Addition of breast density to Tyrer-Cuzick influences risk assessment
Dr Stamatia Destounis of Elizabeth Wende Breast Care in Rochester, NY, discussed the results she and her team found by adding volumetric breast density and BI-RADS to the list of factors in the Tyrer-Cuzick version 8 model.
Breast density is linked to a higher risk of cancer, due not only to its strength as a risk factor, but also to its prevalence in women. It is now included in several risk assessment models and may improve risk stratification, investigators wrote. The Tyrer-Cuzick model is one of the most widely used to assess breast cancer risk. Although the latest version includes breast density as a risk factor, it does not provide guidance on using volumetric breast density percentage or BI-RADS to measure breast density, according to Destounis.
She and her team set out to study the impact of mammographic density measurements on clinically actionable breast cancer risk estimates reported by the Tyrer-Cuzick model. The group conducted a study that included data from 59,257 women who underwent risk assessments using Tyrer-Cuzick version 7 at the time of screening between July 2019 and January 2020. Investigators also considered percent volumetric breast density and BI-RADS using version 8 of the Tyrer-Cuzick Model. The study participants had an average age of 59 years, an average body mass index of 29.9, and an average breast volume density of 8.4%. Postmenopausal women made up the bulk of the study group (67.9%).
Destounis and colleagues found that compared to the 8.3% of women classified as high risk using the version 7 model without density entry, there was a significantly higher proportion of high risk women during the use of version 8 with volumetric breast density (11.4%). However, they also found a significantly lower proportion of women at high risk when using version 8 with BI-RADS (6.9%).
Research presented at RSNA shows that adding breast density to version 8 of the Tyrer-Cuzick model impacts breast cancer risk in younger premenopausal women. The graphic above shows how the odds ratios are affected by the addition of volumetric breast density and BI-RADS to version 8 compared to version 7 of the model, which had no breast density entry. Image courtesy of Dr Stamatia Destounis.
Women under 55 had an odds ratio of 2.8 when using volumetric breast density and 3.5 with BI-RADS (p
Of the 896 women (1.5%) who became at low risk by adding density to the risk assessment tool using volumetric breast density, the researchers found 144 with a family history of a parent at first degree with breast cancer under 45 years old. or at intermediate risk with version 8, 36% had dense breasts.
“Clinics wishing to establish high-risk screening programs should understand that different mammographic density measurements incorporated into risk models may have a different impact on patient management,” concluded Destounis and colleagues.
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