Breast density assessment in adolescent girls using dual-energy X-ray absorptiometry: a feasibility study

Abstract

Breast density, the radiographically opaque fraction of the breast in a mammogram, is one of the strongest biomarkers of breast cancer risk. However, younger populations do not typically have mammograms due to radiation concerns. This study explored a commercially available dual-energy X-ray absorptiometer (DXA) system as a low-dose method to measure breast fibroglandular density in adolescent girls. Eighteen girls (13-14 years old) indicated their breast development according to Tanner and underwent three dedicated DXA scans, two of their left and one of their right breasts. Total projected breast area was manually delineated on each image and percent fibroglandular volume density (%FGV), absolute fibroglandular volume (FGV), total breast area, and volume were computed. It was possible to image breasts representing all five Tanner stages; %FGV ranged from 31.9% to 92.2% with a mean of 71.1 +/- 14.8%, whereas FGV ranged from 80 to 270 cm(3) with a mean of 168 +/- 54 cm(3). Left and right breast %FGV were highly correlated (r(p) = 0.97, P < 0.0001) and of the same magnitude (P = 0.18). However, left total volume and FGV were larger than the right by 38 cm(3) (P = 0.04) and 19 cm(3) (P = 0.02), respectively. Total volume and FGV increased by Tanner stage, whereas %FGV did not. Our method had excellent precision for %FGV and moderate precision for FGV (root mean square SDs of 2.4% and 16.6 cm(3)). These pilot data indicate that dedicated DXA breast scans may be useful in studies exploring breast density in girls.

Figure 1

Breast pubertal stages according to Tanner with the corresponding DXA Image*

Figure 2

Mean breast density measures by Tanner stage.