Research Article| Volume 22, ISSUE 6, P560-566, August 2022

Relationship Between Breast Density, Breast Cancer Subtypes, and Prognosis

Published:April 21, 2022DOI:


      • The link between breast density, breast cancer subtype, and prognosis is unclear.
      • We examined breast cancer subtype and breast composition in Japanese women.
      • No relationship was detected between the cancer subtypes and breast composition.
      • Treatment decision should continue to be made based on cancer subtype.



      In the United States, Europe, and Asia, a consensus has been reached that there is a higher risk of breast cancer in high density breasts. However, there are some contrary reports that suggest the absence of an association between breast composition and breast cancer subtype; thus, there is conflicting evidence. The purpose of this study was to investigate trends in the incidence of breast cancer subtypes according to breast composition and analyze the survival rates in Japanese women.

      Patients and Methods

      Between 2007 and 2008, 1258 Japanese patients with invasive breast cancer who underwent mammography and obtained a pathological diagnosis in our institution were included in the study. We compared cancer subtypes with breast composition types (dense and non-dense breast), and classified them based on initial mammography findings. Information on 5- and 10-year survival rates was collected by chart review for patients with dense and nondense breasts. Statistical analysis was performed using the Pearson's chi-square test for breast composition and cancer subtype. The effect of breast composition on mortality was examined using a multivariate Cox proportional hazards model, and adjusted hazard ratios were calculated.


      No significant difference was found between breast cancer subtype and breast composition (P = .08). Five-year (log-rank test, P = .09) and 10-year (log-rank test, P = .31) survival rates were not significantly different between breast composition types.


      There was no significant association between breast composition and cancer subtypes. There was also no significant difference in the prognosis between patients with and without dense breasts.



      BI-RADS (Breast Imaging-Reporting and Data System), HR (Hormone receptor), HER-2 (Human epidermal growth factor Type 2), BC (Breast cancer), TNBC (Triple negative breast cancer), ER (Estrogen reception), PgR (Progesterone receptor)
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        • Sickles EA
        • D'Orsi CJBL.
        ACR BI-RADS® mammography. In: ACR Bi-RADS® Atlas, Breast Imaging Reporting and Data System.
        American College of Radiology, Reston, VA2013
        • Olsson Å
        • Sartor H
        • Borgquist S
        • Zackrisson S
        • Manjer J.
        Breast density and mode of detection in relation to breast cancer specific survival: a cohort study.
        BMC Cancer. 2014; 14: 229
        • Maskarinec G
        • Pagano IS
        • Little MA
        • Conroy SM
        • Park SY
        • Kolonel LN.
        Mammographic density as a predictor of breast cancer survival: the multiethnic cohort.
        Breast Cancer Res. 2013; 15 (R7)
        • Masarwah A
        • Auvinen P
        • Sudah M
        • et al.
        Very low mammographic breast density predicts poorer outcome in patients with invasive breast cancer.
        Eur Radiol. 2015; 25: 1875-1882
        • Gierach GL
        • Ichikawa L
        • Kerlikowske K
        • et al.
        Relationship between mammographic density and breast cancer death in the Breast Cancer Surveillance Consortium.
        J Natl Cancer Inst. 2012; 104: 1218-1227
        • Maskarinec G
        • Pagano I
        • Chen Z
        • Nagata C
        Gram IT. Ethnic and geographic differences in mammographic density and their association with breast cancer incidence.
        Breast Cancer Res Treat. 2007; 104: 47-56
        • Bertrand KA
        • Tamimi RM
        • Scott CG
        • et al.
        Mammographic density and risk of breast cancer by age and tumor characteristics.
        Breast Cancer Res. 2013; 15: R104
        • Sartor H
        • Zackrisson S
        • Elebro K
        • Hartman L
        • Borgquist S.
        Mammographic density in relation to tumor biomarkers, molecular subtypes, and mode of detection in breast cancer.
        Cancer Causes Control. 2015; 26: 931-939
        • van Gils CH
        • Otten JD
        • Verbeek AL
        • Hendriks JH
        • Holland R.
        Effect of mammographic breast density on breast cancer screening performance: a study in Nijmegen, The Netherlands.
        J Epidemiol Commun Health. 1998; 52: 267-271
        • Cil T
        • Fishell E
        • Hanna W
        • et al.
        Mammographic density and the risk of breast cancer recurrence after breast-conserving surgery.
        Cancer. 2009; 115: 5780-5787
        • Chiu SY
        • Duffy S
        • Yen AM
        • Tabár L
        • Smith RA
        • Chen HH.
        Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-year follow-up of a Swedish mammographic screening.
        Cancer Epidemiol Biomarkers Prev. 2010; 19: 1219-1228
      1. xxx 2022 The Japan Central Organization on Quality Assurance of Breast Cancer Screening. Proposal for response to the “dense breast” problem in countermeasures-based breast cancer screening. (in Japanese).