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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1998 Apr;52(4):267–271. doi: 10.1136/jech.52.4.267

Effect of mammographic breast density on breast cancer screening performance: a study in Nijmegen, The Netherlands

C H van Gils, J D Otten, A L Verbeek, J H Hendriks, R Holland
PMCID: PMC1756693  PMID: 9616416

Abstract

STUDY OBJECTIVE: To study the implications of breast density on mammographic screening performance. DESIGN: Screening outcomes of women with dense breast patterns were compared with those of women with lucent breast patterns (dense > 25% densities, lucent < or = 25% densities); the women were screened in different periods (before/after improvement of the mammographic technique in 1982). SETTING: Nijmegen, the Netherlands, 1977-1994. PARTICIPANTS: Between 1977 and 1994, 73,525 repeat screenings were performed in 19,152 participants (aged 50-69 years) in the Nijmegen breast cancer screening programme (repeat screenings were defined as mammographic examinations that were preceded by an examination in the previous screening round). Participants were screened biennially with mammography. There were 258 screen detected and 145 interval cancers. MAIN RESULTS: Before 1982 (rounds 2-4) the predictive value of a positive screening test (PV+) was lower in women with dense breasts than in those with lucent breasts (dense 29% v lucent 52%, p = 0.003). Also, the ratio of screen detected cancers to the total number of screen detected plus interval cancers (as a proxy for sensitivity) was lower in this group (based on a one year interval: dense 63% v lucent 92%, p = 0.001 and based on a two year interval: dense 41% v lucent 68%, p = 0.002). Moreover, the survival rate was less favourable for those with dense breasts (p = 0.07). In rounds 5- 10, there were no important differences with respect to PV+ (dense 66% v lucent 62%, p = 0.57) or survival (p = 0.48). Moreover, sensitivity based on a one year interval was nearly as high in women with dense breasts as in those with lucent breasts (85% v 86%, p = 0.75). However, based on a two year interval sensitivity was lower (dense 59% v lucent 72%, p = 0.04). CONCLUSIONS: In the early screening years (rounds 2-4) high breast density had an unfavourable effect on screening performance. Nowadays, the situation has improved with respect to PV+, survival and detecting tumours in dense breasts with a lead time of up to one year, but little improvement has occurred in the detection of tumours with a lead time greater than one year.

 

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Selected References

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  1. Andersson I., Aspegren K., Janzon L., Landberg T., Lindholm K., Linell F., Ljungberg O., Ranstam J., Sigfússon B. Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial. BMJ. 1988 Oct 15;297(6654):943–948. doi: 10.1136/bmj.297.6654.943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Baines C. J., Miller A. B., Kopans D. B., Moskowitz M., Sanders D. E., Sickles E. A., To T., Wall C. Canadian National Breast Screening Study: assessment of technical quality by external review. AJR Am J Roentgenol. 1990 Oct;155(4):743–749. doi: 10.2214/ajr.155.4.2119103. [DOI] [PubMed] [Google Scholar]
  3. Bird R. E., Wallace T. W., Yankaskas B. C. Analysis of cancers missed at screening mammography. Radiology. 1992 Sep;184(3):613–617. doi: 10.1148/radiology.184.3.1509041. [DOI] [PubMed] [Google Scholar]
  4. Ciatto S., Zappa M. A prospective study of the value of mammographic patterns as indicators of breast cancer risk in a screening experience. Eur J Radiol. 1993 Sep;17(2):122–125. doi: 10.1016/0720-048x(93)90048-r. [DOI] [PubMed] [Google Scholar]
  5. Fajardo L. L., Hillman B. J., Frey C. Correlation between breast parenchymal patterns and mammographers' certainty of diagnosis. Invest Radiol. 1988 Jul;23(7):505–508. doi: 10.1097/00004424-198807000-00004. [DOI] [PubMed] [Google Scholar]
  6. Feig S. A., Shaber G. S., Patchefsky A., Schwartz G. F., Edeiken J., Libshitz H. I., Nerlinger R., Curley R. F., Wallace J. D. Analysis of clinically occult and mammographically occult breast tumors. AJR Am J Roentgenol. 1977 Mar;128(3):403–408. doi: 10.2214/ajr.128.3.403. [DOI] [PubMed] [Google Scholar]
  7. Frisell J., Eklund G., Hellström L., Lidbrink E., Rutqvist L. E., Somell A. Randomized study of mammography screening--preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat. 1991 Mar;18(1):49–56. doi: 10.1007/BF01975443. [DOI] [PubMed] [Google Scholar]
  8. Hislop T. G., Burhenne L. J., Basco V. E., Ng V. T. The Screening Mammography Program of British Columbia: pilot study. Can J Public Health. 1991 May-Jun;82(3):168–173. [PubMed] [Google Scholar]
  9. Holland R., Hendriks J. H., Mravunac M. Mammographically occult breast cancer. A pathologic and radiologic study. Cancer. 1983 Nov 15;52(10):1810–1819. doi: 10.1002/1097-0142(19831115)52:10<1810::aid-cncr2820521009>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  10. Jackson V. P., Hendrick R. E., Feig S. A., Kopans D. B. Imaging of the radiographically dense breast. Radiology. 1993 Aug;188(2):297–301. doi: 10.1148/radiology.188.2.8327668. [DOI] [PubMed] [Google Scholar]
  11. Kerlikowske K., Grady D., Barclay J., Sickles E. A., Ernster V. Effect of age, breast density, and family history on the sensitivity of first screening mammography. JAMA. 1996 Jul 3;276(1):33–38. [PubMed] [Google Scholar]
  12. Kerlikowske K., Grady D., Rubin S. M., Sandrock C., Ernster V. L. Efficacy of screening mammography. A meta-analysis. JAMA. 1995 Jan 11;273(2):149–154. [PubMed] [Google Scholar]
  13. Lundgren B. The oblique view of mammography. Br J Radiol. 1977 Sep;50(597):626–628. doi: 10.1259/0007-1285-50-597-626. [DOI] [PubMed] [Google Scholar]
  14. Miller W. R., Ellis I. O., Sainsbury J. R., Dixon J. M. ABC of breast diseases. Prognostic factors. BMJ. 1994 Dec 10;309(6968):1573–1576. doi: 10.1136/bmj.309.6968.1573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Otten J. D., van Dijck J. A., Peer P. G., Straatman H., Verbeek A. L., Mravunac M., Hendriks J. H., Holland R. Long term breast cancer screening in Nijmegen, The Netherlands: the nine rounds from 1975-92. J Epidemiol Community Health. 1996 Jun;50(3):353–358. doi: 10.1136/jech.50.3.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Peer P. G., Verbeek A. L., Mravunac M., Hendriks J. H., Holland R. Prognosis of younger and older patients with early breast cancer. Br J Cancer. 1996 Feb;73(3):382–385. doi: 10.1038/bjc.1996.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Peeters P. H., Verbeek A. L., Hendriks J. H., Holland R., Mravunac M. The predictive value of positive test results in screening for breast cancer by mammography in the Nijmegen programme. Br J Cancer. 1987 Nov;56(5):667–671. doi: 10.1038/bjc.1987.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Roberts M. M., Alexander F. E., Anderson T. J., Chetty U., Donnan P. T., Forrest P., Hepburn W., Huggins A., Kirkpatrick A. E., Lamb J. Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet. 1990 Feb 3;335(8684):241–246. doi: 10.1016/0140-6736(90)90066-e. [DOI] [PubMed] [Google Scholar]
  19. Saftlas A. F., Szklo M. Mammographic parenchymal patterns and breast cancer risk. Epidemiol Rev. 1987;9:146–174. doi: 10.1093/oxfordjournals.epirev.a036300. [DOI] [PubMed] [Google Scholar]
  20. Tabàr L., Fagerberg G., Duffy S. W., Day N. E., Gad A., Gröntoft O. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am. 1992 Jan;30(1):187–210. [PubMed] [Google Scholar]
  21. Weaver M. Breast cancer in nonpalpable lesions: can mammographic parenchymal pattern improve the predictive value of biopsy? Am Surg. 1992 Nov;58(11):692–694. [PubMed] [Google Scholar]
  22. Whitehead J., Cooper J. Risk factors for breast cancer by mode of diagnosis: some results from a breast cancer screening study. J Epidemiol Community Health. 1989 Jun;43(2):115–120. doi: 10.1136/jech.43.2.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. van Gils C. H., Otten J. D., Verbeek A. L., Hendriks J. H. Short communication: breast parenchymal patterns and their changes with age. Br J Radiol. 1995 Oct;68(814):1133–1135. doi: 10.1259/0007-1285-68-814-1133. [DOI] [PubMed] [Google Scholar]

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