title: Volumetric breast density affects performance of digital screening mammography.
abstract: To determine to what extent automatically measured volumetric mammographic density influences screening performance when using digital mammography (DM).
  
  
  
  We collected a consecutive series of 111,898 DM examinations (2003-2011) from one screening unit of the Dutch biennial screening program (age 50-75 years). Volumetric mammographic density was automatically assessed using Volpara. We determined screening performance measures for four density categories comparable to the American College of Radiology (ACR) breast density categories.
  
  
  
  Of all the examinations, 21.6% were categorized as density category 1 ('almost entirely fatty') and 41.5, 28.9, and 8.0% as category 2-4 ('extremely dense'), respectively. We identified 667 screen-detected and 234 interval cancers. Interval cancer rates were 0.7, 1.9, 2.9, and 4.4‰ and false positive rates were 11.2, 15.1, 18.2, and 23.8‰ for categories 1-4, respectively (both p-trend < 0.001). The screening sensitivity, calculated as the proportion of screen-detected among the total of screen-detected and interval tumors, was lower in higher density categories: 85.7, 77.6, 69.5, and 61.0% for categories 1-4, respectively (p-trend < 0.001).
  
  
  
  Volumetric mammographic density, automatically measured on digital mammograms, impacts screening performance measures along the same patterns as established with ACR breast density categories. Since measuring breast density fully automatically has much higher reproducibility than visual assessment, this automatic method could help with implementing density-based supplemental screening.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Johanna O P
authors.initials: JO
authors.lastname: Wanders
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Katharina
authors.initials: K
authors.lastname: Holland
authors.affiliation: Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Wouter B
authors.initials: WB
authors.lastname: Veldhuis
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Ritse M
authors.initials: RM
authors.lastname: Mann
authors.affiliation: Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.|Dutch Reference Centre for Screening, Postbus 6873, 6503 GJ, Nijmegen, The Netherlands.
authors.forename: Ruud M
authors.initials: RM
authors.lastname: Pijnappel
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.|MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, St. Mary's Campus, Norfolk Place W2 1PG, London, UK.
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. C.vanGils@umcutrecht.nl.
authors.forename: Carla H
authors.initials: CH
authors.lastname: van Gils
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: Karssemeijer
mesh_terms: D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008327:Mammography / Q000379:methods / Q000592:standards; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D015203:Reproducibility of Results
keywords: Breast; Breast cancer; Cancer screening; Mammographic density; Mammography