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Mammographic density as an image-based biomarker of therapy response in neoadjuvant-treated breast cancer patients

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  • Ida Skarping, Skåne University Hospital, Lund
  • ,
  • Daniel Förnvik, Skåne University Hospital, Lund
  • ,
  • Uffe Heide-Jørgensen
  • Hanna Sartor, Skåne University Hospital, Lund
  • ,
  • Per Hall, Karolinska Institutet, Södersjukhuset
  • ,
  • Sophia Zackrisson, Skåne University Hospital, Lund
  • ,
  • Signe Borgquist

Purpose: Personalized cancer treatment requires predictive biomarkers, including image-based biomarkers. Breast cancer (BC) patients receiving neoadjuvant chemotherapy (NACT) are in a clinically vulnerable situation with the tumor present. This study investigated whether mammographic density (MD), assessed pre-NACT, is predictive of pathological complete response (pCR). Methods: A total of 495 BC patients receiving NACT in Sweden 2005–2019 were included, merged from two different cohorts. Cohort 1 was retrospectively collected (n = 295) and cohort 2 was prospectively collected (n = 200). Mammograms were scored for MD pre-NACT according to the Breast Imaging-Reporting and Data System (BI-RADS), 5th Edition. The association between MD and accomplishing pCR post-NACT was analyzed using logistic regression models—for the whole cohort, stratified by menopausal status, and in different St. Gallen surrogate subtypes. Results: In comparison to patients with low MD (BI-RADS a), the multivariable-adjusted odds ratio (OR) of accomplishing pCR following NACT was on a descending scale: 0.62 (95% confidence interval (CI) 0.24–1.57), 0.38 (95% CI 0.14–1.02), and 0.32 (95% CI 0.09–1.08) for BI-RADS b, c, and d, respectively. For premenopausal patients selectively, the corresponding point estimates were lower, although wider CIs: 0.31 (95% CI 0.06–1.62), 0.24 (95% CI 0.04–1.27), and 0.13 (95% CI 0.02–0.88). Subgroup analyses based on BC subtypes resulted in imprecise estimates, i.e., wide CIs. Conclusions: It seemed as though patients with higher MD at baseline were less likely to reach pCR after NACT—a finding more pronounced in premenopausal women. Larger multicenter studies are needed to enable analyses and interpretation for different BC subtypes.

Original languageEnglish
JournalCancer Causes and Control
Pages (from-to)251-260
Number of pages10
Publication statusPublished - Mar 2021

    Research areas

  • Breast cancer, Breast density, Mammography, Neoadjuvant chemotherapy

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