European Radiology

, Volume 25, Issue 7, pp 1875–1882 | Cite as

Very low mammographic breast density predicts poorer outcome in patients with invasive breast cancer

  • Amro MasarwahEmail author
  • Päivi Auvinen
  • Mazen Sudah
  • Suvi Rautiainen
  • Anna Sutela
  • Outi Pelkonen
  • Sanna Oikari
  • Veli-Matti Kosma
  • Ritva Vanninen



To examine the prognostic value of mammographic breast density (MBD) and mammographic features and their relationship with established prognostic factors in patients with invasive breast cancer.


Mammographic characteristics of 270 patients were analyzed. MBD was classified according to percentile density (<5 %, 5-10 %, 10-25 %, 25-50 %, 50-75 %, >75 %) and further categorized into very low density (VLD; <10 %), low density (LOD; <25 %) and mixed density (MID; >25 %). Mammographic features were compared with established prognostic factors and patient outcomes while correcting for possible confounders.


MBD was inversely associated with tumour grade (p = 0.019). Patients with LOD breasts had worse prognoses compared to those with MID breasts (disease-free survival 74.7 % vs. 84.8 %, p = 0.048; overall survival 75.3 % vs. 90.2 %, p = 0.003). Patients with VLD breasts showed the strongest significance compared to the remaining patients, even after adjusting for age, body mass index, and menopausal status. No other mammographic feature was prognostically significant. In Cox regression analysis, VLD proved to be an independent, poor prognostic feature (hazard ratio = 3.275; p < 0.001).


In patients with newly diagnosed breast cancer, very low MBD proved to be an independent prognostic feature, associated with higher tumour grade and predicted worse survival even after correcting for possible confounders.

Key Points

Percentile mammographic breast density was associated with patient prognosis.

Very low density proved to be an independent poor prognostic factor.

Only patients with densities <10 % displayed this difference in survival.

Mammographic breast density was inversely associated with histological tumour grade.


Breast Cancer Breast neoplasms Mammographic density Prognosis 

Abbreviations and acronyms


Mammographic breast density


Low density


Very low density


Mixed density


Hazard ratio


Body mass index


Human epidermal growth factor receptor 2


Breast Imaging-Reporting and Data System



The scientific guarantor of this publication is Professor Ritva Vanninen. This work was supported in part by the Kuopio University Hospital EVO funding (grant nos. 5063525, 5063532), the Cancer Center of the University of Eastern Finland, the Cancer Foundation of Finland, the University of Kuopio Foundation and by a grant from Mauri and Sirkka Wiljasalo in 2014. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Tuomas Selander kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, performed at one institution. This manuscript was presented at the European Congress of Radiology (ECR) in 2014.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Amro Masarwah
    • 1
    Email author
  • Päivi Auvinen
    • 2
  • Mazen Sudah
    • 1
  • Suvi Rautiainen
    • 1
    • 6
  • Anna Sutela
    • 1
  • Outi Pelkonen
    • 1
  • Sanna Oikari
    • 4
  • Veli-Matti Kosma
    • 3
    • 5
    • 6
  • Ritva Vanninen
    • 1
    • 6
  1. 1.Department of Clinical RadiologyKuopio University HospitalKuopioFinland
  2. 2.Department of OncologyKuopio University HospitalKuopioFinland
  3. 3.Department of Clinical PathologyKuopio University HospitalKuopioFinland
  4. 4.Institute of BiomedicineUniversity of Eastern FinlandKuopioFinland
  5. 5.Institute of Clinical Medicine, Pathology and Forensic MedicineUniversity of Eastern FinlandKuopioFinland
  6. 6.Biocenter Kuopio and Cancer Center of Eastern FinlandUniversity of Eastern FinlandKuopioFinland

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