The University of California San Francisco recently hosted the 8th International Breast Densitometry and Breast Cancer Risk Assessment Workshop (June 7 – 9). It gathered radiologists, epidemiologists, researchers and other health practitioners from ten countries with the aim of equipping them with a “tangible understanding and insights to the clinical applications and research topics in breast density”. It was an informative three days, which covered the clinical aspects of density, the breast density workshop and concluded with “breast cancer risk assessment—putting it all together” – Volpara was represented in 14 presentations, by far the most cited automated density assessment tool.
The conference had several segments. These included some excellent talks about supplemental breast screening for women with dense breasts —from breast tomosynthesis and ultrasound, to the use of MRI to intercept interval cancers in dense breasts (the aim of the Volpara-associated Dutch DENSE trial) and novel technologies for breast screening (an abbreviated MRI protocol from the Memorial Sloan-Kettering Cancer Center and “ultrasound tomography”). There is also a segment on the use of therapeutic interventions to lower breast density and its associated risk. Tamoxifen is one such intervention that offers rapid density reductions; furthermore, a combination of testosterone and anastrozole is being clinically evaluated for reducing density while hopefully avoiding unpleasant side effects from Adelaide. It was also interesting to hear investigations of the molecular biology of density—its relationship to the collagen structure in the stroma, its genetic basis, and the relationship between density, risk and age-related involution of glandular breast tissue. Finally, there is a growing focus on communicating density information to the general public, driven by the fact that 31 US states now legislate that doctors provide some level of breast density notification. Organizations such as DenseBreast-info.org aim to provide a centralized resource for such information—but making sure that both women and doctors have a good understanding of breast density is not a simple task!
However, undoubtedly the largest focus of the meeting was how breast density relates to the risk of breast cancer, and how it can be used to improve risk estimates. High density creates a risk of masking cancers on a mammogram. Results from the Dutch breast screening program, the Mayo Clinic and the San Francisco Mammography Registry confirm that density relates to reduced mammographic sensitivity and increased risk of interval cancers (cancers that arise symptomatically between regular screening appointments). However, breast density is also a stand-alone risk factor for cancer, independently of its masking effect. A collaborative effort is underway through the Australian run “The Measurement Challenge” to further improve estimates of cancer risk based on mammography alone. The conference wrapped up with Prof Jack Cuzick and Dr Adam Brentnall talking about the latest version of the Tyrer-Cuzick model. This latest (8th) installment has incorporated information on breast density (with Volpara the only commercial input approved) and SNPs (single nucleotide polymorphisms) and is expected to provide a better, more accurate estimate of risk.
This meeting re-affirmed Volpara’s leadership in density assessment, both in research and in the clinic with 14 presentations, we look forward to them become peer reviewed papers.
