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. 2025 Jul 1;17(13):2214.
doi: 10.3390/cancers17132214.

Correlations Between Mammographic Breast Density and Outcomes After Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer

Veenoo Agarwal  1   2 , Lisa Spalding  3 , Hilary Martin  1   2 , Ellie Darcey  2 , Jennifer Stone  2 , Andrew Redfern  1   2   3
Affiliations

Correlations Between Mammographic Breast Density and Outcomes After Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer

Veenoo Agarwal et al. Cancers (Basel). .

Abstract

Introduction: An inverse association between high mammographic breast density (MBD) and pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC) for early breast cancer (EBC) has been reported. However, the relationship of MBD to relapse-free (RFS) and breast cancer-specific survival (BCSS) is unexplored. This study aims to validate the relationship between MBD and NAC pCR in EBC and to assess correlations with RFS and BCSS.

Materials & methods: MBD was measured on contralateral mammograms in 127 women before NAC using Cumulus software. The percent dense area was correlated with patient and tumour characteristics, pCR, RFS and BCSS.

Results: Mean MBD was higher in relapsing patients (p = 0.041) but did not vary by pCR or BC-deaths. As a dichotomous variable, no difference was seen between high and low MBD cohorts for pCR (17.5 vs. 25.0%, p = 0.15), BC relapse (38 vs. 30%, p = 0.15) or BC death (32 vs. 25%, p = 0.20). A planned analysis by body mass index (BMI) demonstrated high MBD associated with lower pCR (0% vs. 28.1%, p = 0.036) and trends for higher relapse (56% vs. 28%, p = 0.063) and BC deaths (56 vs. 28%, (p = 0.071)) in obese patients. No relationship was observed in non-obese patients.

Conclusions: Obesity and high MBD may interact to cause chemoresistance. Further research in these patients is warranted.

Keywords: breast cancer; mammographic density; pathological response.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Patient CONSORT diagram.
Figure 2
Figure 2
Relationship between percentage mammographic breast density and clinical complete response, pathological complete response, breast cancer relapse and breast cancer death. X denotes mean density for a cohort.
Figure 3
Figure 3
Kaplan–Meier curves for relationship between MBD and (a) relapse-free survival or (b) breast cancer-specific survival.
Figure 4
Figure 4
Interaction of body mass index with mammographic percent dense area as continuous variables.
Figure 5
Figure 5
Interaction of mammographic breast density and BMI, demonstrating (a) pCR rates and (b) RFS for cohorts by BMI and breast density category.
See this image and copyright information in PMC

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