBD as a possible supplemental screening modality for US. Furthermore, it is equally beneficial for accurate risk assessment and screening recommendations based on MBD.

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“…In 2015, an automated volumetric breast density assessment software (Volpara TM ) (27) was temporarily installed at two screening units for quality assurance and enhancement of the screening program. The three-point scale has been used for annual national reports on early performance measures in the screening program (28) and for the research on the impact of mammographic density on screening performance (29,30). Previous studies using the three-point scale have shown significantly higher positive predictive values and more favorable prognostic tumor characteristics for women with low versus high mammographic density (29,30).…”

Section: Introductionmentioning

confidence: 99%

“…The three-point scale has been used for annual national reports on early performance measures in the screening program (28) and for the research on the impact of mammographic density on screening performance (29,30). Previous studies using the three-point scale have shown significantly higher positive predictive values and more favorable prognostic tumor characteristics for women with low versus high mammographic density (29,30). However, the three-point scale has never been validated with respect to automated density assessment.…”

Section: Introductionmentioning

confidence: 99%

Comparison of subjective and fully automated methods for measuring mammographic density

et al. 2017

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Background Breast radiologists of the Norwegian Breast Cancer Screening Program subjectively classified mammographic density using a three-point scale between 1996 and 2012 and changed into the fourth edition of the BI-RADS classification since 2013. In 2015, an automated volumetric breast density assessment software was installed at two screening units. Purpose To compare volumetric breast density measurements from the automated method with two subjective methods: the three-point scale and the BI-RADS density classification. Material and Methods Information on subjective and automated density assessment was obtained from screening examinations of 3635 women recalled for further assessment due to positive screening mammography between 2007 and 2015. The score of the three-point scale (I = fatty; II = medium dense; III = dense) was available for 2310 women. The BI-RADS density score was provided for 1325 women. Mean volumetric breast density was estimated for each category of the subjective classifications. The automated software assigned volumetric breast density to four categories. The agreement between BI-RADS and volumetric breast density categories was assessed using weighted kappa (k). Results Mean volumetric breast density was 4.5%, 7.5%, and 13.4% for categories I, II, and III of the three-point scale, respectively, and 4.4%, 7.5%, 9.9%, and 13.9% for the BI-RADS density categories, respectively ( P for trend < 0.001 for both subjective classifications). The agreement between BI-RADS and volumetric breast density categories was k = 0.5 (95% CI = 0.47-0.53; P < 0.001). Conclusion Mean values of volumetric breast density increased with increasing density category of the subjective classifications. The agreement between BI-RADS and volumetric breast density categories was moderate.

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Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program

Abstract: PPVs decreased by increasing MD. Fewer women needed to be recalled or undergo an invasive procedure to detect one breast cancer among those with fatty versus dense breasts in the screening program in Norway, 1996-2010.

Cited by 8 publications

References 152 publications

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer

Mammography breast density: an effective supplemental modality for the precise grading of ultrasound BI-RADS 4 categories

Comparison of subjective and fully automated methods for measuring mammographic density

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