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Automated and Clinical Breast Imaging Reporting and Data System Density Measures Predict Risk for Screen-Detected and
Karla Kerlikowske1, Christopher G Scott2, Amir P Mahmoudzadeh1
1University of California, San Francisco, San Francisco, California (K.K., A.P.M.).
Background:
In 30 states, women who have had screening mammography are informed of their breast density on the basis of Breast Imaging Reporting and Data System (BI-RADS) density categories estimated subjectively by radiologists. Variation in these clinical categories across and within radiologists has led to discussion about whether automated BI-RADS density should be reported instead.
Objective:
To determine whether breast cancer risk and detection are similar for automated and clinical BI-RADS density measures.
Design:
Case-control.
Setting:
San Francisco Mammography Registry and Mayo Clinic.
Participants:
1609 women with screen-detected cancer, 351 women with interval invasive cancer, and 4409 matched control participants.
Measurements:
Automated and clinical BI-RADS density assessed on digital mammography at 2 time points from September 2006 to October 2014, interval and screen-detected breast cancer risk, and mammography sensitivity.
Results:
Of women whose breast density was categorized by automated BI-RADS more than 6 months to 5 years before diagnosis, those with extremely dense breasts had a 5.65-fold higher interval cancer risk (95% CI, 3.33 to 9.60) and a 1.43-fold higher screen-detected risk (CI, 1.14 to 1.79) than those with scattered fibroglandular densities. Associations of interval and screen-detected cancer with clinical BI-RADS density were similar to those with automated BI-RADS density, regardless of whether density was measured more than 6 months to less than 2 years or 2 to 5 years before diagnosis. Automated and clinical BI-RADS density measures had similar discriminatory accuracy, which was higher for interval than screen-detected cancer (c-statistics: 0.70 vs. 0.62 [P < 0.001] and 0.72 vs. 0.62 [P < 0.001], respectively). Mammography sensitivity was similar for automated and clinical BI-RADS categories: fatty, 93% versus 92%; scattered fibroglandular densities, 90% versus 90%; heterogeneously dense, 82% versus 78%; and extremely dense, 63% versus 64%, respectively.
Limitation:
Neither automated nor clinical BI-RADS density was assessed on tomosynthesis, an emerging breast screening method.
Conclusion:
Automated and clinical BI-RADS density similarly predict interval and screen-detected cancer risk, suggesting that either measure may be used to inform women of their breast density.
Primary Funding Source:
National Cancer Institute.
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