Breast density measured volumetrically in a clinical environment: cross-sectional study with photon counting technology

  • Jean L. BrowneEmail author
  • Lilian Casas
  • Guillermo Santandreu
  • Ignacio Rodriguez
  • Beatriz Navarro
  • Francesc Tresserra
  • M. Angela Pascual



Mammographic breast density (BDen), the ratio of glandular volume (GVol) to breast volume (BVol), is the second most prevalent risk factor for breast cancer (BC). Newly developed photon counting technology allows precise and systematic measurements in clinical practice. Our objective is to see how these parameters change with age in women with and without cancer.

Materials and methods

This retrospective study analyzed results of BDen, GVol, and BVol in 64,182 mammograms performed with photon counting technology on 32,448 consecutive women from April 2014 to December 2015. Only their first study was included. We excluded women with incomplete data or with breast implants.


Mean age of women without BC diagnosed during the study period was 52.1 ± 9.9. BC and was found in 263 women (0.81%). Mean age was 53.0 ± 10.4. BDen, GVol, and BVol were 14%, 24%, and 2% greater in women with BC (P < 0.001 for BDen and GVol and P = 0.02 for BVol). BDen and GVol diminished following similar patterns across age in both groups, with soft slopes before and after a steep drop from 50 to 60, probably due to menopause.


BDen diminishes with age in women with or without BC, but it is generally higher in women with BC. GVol could be a more robust indicator associated with BC risk than BDen. This technology can ease the way to studies of interventions to diminish BDen (or GVol) in the hope of diminishing BC incidence or predict if longitudinal changes are indicative of impending cancer.


Breast density Mammography Volumetric Breast cancer Photon counting technology 



American College of Radiology


Breast cancer


Breast density


Breast imaging reporting and data system


Breast volume




Generalized Additive Model


Glandular volume


Medio-lateral oblique


Non-cancer contralateral breast


Standard deviation





The authors wish to thank Beatriz Viejo PhD. for writing and editorial assistance in the preparation of this manuscript. This study has been carried out under the auspices of the Càtedra d’Investigació en Obstetrícia i Ginecologia of the Autonomous University of Barcelona, Spain.

Author contributions

Study concepts: Jean L. Browne, L Casas, M. Angela Pascual, I. Rodriguez, Santandreu, B. Navarro; F. Tresserra. Study design: Jean L. Browne, L Casas, M. Angela Pascual, I. Rodriguez, Santandreu, B. Navarro; F. Tresserra. Data acquisition: I. Rodriguez; Jean L. Browne. Quality control of data and algorithms: I. Rodriguez. Data analysis and interpretation: Jean L. Browne; I. Rodriguez; M. Angela Pascual. Statistical analysis: I. Rodriguez. Manuscript preparation: Jean L. Browne; M. Angela Pascual; G. Santandreu; B. Navarro; F. Tresserra. Manuscript editing: Jean L. Browne; M. Angela Pascual; G. Santandreu; B. Navarro; L. Casas. Manuscript review: Jean L. Browne; M. Angela Pascual; F. Tresserra.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This manuscript complies with the current laws of the country.

Statement of human rights

All procedures performed in the study were in accordance with the ethical standards of the institutional review board IRB (Càtedra d´Investigació en Obstetricia I Ginecologia, Universitat Autònoma de Barcelona, reference number: 191611092) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics, Gynecology and ReproductionHospital Universitari DexeusBarcelonaSpain
  2. 2.Department of PathologyHospital Universitari DexeusBarcelonaSpain

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