Applications of Mammographic Density Measurements

In general, factors that allow the identification of women at increased risk have important applications in both clinical and research aspects of the disease. Because it is a strong risk factor that is present in a large proportion of breast cancer cases, this is particularly true of mammographic density. Additional applications arise from the potential to modify a factor that is so strongly associated with the disease.

It is important to remember that risk factors are derived based on populations. Not all women with a particular risk factor for breast cancer will develop the disease, nor will all women without the factor be free of the disease. The data of Table 1 suggest that women with extensive density are more likely to develop breast cancer relative to women with an absence of density. There are, however, women without density who develop breast cancer, and women with extensive density who do not. For an individual woman, risk factor information should be considered only as a guide. With factors over which the individual has some control, e.g., environmental exposures or lifestyle choices, this information may provide insight as to how risk might be reduced.

Women identified to be at increased risk for breast cancer may benefit from being followed more closely in screening programs and this may also make more effective use of resources. Some women without mammographic density will develop breast cancer. This fact suggests that, regardless of mammographic density, all women within recommended age groups should be screened at least on some regular interval. Mammographic density may have a role in the determination of that interval for different risk groups.

Information on mammographic density may be most useful in the research of breast cancer. In particular, women at increased risk for the disease are good subjects in whom to study its causes. The strong relationship between mammo-graphic density and breast cancer risk suggests that the causes of breast cancer may be better understood by finding the factors that are associated with mammographically dense tissue and how that tissue changes. As a strong risk predictor for breast cancer that is potentially modifiable, mammographic density may also be a good target for the development and monitoring of potential preventive strategies. For example, changes that occur in mammographic density may be an important interim observation with manipulation of hormones [17], tamoxifen [49], or a dietary intervention [50].

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