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Quantitative Assessment of Mammographic Breast Density: Relationship with Breast Cancer Risk¹

¹ From the Departments of Radiology (J.A.H.) and Health Evaluation Sciences (V.E.B.), University of Virginia, Box 800170, Charlottesville, VA 22908. Received July 18, 2002; revision requested August 27; revision received October 23; accepted January 8, 2003. Address correspondence to J.A.H. (e-mail: jah7w@virginia.edu).

View larger version (70K): [in a new window]   Figure 1. Quantitative assessment of breast density with a computerized thresholding method (35). The computer interface is demonstrated. With this technique, the digitized mammogram is displayed. The red line marks the skin edge and is controlled by the bar labeled "Edge Threshold" in the threshold panel. The green line marks the breast parenchyma and is controlled by the bar labeled "Density Threshold." The user can move either bar to select the appropriate skin line and the area of breast tissue. The user draws a line to denote the boundary of the pectoralis muscle and that area is excluded. Two other masks can be used to exclude markers, et cetera. The total, dense area, and percentage of density are then calculated. In this example, the breast is 26.5% dense. (Image courtesy of Martin Yaffe, University of Toronto).

View larger version (90K): [in a new window]   Figure 2. Mammograms demonstrate marked increase in density with HRT. A, Prior to HRT use, the breast is minimally dense. B, After 1 year, the breast is extremely dense and has increased in size.

View larger version (76K): [in a new window]   Figure 3. Mammograms obtained in a 65-year-old woman taking 1 mg estradiol daily. A, Right mediolateral oblique view from a baseline mammogram shows heterogeneously moderate breast density. B, One year later, the right mediolateral oblique view from a screening mammogram shows that the breast density has undergone mild diffuse increase with development of a focal density (arrow). C, Right mediolateral oblique view from a diagnostic mammogram obtained after stopping estrogen for 2 weeks shows that the focal density has resolved and the appearance is similar to that at baseline. Metallic marker identifies an incidental skin lesion.

View larger version (107K): [in a new window]   Figure 4. Right craniocaudal mammographic views show a marked decrease in breast density at baseline (left) and 2 years (right) after beginning treatment with tamoxifen for contralateral breast cancer.

View larger version (18K): [in a new window]   Figure 5. Graphs demonstrate that the overall percentage of women with change in density (left) is similar to the relative risk of breast cancer (right) associated with the hormonal agents. Note that the relative risk of breast cancer with tamoxifen (white bar) use is reported for high-risk women (84), while raloxifene (striped bar) use is reported for average-risk women (85). Black bar = estrogen; gray bar = estrogen plus progesterone.