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Mammographic density is not a worthwhile examination to distinguish high cancer risk women in screening

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Abstract

Numerous studies established high mammographic density (MD) as a significant breast cancer risk. By adopting both radiological and epidemiological perspectives, we analysed the capacity of this radiological parameter to express an individual level of risk and the methods for assessing the relationship between MD categories and risk. MD is unable to identify individual underlying anatomical and physiological components. Many factors affect accurate and reproducible measurements and consequently classifications of MD. Significant relative risks were found by comparing the MD categories in the tails of distribution (i.e. the group of women with the lowest MD to that with the highest MD), which represent <10 % of women in each group: the majority of the population was ignored. When a relevant threshold of MD was applied to compare another group and the entire population was included to compare the two groups, some studies showed no significant or only moderate relative risk (RR) between women with readings above and those below the threshold. Sensitivity and specificity remain unknown. MD cannot be considered a worthwhile test by which to categorically identify high-risk women in screening.

Key points

• Unknown individual anatomical and physiological components do not express the risk level.

• The epidemiological conditions are not relevant to distinguish a high-risk category.

• The most relevant studies show no or moderate risks

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Acknowledgments

The scientific guarantor of this publication is Dr Catherine Colin, MD, PhD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise in analysing the cited studies in this paper: Pr. Anne-Marie Schott, Epidemiology Department, University Lyon 1, France. Institutional Review Board approval and written informed consent were not required, because it is not applicable. Approval from the institutional animal care committee was not required. Methodology: not applicable.

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Authors and Affiliations

  1. Radiology Unit, Lyon Sud Hospital, Lyon 1 University, Hospices Civils de Lyon, 69495, Pierre Bénite Cedex, France

    Catherine Colin & Pierre-Jean Valette

  2. Epidemiology Department, Pôle IMER, Lyon 1 University, Hospices Civils de Lyon, 69003, Lyon, France

    Anne-Marie Schott

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  1. Catherine Colin
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  2. Anne-Marie Schott
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Correspondence to Catherine Colin.

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Colin, C., Schott, AM. & Valette, PJ. Mammographic density is not a worthwhile examination to distinguish high cancer risk women in screening. Eur Radiol 24, 2412–2416 (2014). https://doi.org/10.1007/s00330-014-3278-7

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  • DOI: https://doi.org/10.1007/s00330-014-3278-7

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