Details

Autor(en) / Beteiligte

• Posso, Margarita
• Louro, Javier
• Sánchez, Mar
• Román, Marta
• Vidal, Carmen
• Sala, María
• Baré, Marisa
• Castells, Xavier

Titel

Mammographic breast density: How it affects performance indicators in screening programmes?

Ist Teil von

• European journal of radiology, 2019-01, Vol.110, p.81-87

Ort / Verlag

Ireland: Elsevier B.V

Erscheinungsjahr

2019

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• •Screening performance measures are negatively affected by mammographic density.•Digital mammography is not entirely adequate for screening women with dense breasts.•Women 60–69 years with extremely breast dense had the worst performance measures. To investigate how breast density affects screening performance indicators in a digital mammography context. We assessed the effect of breast density over the screen-detected and interval cancers rates, false-positives, specificity, sensitivity, recall rate, positive predictive value of recall (PPV-1), and PPV of invasive tests (PPV-2). Radiologists classified breast density using the BIRADS System. We used generalized estimating equations to account for within-woman correlation by means of the robust Huber-White variance estimator. We included 177,164 women aged 50–69 years who underwent 499,251 digital mammograms from 2004 to 2015 in Spain. According to the fibroglandular tissue percentage, 24.7% of mammograms were classified as BI-RADS 1 (<25% glandular), 54.7% as BI-RADS 2 (25–50% glandular), 14.0% as BI-RADS 3 (51–75% glandular) and 6.6% as BI-RADS 4 (>75% glandular). Overall, women with BI-RADS 3 had the highest screen-detected cancer rate (5.9 per 1000) and BI-RADS 4 the highest interval cancer rate (2.4 per 1000). Sensitivity decreased from 89.2% in women with BI-RADS 1 to 67.9% in BI-RADS 4. Both PPV-1 and PPV-2 decreased from 10.4% to 5.7% and from 49.8% to 32.4% in women with BI-RADS 1 and BI-RADS 4, respectively. Women aged 60–69 years with BI-RADS 4 had the lowest sensitivity (54.9%) and the highest interval cancer rate (3.8 per 1000). Performance screening measures are negatively affected by breast density falling to a lower sensitivity and PPV, and higher interval cancer rate as breast density increases. Particularly women aged 60–69 years with >75% glandular breasts had the worst results and therefore may be candidates for screening using other technologies.