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Clin Epidemiol. 2017 Dec 28;10:61-70. doi: 10.2147/CLEP.S144918. eCollection 2018.

Does breast density measured through population-based screening independently increase breast cancer risk in Asian females?

Author information

National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.
National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
Department of Radiology, Seoul St Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
Center for Breast Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea.
Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.



The purpose of this study was to investigate the effects of breast density on breast cancer risk among women screened via a nationwide mammographic screening program.

Patients and methods:

We conducted a nested case-control study for a randomly selected population of 1,561 breast cancer patients and 6,002 matched controls from the National Cancer Screening Program. Breast density was measured and recorded by two independent radiologists using the Breast Imaging Reporting and Data System (BI-RADS). Associations between BI-RADS density and breast cancer risk were evaluated according to screening results, time elapsed since receiving non-recall results, age, and menopausal status after adjusting for possible covariates.


Breast cancer risk for women with extremely dense breasts was five times higher (adjusted odds ratio [aOR] =5.0; 95% confidence interval [CI]) =3.7-6.7) than that for women with an almost entirely fatty breast, although the risk differed between recalled women (aOR =3.3, 95% CI =2.3-3.6) and women with non-recalled results (aOR =12.1, 95% CI =6.3-23.3, P-heterogeneity =0.001). aORs for BI-RADS categories of breast density were similar when subjects who developed cancer after showing non-recall findings during initial screening were grouped according to time until cancer diagnosis thereafter (<1 and ≥1 year). The prevalence of dense breasts was higher in younger women, and the association between a denser breast and breast cancer was stronger in younger women (heterogeneously dense breast: aOR =7.0, 95% CI =2.4-20.3, women in their 40s) than older women (aOR =2.5, 95% CI =1.1-6.0, women in their 70s or more). In addition, while the positive association remained, irrespective of menopausal status, the effect of a dense breast on breast cancer risk was stronger in premenopausal women.


This study confirmed an increased risk of breast cancer with greater breast density in Korean women which was consistent regardless of BI-RADS assessment category, time interval after initially non-recall results, and menopausal status.


breast cancer; breast density; breast imaging reporting and data system; nationwide mammographic screening program

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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