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Measuring breast density — are we there yet?

by Loren Bonner, DOTmed News Online Editor | June 04, 2014
Jim Pike
At this point, we can all be certain breast density is a real thing. But questions still remain about what constitutes dense breast tissue and how it should be measured.

Jim Pike is co-founder, president and CTO of VuCOMP, a company that develops automated breast density assessment technology and advanced computer-aided detection (CAD) for mammography. He spoke with DOTmed News about some of the benefits and challenges of a technology like this.

DMN: At one point the whole breast density discussion was quite contentious, but that seems to have softened. Why do you think this is the case, and is there much debate among radiologists about the value of breast density measurement at this point?

JP: Many doctors remain apprehensive about reporting breast density; patient groups continue to strongly advocate for it. Since clinical standards remain noncommittal about what should be done for women with dense breasts, reporting the information can cause difficulties for both the doctor and the patient.

In my opinion, doctors are recognizing the patient-driven desire for reporting breast density, and they seem to be slowly accepting its inevitability.

DMN: Describe what breast density actually is and what risks it presents to a woman.

JP: Breast density is the amount of dense (i.e. radio-opaque) fibroglandular tissue (as opposed to radiolucent fat tissue) in the breast. As breast density increases, the risk of developing breast cancer increases, while the sensitivity of mammography decreases. More specifically, mammographic sensitivity decreases by as much as 16 percent for dense breasts, and 40 percent of women will have dense breasts at some point in their lives. Additionally, women with a BI-RADS 4 breast density have over four times the relative risk of developing breast cancer compared to those with BI-RADS 1. Consequently, current guidelines (e.g. NCCN) suggest that additional screening modalities such as ultrasound or magnetic resonance imaging should be considered for some women with dense breasts.

DMN: How would a system like yours, an automated breast density assessment tool and CAD, inform the radiologist?

JP: M-Vu assesses breast density by examining the mammographic texture and appearance of the dense tissue, emulating -- quantitatively -- the approach advocated by the American College of Radiology. The advantage of this approach is that in addition to considering the percent of breast density, it also analyzes the texture and dispersion pattern of the tissue. Interestingly, in our own study, we noticed that in 4 percent of all pairs of cases in which the BI-RADS assignments (of the two cases) differed by one category, the difference in breast density (as assessed by radiologists) was inversely proportional to the difference in BI-RADS category. This suggests that percent breast density alone is insufficient to correctly assign BI-RADS categories to mammograms. Therefore, we designed our system to analyze the texture and dispersion pattern of tissue.

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