Mammographic Breast Density: Current Assessment Methods, Clinical Implications, and Future Directions

Assessing the Factors Leading to Missed Breast Cancer Diagnoses in Mammography Among Pakistani Women: A Prospective Cross-Sectional Study

Objective To determine the frequency of false-negative mammograms, and identify the factors contributing to missed breast cancer diagnoses in Pakistani women. Materials and methods This descriptive, prospective cross-sectional study was conducted at a tertiary care hospital from December 15, 2020, to December 10, 2023, including 150 women aged 30 to 60 who underwent bilateral mammography and concurrent breast ultrasound. The study analyzed the frequency and causes of false negatives, categorizing them into patient-related, tumor-related, technical-related, and provider-related factors. Stratification was performed based on age groups and Breast Imaging Reporting and Data System (BI-RADS) scores, and statistical significance was assessed using Chi-square tests. Results The study found a 5.1% frequency of false-negative mammograms. Lesion-related factors were seen in 59 (39.7%) patients; patient-related factors were seen in 40 (26.7%) patients; provider-related factors were seen in 29 (19.3%) patients; and technical-related factors were seen in 22 (26.7%) patients. Conclusion Dense breast tissue significantly contributes to missed breast cancer diagnoses in Pakistani women. While lesion-related, provider-related, and technical-related factors uniformly affect mammography outcomes, addressing patient-specific challenges - particularly in younger women with dense breasts - is crucial. The study suggests incorporating supplementary imaging modalities, like ultrasound, in routine screening for better detection, potentially informing national breast cancer screening guidelines in Pakistan.

Physical Activity and Mammographic Density in Japanese Women

BACKGROUND

Dense breast is one of the strong risk factors for breast cancer among women. While it has been established that physical activity is associated with decreased risk for breast cancer, results have been inconsistent in terms of mammographic density. Thus, we examined physical activity in relation to mammographic density among Japanese women in Tokyo.

METHODS

We used 123,026 records from 33,698 Japanese women without a history of breast cancer who got mammograms at St. Luke's International Hospital in Tokyo, Japan from 2004 to 2019. Mammographic density was classified according to the Breast Imaging Reporting and Data System (BI-RADS), and women self-reported their physical activity level over the past year. ORs were estimated using logistic generalized estimating equations after adjusting for age, body mass index, menopausal status, parity, family history of breast or ovarian cancer, hormone therapy use, smoking status, alcohol consumption, and year.

RESULTS

We observed inverse associations of physical activity with dense breasts. Adjusted ORs were 0.96 (95% confidence interval: 0.91-1.00) for women with physical exercise for 1-2 days per week, 0.94 (0.88-0.99) for those with physical exercise for 3-5 days per week, and 0.91 (0.84-0.99) for those with daily physical exercise when compared with those reported seldom physical exercise.

CONCLUSIONS

Higher levels of physical activity may be associated with decreased mammographic density levels in Japanese women.

IMPACT

Increasing physical activity may serve as a reasonable intervention to reduce mammographic density, and thereby, to mitigate the risk of breast cancer in Asian women.