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Breast Cancer Res. 2019 Oct 28;21(1):118. doi: 10.1186/s13058-019-1198-9.

Automated volumetric breast density measures: differential change between breasts in women with and without breast cancer.

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Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA.
Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA, 94612, USA.
California Pacific Medical Center Research Institute, 475 Brannan Street #220, San Francisco, CA, 94107, USA.
Department of Epidemiology and Biostatistics, University of California, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA.
University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA.



Given that breast cancer and normal dense fibroglandular tissue have similar radiographic attenuation, we examine whether automated volumetric density measures identify a differential change between breasts in women with cancer and compare to healthy controls.


Eligible cases (n = 1160) had unilateral invasive breast cancer and bilateral full-field digital mammograms (FFDMs) at two time points: within 2 months and 1-5 years before diagnosis. Controls (n = 2360) were matched to cases on age and date of FFDMs. Dense volume (DV) and volumetric percent density (VPD) for each breast were assessed using Volpara™. Differences in DV and VPD between mammograms (median 3 years apart) were calculated per breast separately for cases and controls and their difference evaluated by using the Wilcoxon signed-rank test. To simulate clinical practice where cancer laterality is unknown, we examined whether the absolute difference between breasts can discriminate cases from controls using area under the ROC curve (AUC) analysis, adjusting for age, BMI, and time.


Among cases, the VPD and DV between mammograms of the cancerous breast decreased to a lesser degree (- 0.26% and - 2.10 cm3) than the normal breast (- 0.39% and - 2.74 cm3) for a difference of 0.13% (p value < 0.001) and 0.63 cm3 (p = 0.002), respectively. Among controls, the differences between breasts were nearly identical for VPD (- 0.02 [p = 0.92]) and DV (0.05 [p = 0.77]). The AUC for discriminating cases from controls using absolute difference between breasts was 0.54 (95% CI 0.52, 0.56) for VPD and 0.56 (95% CI, 0.54, 0.58) for DV.


There is a small relative increase in volumetric density measures over time in the breast with cancer which is not found in the normal breast. However, the magnitude of this difference is small, and this measure alone does not appear to be a good discriminator between women with and without breast cancer.


Breast cancer; Breast density; Risk; Tissue asymmetry; Volumetric density

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