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Meta-Analysis
. 2022 Dec:66:62-68.
doi: 10.1016/j.breast.2022.09.007. Epub 2022 Sep 26.

Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis

F T H Bodewes  1 , A A van Asselt  1 , M D Dorrius  2 , M J W Greuter  2 , G H de Bock  3
Affiliations
Meta-Analysis

Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis

F T H Bodewes et al. Breast. 2022 Dec.

Abstract

Objectives: Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.

Methods: Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I2 statistic, stratified and sensitivity analyses.

Results: Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84-2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52-2.21) increased. Both results were statistically significant and homogenous.

Conclusions: Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.

Keywords: BI-RADS; Breast cancer; Breast cancer risk; Breast density; Mammographic density.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram.
Fig. 2
Fig. 2
Forest plot of the pooled risk (95% CI) for five included studies. Breast cancer risk for women with BI-RADS density D compared to women with BI-RADS B. Maximally-adjusted data were used. Standard Error (SE); Confidence Interval (CI).
Fig. 3
Fig. 3
Funnel plot of the breast cancer risk in five included studies in which effects estimates (ORs) are plotted against their standard errors (SEs) in a fixed-effect meta-analyses. Maximally-adjusted data were used.
See this image and copyright information in PMC

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