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.