Exploring Dense Breast Density in Mammography: A Comparative Analysis of Breast Cancer Risk

Background: Breast density is a strong predictor of breast cancer. However, the difference in risk between breast density categories C and D remains inadequately explored. Given the low occurrence of extremely dense breasts, this investigation is crucial because it may lead to modifications in screening techniques for those with these conditions.

Objective: The objective of the study is to evaluate the difference in breast cancer risk among women undergoing mammography and biopsy at a tertiary referral hospital in Colombia, based on American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) results in categories of breast density C (heterogeneously dense) and D (extremely dense). Methods: This retrospective cross-sectional study recorded variables from the mammographic BI-RADS scale, as well as histological and clinical variables from digital medical records. A stratified analysis of lesion malignancy/benignity was conducted according to density category by mammography and histological findings. The association between mammographic breast density subclassification of dense breasts and the occurrence or not of pathology-defined malignancy was sought. Results: A total of 107 patients with breast density in categories C and D were included, with 88.7% having heterogeneously dense breasts. The frequency of breast cancer was 32%. Infiltrating ductal carcinoma was the most frequently diagnosed malignancy (N = 14). A higher BI-RADS category was correlated with breast density grade D and malignancy. A statistically significant association (p <0.045, RR 1.95, CI: 1.12-3.50) was found when comparing breast density (categories C and D) with the risk of malignancy. The positive predictive value (PPV) varied across different BI-RADS categories (BI-RADS 4A 25% vs. 0%; p-value 0.005; BI-RADS 4B 50% vs 10.5%; p-value 0.032).

Conclusion: Efforts and resources should be focused on patients with extremely dense breasts, emphasizing the importance of additional (individualized) screening. Breast density could change the PPV within each BI-RADS category. However, further studies are needed to define the risk associated with each breast density subcategory and within BI-RADS categories, as well as to assess the efficacy of additional screening in patients with extremely dense breasts.