Mammographic Density Errors during Interpretation of Breast Examinations

Tamara V. Pavlova, Aleksandr Yu. Vasilyev, Ivan V. Buromsky

International Journal of Biomedicine. 2020;10(4):378-381.
DOI: 10.21103/Article10(4)_OA9
Originally published December 10, 2020


Background: This article discusses errors that may occur when radiologists deal with mammographic density (MD) and present their performance analysis in Russia.
Methods and Results: The authors of this report have analyzed 24,485 mammographic reports for 20,000 female patients (aged 29-85 years) that were made in various healthcare facilities in the Russian Federation. In 249(1.7%) mammographic exam reports, we observed a wrong MD interpretation.
Conclusion: Diagnostic errors during mammographic examination occur because the radiologists lack theoretical knowledge about MD. This lack, in turn, results in a decrease in the quality of medical care provided for female patients and an increase in the number of diagnostic iatrogeny. 

mammographic density • iatrogeny • error • breast cancer
  1. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, Znaor A, Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019 Apr 15;144(8):1941-1953. doi: 10.1002/ijc.31937.
  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492.
  3. Torre LA, Siegel RL, Ward EM, Jemal A. Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomarkers Prev. 2016 Jan;25(1):16-27. doi: 10.1158/1055-9965.
  4. Labazanova PG, Rozhkova NI, Burdina II, Zapirova SB, Mazo ML, Mikushin SYu, Prokopenko SP, Jacobs OE. [Mammographic density and risk of breast cancer (a look at the history of studying the issue)]. Russian Electronic Journal of Radiology. 2020; 10(2):205-222. DOI:10.21569/2222-7415-2020-10-2-205-222.[Article in Russian].
  5. Duffy SW, Morrish OWE, Allgood PC, Black R, Gillan MGC, Willsher P, Cooke J, Duncan KA, Michell MJ, Dobson HM, Maroni R, Lim YY, Purushothaman HN, Suaris T, Astley SM, Young KC, Tucker L, Gilbert FJ. Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer. Eur J Cancer. 2018 Jan;88:48-56. doi: 10.1016/j.ejca.2017.10.022.
  6. Nazari SS, Mukherjee P. An overview of mammographic density and its association with breast cancer. Breast Cancer. 2018 May;25(3):259-267. doi: 10.1007/s12282-018-0857-5. 
  7. Sprague BL, Gangnon RE, Burt V, Trentham-Dietz A, Hampton JM, Wellman RD, Kerlikowske K, Miglioretti DL. Prevalence of mammographically dense breasts in the United States. J Natl Cancer Inst. 2014 Sep 12;106(10):dju255. doi: 10.1093/jnci/dju255.
  8. Bakker MF, de Lange SV, Pijnappel RM, Mann RM, Peeters PHM, Monninkhof EM, Emaus MJ, Loo CE, Bisschops RHC, Lobbes MBI, de Jong MDF, Duvivier KM, Veltman J, Karssemeijer N, de Koning HJ, van Diest PJ, Mali WPTM, van den Bosch MAAJ, Veldhuis WB, van Gils CH; DENSE Trial Study Group. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019 Nov 28;381(22):2091-2102. doi: 10.1056/NEJMoa1903986. 
  9. Nelson HD, O'Meara ES, Kerlikowske K, Balch S, Miglioretti D. Factors Associated With Rates of False-Positive and False-Negative Results From Digital Mammography Screening: An Analysis of Registry Data. Ann Intern Med. 2016 Feb 16;164(4):226-35. doi: 10.7326/M15-0971.
  10. Wadhwa A, Sullivan JR, Gonyo MB. Missed Breast Cancer: What Can We Learn? Curr Probl Diagn Radiol. 2016 Nov-Dec;45(6):402-419. doi: 10.1067/j.cpradiol.2016.03.001. 
  11. Natesan R, Wiskin J, Lee S, Malik BH. Quantitative Assessment of Breast Density: Transmission Ultrasound is Comparable to Mammography with Tomosynthesis. Cancer Prev Res (Phila). 2019 Dec;12(12):871-876. doi: 10.1158/1940-6207.CAPR-19-0268. 
  12. Boyd NF, O'Sullivan B, Campbell JE, Fishell E, Simor I, Cooke G, Germanson T. Mammographic signs as risk factors for breast cancer. Br J Cancer. 1982 Feb;45(2):185-93. doi: 10.1038/bjc.1982.32. 
  13. Wolfe JN. Risk for breast cancer development determined by mammographic parenchymal pattern. Cancer. 1976 May;37(5):2486-92. doi: 10.1002/1097-0142(197605)37:5<2486::aid-cncr2820370542>;2-8. 
  14. Spak DA, Plaxco JS, Santiago L, Dryden MJ, Dogan BE. BI-RADS® fifth edition: A summary of changes. Diagn Interv Imaging. 2017 Mar;98(3):179-190. doi: 10.1016/j.diii.2017.01.001. 
  15. D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA. ACR BI-RADS Atlas: Breast Imaging Re-porting and Data System. American College of Radiology, Reston, VA, USA; 2013.

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Received October 26, 2020.
Accepted November 30, 2020.
©2020 International Medical Research and Development Corporation.