Impact of breast size and composition on the accuracy of mammography and ultrasonography in breast cancer screening

Akira Nakamura; Koji Ohnuki; Haruka Takahashi; Shin Usami; Yuki Ishida; Setsuko Shibata; Akiko Umemura; Atsushi Kano

doi:10.1007/s12282-024-01664-5

Impact of breast size and composition on the accuracy of mammography and ultrasonography in breast cancer screening

Breast Cancer. 2025 Jan 2. doi: 10.1007/s12282-024-01664-5. Online ahead of print.

Authors

Akira Nakamura^{1

2}, Koji Ohnuki³, Haruka Takahashi⁴, Shin Usami⁵, Yuki Ishida⁴, Setsuko Shibata⁴, Akiko Umemura⁵, Atsushi Kano⁴

Affiliations

¹ Department of Breast and Endocrine Surgery, Iwate Prefectural Central Hospital, 4-1, Ueda, Morioka, Iwate, 020-0066, Japan. [email protected].
² Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan. [email protected].
³ Department of Breast Oncology, Miyagi Cancer Center, Natori, Japan.
⁴ Iwate Cancer Society, Morioka, Japan.
⁵ Department of Breast and Endocrine Surgery, Iwate Prefectural Central Hospital, 4-1, Ueda, Morioka, Iwate, 020-0066, Japan.

PMID: 39751707
DOI: 10.1007/s12282-024-01664-5

Abstract

Background: The accuracy of mammography in breast cancer screening is influenced by different factors such as breast composition. However, previous studies did not evaluate the impact of breast size on examination accuracy. This study aimed to investigate the influence of breast size on the accuracy of mammography and ultrasonography in breast cancer screening using compressed breast thickness (CBT) on mammography as an indicator of breast size.

Methods: This study included Japanese women in their 40 s who underwent mammography alone (MG group) or mammography with adjunctive ultrasonography (MG + US group) at the Iwate Cancer Society (Iwate, Japan) in 2018 and 2019. Based on CBT, the participants were further divided into the L group (< 30 mm) and U group (≥ 30 mm). The recall rate, cancer detection rate, and positive predictive value of the L and U groups based on screening method and breast size were evaluated.

Results: Of 15,897 patients, 10,162 and 5735 underwent mammography alone and mammography with adjunctive ultrasonography, respectively. In the L group, the MG and MG + US groups did not significantly differ in terms of recall rate (1.9%, 95% CI 1.4-2.6 vs 1.9%, 1.2-2.9; p = 0.972). Moreover, the MG + US group had a higher cancer detection rate than the MG group. However, the difference was not significant (0.20%, 0.05-0.51 vs 0.63%, 0.25-1.29; p = 0.054). In the U group, the MG + US group had a significantly higher recall rate than the MG group (2.2%, 1.9-2.5 vs 2.9%, 2.5-3.4; p < 0.05). Nevertheless, there was no significant difference in the cancer detection rate (0.15%, 0.08-0.25 vs 0.28%, 0.15-0.48; p = 0.099).

Conclusions: To the best of our knowledge, this study first showed that breast size, in addition to breast composition, influences the accuracy of mammography and ultrasonography in breast cancer screening. Hence, screening methods tailored to individual breast characteristics should be considered.

Keywords: Breast cancer screening; Compressed breast thickness; Mammography; Ultrasonography.