Background: Given that breast cancer and normal dense fibroglandular tissue have similar radiographic\nattenuation, we examine whether automated volumetric density measures identify a differential change between\nbreasts in women with cancer and compare to healthy controls.\nMethods: Eligible cases (n = 1160) had unilateral invasive breast cancer and bilateral full-field digital mammograms\n(FFDMs) at two time points: within 2 months and 1-5 years before diagnosis. Controls (n = 2360) were matched to\ncases on age and date of FFDMs. Dense volume (DV) and volumetric percent density (VPD) for each breast were\nassessed using Volparaâ?¢. Differences in DV and VPD between mammograms (median 3 years apart) were calculated\nper breast separately for cases and controls and their difference evaluated by using the Wilcoxon signed-rank test.\nTo simulate clinical practice where cancer laterality is unknown, we examined whether the absolute difference\nbetween breasts can discriminate cases from controls using area under the ROC curve (AUC) analysis, adjusting for\nage, BMI, and time.\nResults: Among cases, the VPD and DV between mammograms of the cancerous breast decreased to a lesser\ndegree (- 0.26% and - 2.10 cm3) than the normal breast (- 0.39% and - 2.74 cm3) for a difference of 0.13% (p value\n< 0.001) and 0.63 cm3 (p = 0.002), respectively. Among controls, the differences between breasts were nearly\nidentical for VPD (- 0.02 [p = 0.92]) and DV (0.05 [p = 0.77]). The AUC for discriminating cases from controls using\nabsolute difference between breasts was 0.54 (95% CI 0.52, 0.56) for VPD and 0.56 (95% CI, 0.54, 0.58) for DV.\nConclusion: There is a small relative increase in volumetric density measures over time in the breast with cancer\nwhich is not found in the normal breast. However, the magnitude of this difference is small, and this measure alone\ndoes not appear to be a good discriminator between women with and without breast cancer.
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