Abstract
Breast density is an important breast cancer risk factor related to decreased mammography sensitivity and as an independent risk factor. This research aims to establish the distribution of breast density in the Saudi screening population and to identify the relationship between visual and automated breast density methods. Screening mammograms from 2905 cancer-free women were retrospectively collected from the Saudi National Breast Cancer Screening Programme. Breast density of screening mammograms were assessed visually by 11 radiologists using the Breast Imaging and Reporting Data System (BIRADS) 5th edition and Visual Analogue Scale (VAS), and by automated methods; predicted VAS processed (pVASprocessed), predicted VAS raw (pVASraw) and VolparaTM. The relationship between breast density methods was assessed using the intra-class coefficient (ICC) and weighted kappa (.). Results indicated that around one-third of Saudi women of screening age had high breast density (BI-RADS C/D: 31.5% or Volpara Density Grade (VDG) C/D: 29.0%). Full screening mammograms from 1022 women were used to assess the relationship between all methods. Predicted VAS estimates of percent density were generally lower than VAS. The highest ICC was between VAS and pVASraw (ICC=0.86, 95% CI 0.84-0.88). For categorical breast density methods, VDG 5th edition showed fair agreement with BI-RADS 5th edition (.=0.35, 95% CI 0.29-0.39). In conclusion, this study shows the majority of Saudi women of screening age have low breast density as shown by visual and automated methods, and there is a positive relationship between visual and automated methods, being strongest for VAS and pVASraw.