Epithelium and stromal tissues that are strongly related to risk of breast cancer appear radiologically dense, whereas fat appears radiologically lucent.93 The proportion of the mammographic image occupied by radiologically dense tissue is a composite measure of breast tissue composition. At present, the role of mammographic density in breast cancer etiology is not clear.94 However, it has been established that mammographic density is an independent predictor of breast cancer risk, with associated relative risks between 4 and 6 for the highest vs. the lowest quartile of mammographic density. Evidence suggests that the magnitude of the increase in breast cancer risk is greater than that associated with nearly all other breast cancer risk factors after adjustment for age, body mass index (BMI), age at menarche, breast cancer family history, parity, menopausal status, and HRT use.93,95
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