Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 May 19;162(10):673-81.
doi: 10.7326/M14-1465.

Identifying women with dense breasts at high risk for interval cancer: a cohort study

Karla Kerlikowske, Weiwei Zhu, Anna N A Tosteson, Brian L Sprague, Jeffrey A Tice, Constance D Lehman, Diana L Miglioretti; Breast Cancer Surveillance Consortium
Collaborators

Identifying women with dense breasts at high risk for interval cancer: a cohort study

Karla Kerlikowske et al. Ann Intern Med. .

Abstract

Background: Twenty-one states have laws requiring that women be notified if they have dense breasts and that they be advised to discuss supplemental imaging with their provider.

Objective: To better direct discussions of supplemental imaging by determining which combinations of breast cancer risk and Breast Imaging Reporting and Data System (BI-RADS) breast density categories are associated with high interval cancer rates.

Design: Prospective cohort.

Setting: Breast Cancer Surveillance Consortium (BCSC) breast imaging facilities.

Patients: 365,426 women aged 40 to 74 years who had 831,455 digital screening mammography examinations.

Measurements: BI-RADS breast density, BCSC 5-year breast cancer risk, and interval cancer rate (invasive cancer ≤12 months after a normal mammography result) per 1000 mammography examinations. High interval cancer rate was defined as more than 1 case per 1000 examinations.

Results: High interval cancer rates were observed for women with 5-year risk of 1.67% or greater and extremely dense breasts or 5-year risk of 2.50% or greater and heterogeneously dense breasts (24% of all women with dense breasts). The interval rate of advanced-stage disease was highest (>0.4 case per 1000 examinations) among women with 5-year risk of 2.50% or greater and heterogeneously or extremely dense breasts (21% of all women with dense breasts). Five-year risk was low to average (0% to 1.66%) for 51.0% of women with heterogeneously dense breasts and 52.5% with extremely dense breasts, with interval cancer rates of 0.58 to 0.63 and 0.72 to 0.89 case per 1000 examinations, respectively.

Limitation: The benefit of supplemental imaging was not assessed.

Conclusion: Breast density should not be the sole criterion for deciding whether supplemental imaging is justified because not all women with dense breasts have high interval cancer rates. BCSC 5-year risk combined with BI-RADS breast density can identify women at high risk for interval cancer to inform patient-provider discussions about alternative screening strategies.

Primary funding source: National Cancer Institute.

PubMed Disclaimer

Comment in

Summary for patients in

References

    1. Boyd N, Guo H, Martin L, et al. Mammographic density, and risk and detection of breast cancer. N Engl J Med. 2007;356(3):227–236. - PubMed
    1. Are You Dense. 2014 Sep 21; http://www.areyoudense.org/worxcms_published/news_page227.shtml.
    1. American College of Radiology. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) 4th. Reston, VA: American College of Radiology; 2003.
    1. Kerlikowske K. The mammogram that cried Wolfe. N Engl J Med. 2007;356(3):297–300. - PubMed
    1. Sprague B, Gangnon R, Burt V, et al. Prevalence of mammographically dense breasts in the United States. J Natl Cancer Inst. 2014;106(10) dju255. - PMC - PubMed

Publication types