title: AutoDensity: an automated method to measure mammographic breast density that predicts breast cancer risk and screening outcomes.
abstract: BACKGROUND
  While Cumulus - a semi-automated method for measuring breast density - is utilised extensively in research, it is labour-intensive and unsuitable for screening programmes that require an efficient and valid measure on which to base screening recommendations. We develop an automated method to measure breast density (AutoDensity) and compare it to Cumulus in terms of association with breast cancer risk and breast cancer screening outcomes.
  
  
  METHODS
  AutoDensity automatically identifies the breast area in the mammogram and classifies breast density in a similar way to Cumulus, through a fast, stand-alone Windows or Linux program. Our sample comprised 985 women with screen-detected cancers, 367 women with interval cancers and 4,975 controls (women who did not have cancer), sampled from first and subsequent screening rounds of a film mammography screening programme. To test the validity of AutoDensity, we compared the effect estimates using AutoDensity with those using Cumulus from logistic regression models that tested the association between breast density and breast cancer risk, risk of small and large screen-detected cancers and interval cancers, and screening programme sensitivity (the proportion of cancers that are screen-detected). As a secondary analysis, we report on correlation between AutoDensity and Cumulus measures.
  
  
  RESULTS
  AutoDensity performed similarly to Cumulus in all associations tested. For example, using AutoDensity, the odds ratios for women in the highest decile of breast density compared to women in the lowest quintile for invasive breast cancer, interval cancers, large and small screen-detected cancers were 3.2 (95% CI 2.5 to 4.1), 4.7 (95% CI 3.0 to 7.4), 6.4 (95% CI 3.7 to 11.1) and 2.2 (95% CI 1.6 to 3.0) respectively. For Cumulus the corresponding odds ratios were: 2.4 (95% CI 1.9 to 3.1), 4.1 (95% CI 2.6 to 6.3), 6.6 (95% CI 3.7 to 11.7) and 1.3 (95% CI 0.9 to 1.8). Correlation between Cumulus and AutoDensity measures was 0.63 (P < 0.001).
  
  
  CONCLUSIONS
  Based on the similarity of the effect estimates for AutoDensity and Cumulus inmodels of breast density and breast cancer risk and screening outcomes, we conclude that AutoDensity is a valid automated method for measuring breast density from digitised film mammograms.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Nickson
authors.forename: Yulia
authors.initials: Y
authors.lastname: Arzhaeva
authors.forename: Zoe
authors.initials: Z
authors.lastname: Aitken
authors.forename: Tarek
authors.initials: T
authors.lastname: Elgindy
authors.forename: Mitchell
authors.initials: M
authors.lastname: Buckley
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Dallas R
authors.initials: DR
authors.lastname: English
authors.forename: Anne M
authors.initials: AM
authors.lastname: Kavanagh
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008327:Mammography; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012306:Risk; D012307:Risk Factors
references.citation: Eur J Epidemiol. 1998 Jun;14(4):315-20
references.pmid: 9690746
references.citation: Breast Cancer Res. 2011 Oct 21;13(5):R100
references.pmid: 22017857
references.citation: Breast Cancer Res. 2010;12(6):R97
references.pmid: 21087468
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Dec;19(12):3096-105
references.pmid: 20921336
references.citation: Breast. 2005 Aug;14(4):269-75
references.pmid: 16085233
references.citation: Breast Cancer Res. 2007;9(6):217
references.pmid: 18190724
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Feb;19(2):456-63
references.pmid: 20142244
references.citation: Med Image Comput Comput Assist Interv. 2011;14(Pt 3):562-9
references.pmid: 22003744
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11):3090-7
references.pmid: 18990749
references.citation: J Med Screen. 2009;16(3):140-6
references.pmid: 19805755
references.citation: JAMA. 2012 Apr 4;307(13):1394-404
references.pmid: 22474203
references.citation: Med Phys. 2003 Mar;30(3):352-64
references.pmid: 12674236
references.citation: J Med Screen. 1998;5(4):207-12
references.pmid: 9934652
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Oct;17(10):2818-24
references.pmid: 18843028
references.citation: IEEE Trans Med Imaging. 2001 Aug;20(8):792-803
references.pmid: 11513030
references.citation: BMC Cancer. 2009 Sep 20;9:335
references.pmid: 19765317
references.citation: AJR Am J Roentgenol. 2001 May;176(5):1241-8
references.pmid: 11312188
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2086-92
references.pmid: 17119032
references.citation: N Engl J Med. 2007 Jan 18;356(3):227-36
references.pmid: 17229950
references.citation: Breast Cancer Res Treat. 2012 Apr;132(3):1163-71
references.pmid: 22222356
references.citation: J Natl Cancer Inst. 2000 Jul 5;92(13):1081-7
references.pmid: 10880551
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Jun;15(6):1159-69
references.pmid: 16775176
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Feb;19(2):418-28
references.pmid: 20142240
references.citation: J Natl Cancer Inst. 1992 May 20;84(10):781-5
references.pmid: 1573665
references.citation: Technol Cancer Res Treat. 2005 Apr;4(2):173-82
references.pmid: 15773786
references.citation: Cancer Epidemiol Biomarkers Prev. 2005 May;14(5):1060-4
references.pmid: 15894653
references.citation: Cancer Epidemiol Biomarkers Prev. 2007 Jan;16(1):43-9
references.pmid: 17220330
references.citation: J Epidemiol Community Health. 1998 Apr;52(4):267-71
references.pmid: 9616416
references.citation: Eur J Cancer. 2011 May;47(7):1021-6
references.pmid: 21211962
references.citation: Breast Cancer Res. 2012 Jul 30;14(4):R114
references.pmid: 22846386
references.citation: Eur Radiol. 2000;10(1):157-61
references.pmid: 10663736
references.citation: J Clin Oncol. 2010 Aug 20;28(24):3830-7
references.pmid: 20644098
references.citation: J Natl Cancer Inst. 2012 Jul 3;104(13):1028-37
references.pmid: 22761274
references.citation: Cancer Epidemiol Biomarkers Prev. 2011 Jul;20(7):1473-82
references.pmid: 21610220
references.citation: Semin Ultrasound CT MR. 2000 Aug;21(4):325-36
references.pmid: 11014255
references.citation: Acta Radiol. 2010 Sep;51(7):715-21
references.pmid: 20707656
references.citation: Phys Med Biol. 1994 Oct;39(10):1629-38
references.pmid: 15551535
references.citation: Radiology. 2002 Oct;225(1):165-75
references.pmid: 12355001