The risk model for predicting a woman’s 10-year risk for developing breast cancer is improved with the addition of a patient’s breast density score.
After years of getting annual mammograms, Patti Beyer was told that she had dense breast tissue. Unsure of what to do next, her sister recommended she ask for an ultrasound. Luckily for Patti, her additional screening exam with an Invenia ABUS (automated breast ultrasound) likely saved her life. “If it hadn’t been for ultrasound, my cancer would’ve continued to grow and spread,” Patti said.
Scientists like Dr. Jack Cuzick, a British academic, Director of the Wolfson Institute of Preventive Medicine in London and head of the Centre for Cancer Prevention, are working to take luck out of the equation and empower women and clinicians with a risk assessment tool to personalize screening regimens.
Dr. Cuzick’s work has had a significant influence in personalizing breast care for women with dense breast tissue. His work has helped physicians save lives ever since he applied his background as a statistician and epidemiologist to understanding how different factors may affect a woman’s risk for developing breast cancer. He is one of the most published experts on this topic with hundreds of publications and is now focused on breast density and texture as key attributes in the development of breast cancer.
Why is breast density important? According to a 2017 JAMA study, high breast density was found to be the most common risk factor for developing breast cancer, even more significant than family history. “Breast density is a significant factor for breast cancer risk,” said Dr. Cuzick. “It increases the risk of developing cancer1 and it can also obscure an existing cancer in a mammogram making it more difficult to detect it.”2
Dr. Cuzick’s research also led to the creation of the Tyrer-Cuzick (or IBIS-1) risk model for predicting a woman’s 10-year risk for developing breast cancer. It involves answering a questionnaire to capture risk factors such as family history and age of first pregnancy, which are obtained from the patient. The risk model 8th edition now includes the patient’s breast density score or volumetric breast density percentage which Dr. Cuzick believes provides important predictive information to better personalize a screening regimen.
When patients and clinicians understand the risk, it can drive a more informed conversation around a personalized approach to breast care which can make all the difference. “We are able to identify women who are at sufficient risk to consider preventive therapy, and also guide personalized screening regimens – so high-risk women get more screening and low risk women can be spared too much screening at short intervals,” said Dr. Cuzick.
Dr. Cuzick, however, believes that obtaining personalized care is easier said than done. “There is a lack of awareness by the medical profession and the public about the value that a risk assessment can have in guiding screening intervals and the use of preventive therapy. This is compounded by a shortage of trained professionals that can provide information to interpret risk and suggest what can be done to reduce [risk].”
Breast density has become part of the national discussion in recent years. Connecticut became the first state to pass a law requiring that women who have mammograms are informed about breast density in 2009. Today, 36 states have Density Inform laws3.
Dr. Joseph P. Russo, Section Chief of Women’s Imaging, at St. Luke’s University Health Network says that the state of Pennsylvania, like most of these states, adopted a notification law without standards of care for managing dense breast patients4. He decided to create his own personalized screening program to “triage” the right women toward additional screening.
As part of this program, Dr. Russo adopted the Tyrer-Cuzick risk model for his patients but soon realized that he needed a technology better suited to imaging dense breasts. Dr. Russo became an early adopter of Invenia ABUS automated breast ultrasound which is the only FDA approved ultrasound system for screening dense breasts. He says most women are still surprised to learn about the importance of breast density as a risk for developing cancer and how density may affect screening.
”There are still certain signs of breast cancer that are best seen on a mammogram which is why Invenia ABUS is used in addition to mammography. ABUS screening helps find cancers hiding in dense tissue. Accurate density measurements and quality imaging are also very important in breast cancer detection. That is why we have integrated VolparaDensity software to help us accurately measure breast density, and to further ensure quality, we are using VolparaEnterprise software to help us maintain high image quality. I encourage women to learn their breast density, seek our risk assessments and talk to their healthcare providers to get the personalized healthcare they need.“
- Engmann, et al, JAMA Oncology, February, 2017
- Mandelson et al. J Natl Cancer Inst 2000; 92:1081–1087.