Exploring Imaging Biomarkers to Improve Equity in Supplemental and High-Risk Breast Cancer Screening Between Black and White Women: A Perspective on Background Parenchymal Enhancement and Breast Density

Abstract

Purpose: Breast density is recognized as a well-established risk factor for breast cancer, influencing screening recommendations. While quantitative measures of breast density have been developed to address limitations of qualitative measures, the role of racial differences in quantitative measures and their effect on breast cancer risk, especially in Black women, remains unclear. Additionally, while background parenchymal enhancement (BPE) is an established as a predictor of breast cancer risk, no research has been conducted to investigate whether the impact of BPE varies by race or ethnicity. This perspective reviews existing data on BPE, specifically its relationship with breast density and breast cancer risk and emphasizes the need for further investigation in Black women.

Discussion: Current supplemental screening methods are heavily reliant on qualitative breast density assessments, which may disadvantage Black women. Although BPE has been significantly associated with breast cancer risk independent of breast density, no studies were found that explored the relationship between BPE and breast cancer risk in Black women.

Conclusion: The limited data on absolute quantitative density measures, such as dense volume, which could improve screening practices, is highlighted in this review. While BPE is well-established as a breast cancer risk factor, further research is needed to investigate racial differences in BPE and its association with breast cancer risk, particularly among Black women.

Keywords: BPE; Breast; Racial disparities; Review; Risk prediction.