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Mammographic Features and Subsequent Risk of Breast Cancer: A Comparison of Qualitative and Quantitative Evaluations in the Guernsey Prospective Studies

¹ Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine and ² Academic Oncology Unit, Guy's Hospital, London, England; ³ Mecánica Aplicada, Instituto de Ingeniería, Universidad Nacional Autónoma de México, Mexico; and ⁴ Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal

Requests for reprints: Isabel dos Santos Silva, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England. Phone: 44-20-7927-2113; Fax: 44-20-7580-6897. E-mail: isabel.silva{at}lshtm.ac.uk

Mammographic features are known to be associated with breast cancer but the magnitude of the effect differs markedly from study to study. Methods to assess mammographic features range from subjective qualitative classifications to computer-automated quantitative measures. We used data from the UK Guernsey prospective studies to examine the relative value of these methods in predicting breast cancer risk. In all, 3,211 women ages 35 years who had a mammogram taken in 1986 to 1989 were followed-up to the end of October 2003, with 111 developing breast cancer during this period. Mammograms were classified using the subjective qualitative Wolfe classification and several quantitative mammographic features measured using computer-based techniques. Breast cancer risk was positively associated with high-grade Wolfe classification, percent breast density and area of dense tissue, and negatively associated with area of lucent tissue, fractal dimension, and lacunarity. Inclusion of the quantitative measures in the same model identified area of dense tissue and lacunarity as the best predictors of breast cancer, with risk increasing by 59% [95% confidence interval (95% CI), 29-94%] per SD increase in total area of dense tissue but declining by 39% (95% CI, 53-22%) per SD increase in lacunarity, after adjusting for each other and for other confounders. Comparison of models that included both the qualitative Wolfe classification and these two quantitative measures to models that included either the qualitative or the two quantitative variables showed that they all made significant contributions to prediction of breast cancer risk. These findings indicate that breast cancer risk is affected not only by the amount of mammographic density but also by the degree of heterogeneity of the parenchymal pattern and, presumably, by other features captured by the Wolfe classification.

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