Women with high mammographic density (MD) have an increased risk of breast cancer. They may be offered contrast-enhanced mammogram (CEM) to improve breast cancer screening performance. Using a cohort of women receiving CEM, we evaluated whether conventional and modified MD measures were associated with breast cancer. Sixty-six cases with newly diagnosed unilateral breast cancer were frequency-matched on age to 133 cancer-free controls. On low-energy cranio-caudal CEMs (equivalent to standard mammogram), we measured quantitative MD using CUMULUS software at the conventional intensity threshold ("Cumulus") and higher-than-conventional thresholds ("Altocumulus", "Cirrocumulus"). The measures were standardized to enable estimation of odds per age- and adiposity-adjusted standard deviation (OPERA). In multivariable logistic regression of case-control status, only the highest-intensity measure, Cirrocumulus, was statistically significantly associated with breast cancer (OPERA = 1.40, 95% CI 1.04-1.89). Conventional Cumulus did not contribute to model fit. For women receiving CEM, Cirrocumulus MD might better predict breast cancer than conventional quantitative MD.
© The Author(s) 2024. Published by Oxford University Press.