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Breast density, a radiologic term that describes the proportion of parenchymal relative to fatty tissue in mammograms, is a strong and prevalent risk factor. With increasing breast density, the risk of having a breast cancer masked or hidden on mammography increases, as does future breast cancer risk.1 Almost 50% of US women aged 40 to 74 years have dense breasts (an estimated 27.6 million women). The widespread incorporation of breast density information into screening mammography reports in 36 US states and suggestion to consider supplemental imaging has resulted in women raising questions about breast density and supplemental imaging with their clinicians.2 Thus, clinicians need to be knowledgeable of the clinical significance of breast density and how it may be useful when combined with breast cancer risk to inform screening discussions.
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Corresponding Author: Karla Kerlikowske, MD, San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, 111A1, 4150 Clement St, San Francisco, CA 94121 (Karla.Kerlikowske@ucsf.edu).
Published Online: May 31, 2019. doi:10.1001/jama.2019.6247
Conflict of Interest Disclosures: Dr Kerlikowske reported receiving grant support from the National Cancer Institute and the Patient-Centered Outcomes Research Institute during the conduct of the study, receiving grant support from Google Sciences, and is a nonpaid consultant with GRAIL on the STRIVE study. Dr Miglioretti reported receiving grants from the National Cancer Institute and the Patient-Centered Outcomes Research Institute during the conduct of the study and personal fees from Hologic for serving on the scientific advisory board outside the submitted work. Dr Vachon reported receiving grants from GRAIL and having a patent to an automated breast density measure issued. No other disclosures were reported.
Additional Contributions: The authors thank Kathleen R. Brandt, MD (Mayo Clinic), for her critical review of the article.
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