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Breast density and mammographic sensitivity have a strong linear correlation

by Christina Hwang , Contributing Reporter
A linear relationship between breast density and mammographic sensitivity was further evaluated by research published in the American Journal of Roentgenology.

A team from Elizabeth Wende Breast Care (EWBC) conducted a study over a four year time period, collecting the information of 771 patients with breast cancer. Breast density was measured using the American College of Radiology’s BI-RADS density categories. VolparaDensity, a software tool that generates a breast density percentage and a Volpara Density Grade — similar to the BI-RADS categories — was also used to assess breast density.

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When using the BI-RADS categories to classify breast density as almost entirely fatty, scattered density, heterogeneously dense, and extremely dense, the researchers found that mammographic sensitivity was 82 percent, 90 percent, 84 percent and 66 percent, respectively.

According to the researchers, the linear relationship between mammographic sensitivity and breast density was more apparent when using the Volpara Density Grade than when using the BI-RADS categories. Using VolparaDensity categories, the mammographic sensitivity was 95 percent, 89 percent, 83 percent and 65 percent.

“The visual assessment of determining BI-RADS categories tends to be subjective from radiologist to radiologist and less reproducible depending on the experience of the radiologist, volume of interpretation by the radiologist, prior mammogram density assignment – and is much less consistent,” Dr. Stamatia Destounis, Elizabeth Wende Breast Care, clinical professor, University of Rochester School of Medicine & Dentistry, told HCB News.

Results from the study showed that denser breasts were associated with the risk of being diagnosed with an interval cancer, a cancer that is not detected by screening but possibly palpated by the patient or her physician.

“Prior studies have detected higher rates of missed cancers in the denser breast tissue leading to higher numbers of interval cancers, but also higher breast cancer detection rates in denser breasts,” Destounis said.

Within each density category, the researchers also discovered there was a wide range of mammographic sensitivity. For example, women who were categorized in the “low” Volpara Density Grade category four had a sensitivity of 72 percent, and women in the “high” category four had a sensitivity of 58 percent.

According to Destounis, these results suggest that some women with dense breasts may still have an acceptable level of sensitivity and additional screening is unnecessary. Instead of giving women a density score, the patient could be given the average sensitivity for women in the same breast density, so she could make a more educated decision on whether or not she needs additional screening.

“Correct assessment of a woman’s breast density is important, as it can help to appropriately determine who may benefit most from adjunct screening, such as screening ultrasound,” said Destounis. “This is ever the more important as more states adopt density notification legislation, and demand increases for additional screening services.”

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