Breast Density Distribution in the Indian Population in a Tertiary-Care Diagnostic Setting: A Comparison with Indian and Western Screening Cohorts

Although it is often believed that a large proportion of Asian women have dense breasts, population-specific data for Indian women remain limited. This study analyzes breast density distribution in an Indian diagnostic mammography (IDM) setting, its variation with age, and comparisons with previously reported Indian screening mammography (ISM) and Western screening mammography (WSM) cohorts.

This retrospective study analyzed consecutive mammogram reports from January 2020 to December 2023 at a tertiary-care oncology center. Breast density was categorized per ACR BIRADS guidelines, and age and density data were extracted. The population was stratified into six age groups. Statistical analysis included chi-squared tests for distribution differences, Spearman correlation for age-density trends, two-sample Z-tests for inter-dataset comparisons, and ANOVA for mean percentage differences across datasets.

Among 7,144 patients, category B (47.6%) was most prevalent, followed by A (32.8%). Breast density decreased with age (ρ = -0.283, p < 0.001). IDM had higher proportion of dense breasts than ISM, while WSM had the highest overall. Even when IDM and ISM were combined, the prevalence of dense breasts (C and D) remained substantially lower (16.3%) compared to WSM (55.4%). In the 40-49 and 50-59 age groups, category C was significantly less common in IDM than WSM (Z = -21.27 and -25.60, respectively; both p < 0.001).

In contrast to commonly prevailing assumptions, Indian women had a lower prevalence of dense breasts compared to Western data. These findings have important implications for tailoring breast cancer screening strategies in India.

The online version contains supplementary material available at https://doi.org/10.1007/s13193-025-02521-3.