Effect of Background Parenchymal Enhancement on Cancer Risk Across Different High-Risk Patient Populations Undergoing Screening Breast MRI

PURPOSE To evaluate comparative associations of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and mammographic breast density with subsequent breast cancer risk. PATIENTS AND METHODS We examined women undergoing breast MRI in the Breast Cancer Surveillance Consortium from 2005 to 2015 (with one exam in 2000) using qualitative BPE assessments of minimal, mild, moderate, or marked. Breast density was assessed on mammography performed within 5 years of MRI. Among women diagnosed with breast cancer, the first BPE assessment was included if it was more than 3 months before their first diagnosis. Breast cancer risk associated with BPE was estimated using Cox proportional hazards regression. RESULTS Among 4,247 women, 176 developed breast cancer (invasive, n = 129; ductal carcinoma in situ,n = 47) over a median follow-up time of 2.8 years. More women with cancer had mild, moderate, or marked BPE than women without cancer (80% v 66%, respectively). Compared with minimal BPE, increasing BPE levels were associated with significantly increased cancer risk (mild: hazard ratio [HR], 1.80; 95% CI, 1.12 to 2.87; moderate: HR, 2.42; 95% CI, 1.51 to 3.86; and marked: HR, 3.41; 95% CI, 2.05 to 5.66). Compared with women with minimal BPE and almost entirely fatty or scattered fibroglandular breast density, women with mild, moderate, or marked BPE demonstrated elevated cancer risk if they had almost entirely fatty or scattered fibroglandular breast density (HR, 2.30; 95% CI, 1.19 to 4.46) or heterogeneous or extremely dense breasts (HR, 2.61; 95% CI, 1.44 to 4.72), with no significant interaction ( P = .82). Combined mild, moderate, and marked BPE demonstrated significantly increased risk of invasive cancer (HR, 2.73; 95% CI, 1.66 to 4.49) but not ductal carcinoma in situ (HR, 1.48; 95% CI, 0.72 to 3.05). CONCLUSION BPE is associated with future invasive breast cancer risk independent of breast density. BPE should be considered for risk prediction models for women undergoing breast MRI.

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Background parenchymal enhancement and fibroglandular tissue on breast MRI in women with high genetic risk: Are changes before and after risk-reducing salpingo-oophorectomy associated with breast cancer risk?

European Journal of Radiology ◽

10.1016/j.ejrad.2018.10.030 ◽

2018 ◽

Vol 109 ◽

pp. 171-177 ◽

Cited By ~ 2

Author(s):

Cécile Bermot ◽

Caroline Saint-Martin ◽

Caroline Malhaire ◽

Delphine Sebbag-Sfez ◽

Emmanuelle Mouret-Fourme ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Genetic Risk ◽

Breast Mri ◽

High Genetic Risk ◽

Background Parenchymal Enhancement ◽

Before And After ◽

Risk Reducing ◽

Parenchymal Enhancement

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Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk

Academic Radiology ◽

10.1016/j.acra.2018.03.013 ◽

2019 ◽

Vol 26 (1) ◽

pp. 69-75 ◽

Cited By ~ 18

Author(s):

Lars J. Grimm ◽

Ashirbani Saha ◽

Sujata V. Ghate ◽

Connie Kim ◽

Mary Scott Soo ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Risk Screening ◽

Background Parenchymal Enhancement ◽

Parenchymal Enhancement ◽

High Risk Screening

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Short breast MRI screening trial in women at high-risk for breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e13049 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e13049-e13049 ◽

Cited By ~ 2

Author(s):

Marion Scoggins ◽

Basak Dogan ◽

Jingfei Ma ◽

Wei Wei ◽

Jong Bum Song ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Primary Endpoint ◽

Hormone Replacement ◽

High Risk Patient ◽

Breast Mri ◽

Acquisition Time ◽

Informed Consent Form

e13049 Background: The American Cancer Society (ACS) recommends yearly breast MRI (BMRI) in addition to mammography for women with high breast cancer risk. However, standard BMRI protocols have a long acquisition time and consequently long interpretation time, which can reduce patient compliance and drive MRI cost. Therefore, we aimed to evaluate an American College of Radiology (ACR)-compliant short BMRI (SBMRI) protocol vis-à-vis compared with standard of care BMRI (SOC-BMRI) obtained in the same high-risk patient. To the best of our knowledge, a prospective study comparing both techniques does not exist. Our primary endpoint is to compare positive predictive value and cancer detection rate. Secondary endpoint is measuring and comparing patient experience between two techniques. As the study and accrual is ongoing and primary endpoint will be evaluated at the completion of accrual in a blinded fashion, here we report characteristics of patients who participated so far. Methods: This is a prospective HIPAA compliant and IRB approved trial. High risk women undergoing SOC-BMRI based on ACS screening guidelines signed an informed consent form to undergo an additional SBMRI within 7 days of the SOC-BMRI. Accrual target goal is 200 patients to give statistical power to estimate sensitivity and 95% confidence interval, with 10% or less expected to have breast cancer. Results: A total of 59 women were enrolled so far. Median age is 53 (range 26-72). Nine (15.3%) had BRCA1 or BRCA2 pathogenic mutations; 6 (10.2%) variant of uncertain significance (VUS). One (1.7%) had CDH1 pathogenic mutation, one (1.7%) had VUS in PALB2. Personal history of breast cancer was present in 2 (3.4%), atypical hyperplasia in 9 (15.3%), LCIS in 3 (5.1%), family history (FH) of breast cancer in 55 (93.2%). Hormone replacement therapy use was current in 2 (3.4%), past in 10 (16.9%). Use of raloxifene, tamoxifen, or aromatase inhibitors was current in 8 (13.6%), past in 5 (8.5%). Conclusions: In this BMRI study comparing SOC-BMRI versus SBMRI, the distribution of breast cancer risk factors reflects our routine cohort, with most patients screened based on FH of breast cancer. Clinical trial information: Primary ID 2015-0243 Secondary IDs NCI-2015-02031 Clinicaltrials.gov ID NCT02590458.

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Qualitative Assessments of Density and Background Parenchymal Enhancement on Contrast-Enhanced Spectral Mammography Associated with Breast Cancer Risk of High-Risk Women

10.21203/rs.3.rs-36421/v1 ◽

2020 ◽

Author(s):

Ning Mao ◽

Ping Yin ◽

Fan Lin ◽

Zhongyi Wang ◽

Ping Yang ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Breast Cancer Risk ◽

Cancer Risk ◽

High Risk Women ◽

Background Parenchymal Enhancement ◽

Contrast Enhanced ◽

History Of ◽

Parenchymal Enhancement

Abstract Background: To investigate the correlation between the risk of developing breast cancer for high-risk women and the density and background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM).Methods: This retrospective study was approved by the Institutional Review Board of our hospital. Women at high risk, without breast cancer history and received CESM examination from July 2016 to December 2017 were retrospectively enrolled. Patients who developed breast cancer after CESM examination were classified as cancer cohorts, and women who did not develop breast cancer with maximized follow-up time were categorized as control cohorts. These two cohorts were one-to-one matched in age, family and/or genetic history of breast cancer, and BRCA status. The density and amount of BPE at CESM imaging were assessed. Conditional logistic regression was applied to evaluate the relationship between imaging features and breast cancer risk. Results: During the follow-up interval, 90 women at high risk with no history of breast cancer were diagnosed with breast cancer (invasive, n = 46; in situ, n = 44). During follow-up, women with mild, moderate or significant BPE were seven times more likely to be diagnosed with breast cancer than women with minimal BPE [P = 0.005; odds ratio (OR) = 7.0; 95% confidence interval(CI): 1.1-71.1]. Breast density was not significantly different between the two cohorts (P = 0.5). Conclusions: Increased BPE levels increase the risk of breast cancer among high-risk women.

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Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications

Current Radiology Reports ◽

10.1007/s40134-021-00386-2 ◽

2021 ◽

Vol 9 (10) ◽

Author(s):

James S. Chalfant ◽

Shabnam Mortazavi ◽

Stephanie A. Lee-Felker

Keyword(s):

Breast Cancer ◽

Clinical Practice ◽

Breast Cancer Risk ◽

Neoadjuvant Chemotherapy ◽

Cancer Risk ◽

Quantitative Assessment ◽

Breast Mri ◽

Clinical Implications ◽

Background Parenchymal Enhancement ◽

Parenchymal Enhancement

Abstract Purpose of Review To present recent literature regarding the assessment and clinical implications of background parenchymal enhancement on breast MRI. Recent Findings The qualitative assessment of BPE remains variable within the literature, as well as in clinical practice. Several different quantitative approaches have been investigated in recent years, most commonly region of interest-based and segmentation-based assessments. However, quantitative assessment has not become standard in clinical practice to date. Numerous studies have demonstrated a clear association between higher BPE and future breast cancer risk. While higher BPE does not appear to significantly impact cancer detection, it may result in a higher abnormal interpretation rate. BPE is also likely a marker of pathologic complete response after neoadjuvant chemotherapy, with decreases in BPE during and after neoadjuvant chemotherapy correlated with pCR. In contrast, pre-treatment BPE does not appear to be predictive of pCR. The association between BPE and prognosis is less clear, with heterogeneous results in the literature. Summary Assessment of BPE continues to evolve, with heterogeneity in approaches to both qualitative and quantitative assessment. The level of BPE has important clinical implications, with associations with future breast cancer risk and treatment response. BPE may also be an imaging marker of prognosis, but future research is needed on this topic.

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