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      Mammographic density. Measurement of mammographic density

      review-article
      1 ,
      Breast Cancer Research : BCR
      BioMed Central

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          Abstract

          Mammographic density has been strongly associated with increased risk of breast cancer. Furthermore, density is inversely correlated with the accuracy of mammography and, therefore, a measurement of density conveys information about the difficulty of detecting cancer in a mammogram. Initial methods for assessing mammographic density were entirely subjective and qualitative; however, in the past few years methods have been developed to provide more objective and quantitative density measurements. Research is now underway to create and validate techniques for volumetric measurement of density. It is also possible to measure breast density with other imaging modalities, such as ultrasound and MRI, which do not require the use of ionizing radiation and may, therefore, be more suitable for use in young women or where it is desirable to perform measurements more frequently. In this article, the techniques for measurement of density are reviewed and some consideration is given to their strengths and limitations.

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          Most cited references52

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          Breast patterns as an index of risk for developing breast cancer.

          The radiographic appearance of the breast parenchyma provides a method of predicting who will develop a breast cancer. This paper describes a restrospective study of 7,214 patients. On the basis of the radiographic appearance of the breast parenchyma, patients were placed into one of four groups of risk for developing carcinoma of the breast. Follow-up studies revealed a stepwise progression in the incidence of developing carcinoma of the breast at least 6 months after the radiographic examination. In one of the two substudies, there was a 37 times greater incidence for those at highest risk compared to the low risk group. The classifications presented are thought to be of value in the everyday practice of mammography as well as in planning screening programs.
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            Breast imaging reporting and data system (BI-RADS).

            The Breast Imaging Reporting and Data System (BI-RADS) lexicon was developed by the American College of Radiology to standardize mammographic reporting. The BI-RADS lexicon defines terms to describe abnormalities on mammograms, and it defines final assessment categories that are predictive of the likelihood of malignancy. Although the lexicon is clinically useful and facilitates communication and research, there is still substantial interobserver variability in its application. Lexicons for breast sonography and breast MRI are in progress.
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              Mammographic densities and breast cancer risk.

              The radiological appearance of the female breast varies among individuals because of differences in the relative amounts and X-ray attenuation characteristics of fat and epithelial and stromal tissues. Fat is radiolucent and appears dark on a mammogram, and epithelium and stroma are radiodense and appear light. We review here the evidence that these variations, known as mammographic parenchymal patterns, are related to risk of breast cancer. Studies that used quantitative measurement to classify mammographic patterns have consistently found that women with dense tissue in more than 60-75% of the breast are at four to six times greater risk of breast cancer than those with no densities. These risk estimates are independent of the effects of other risk factors and have been shown to persist over at least 10 years of follow up. Estimates of attributable risk suggest that this risk factor may account for as many as 30% of breast cancer cases. Mammographically dense breast tissue is associated both with epithelial proliferation and with stromal fibrosis. The relationship between these histological features and risk of breast cancer may by explained by the known actions of growth factors that are thought to play important roles in breast development and carcinogenesis. Mammographically dense tissue differs from most other breast cancer risk factors in the strength of the associated relative and attributable risks for breast cancer, and because it can be changed by hormonal and dietary interventions. This risk factor may be most useful as a means of investigating the etiology of breast cancer and of testing hypotheses about potential preventive strategies.
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                Author and article information

                Journal
                Breast Cancer Res
                Breast Cancer Research : BCR
                BioMed Central
                1465-5411
                1465-542X
                2008
                19 June 2008
                : 10
                : 3
                : 209
                Affiliations
                [1 ]Imaging Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5
                Article
                bcr2102
                10.1186/bcr2102
                2481498
                18598375
                4b3249fb-32e8-4737-8377-2fc5bdc99037
                Copyright © 2008 BioMed Central Ltd
                History
                Categories
                Review

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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