Chemoprevention of breast cancer has the potential of a bright future in menopausal medicine. However, before chemoprevention can be implemented effectively, better methods for the reliable prediction of breast cancer are needed. Three major strategies for early prediction or risk assessment of breast cancer have been established. Next to the algorithm of epidemiological factors, as given by the Gail criteria, rank the assessment of the endocrine environment, mainly the circulating sex steroids, and mammographic density of the breast. The latter has been shown to provide an independent prediction of the breast cancer risk, although the link between enhanced mammographic density and the cellular and molecular pathways leading to breast cancer has not yet been elucidated.
Checka and co-workers  now present a retrospective analysis of a large cohort of more than 7000 women, in which the relationship between mammographic density, as given by the BI-RADS density categories, and age is analyzed. BI-RADS is the acronym for Breast Imaging-Reporting and Data System and was defined and published by the American College of Radiology. The BI-RADS assessment system consists of seven categories, but only those ranking from 1 to 4 can be used for the prediction of breast cancer risk, as they classify mammographic density differences from negative to suspicious. The median age of the cohort was 57 years. There was a significant inverse relationship between age and breast density ([i]p[/i] < 0.001). Seventy-four percent of the patients between 40 and 49 years of age had increased mammographic density. This percentage decreased to 57% among women in their fifties. However, 44% of women in their sixties and 36% of women in their seventies still had increased mammographic density. The results of the retrospective analysis of a large number of mammograms clearly demonstrate the age-dependent decrease of the incidence of the higher ranking categories of mammographic density with rising age. Despite this, a significant number of women, varying between 4 and 30% at different ages, still present with a mammographic density categorized at the fourth level indicating a suspicious abnormality requiring biopsy.
Christian De Geyter
Division Chief and Research Group Leader, Gynecological Endocrinology and Reproductive Medicine, University of Basel, Switzerland
Checka CM, Chun JE, Schnabel FR, Lee J, Toth H. The relationship of mammographic density and age: implications for breast cancer screening. AJR 2012;198:W292-5.