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Racial differences in quantitative background parenchymal enhancement on breast magnetic resonance imaging.

Mattia A Mahmoud1, Christine E Edmonds2,3, Bruno Barufaldi3

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Black women exhibit higher quantitative background parenchymal enhancement (BPE) on MRI, independent of other risk factors. This finding suggests BPE may improve breast cancer risk prediction and reduce disparities for Black women.

Keywords:
BI‐RADSMRIbreast densityquantitative BPErace

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Black women have higher absolute quantitative breast density but lower subjective BI-RADS density scores than White women.
  • Background parenchymal enhancement (BPE) on MRI is linked to breast cancer risk and may aid risk stratification.

Purpose of the Study:

  • To assess differences in quantitative BPE between Black and White women.
  • To determine if breast cancer risk factors mediate these racial differences in BPE.

Main Methods:

  • A cross-sectional study analyzed 1202 women (200 Black, 1002 White) aged 40-74 with negative mammograms.
  • Breast MRI data was used to quantify BPE, controlling for BI-RADS density, fibroglandular tissue volume, and other covariates.

Main Results:

  • Black women had significantly higher quantitative BPE than White women (median difference, 1.51), independent of covariates.
  • Fewer Black women were classified as having extremely dense breasts, yet similar proportions showed high qualitative BPE.
  • No identified risk factors mediated the observed racial differences in quantitative BPE.

Conclusions:

  • Higher quantitative BPE in Black women, despite lower BI-RADS density, indicates BPE captures distinct breast tissue characteristics.
  • Incorporating BPE into breast cancer risk models could enhance performance and mitigate disparities in risk prediction for diverse populations.