CHICAGO — Stamatia Destounis, MD, has been busy showing how volumetric breast density plays a role in cancer risk assessment.
Destounis, a fellowship-trained breast radiologist at Elizabeth Wende Breast Care in Rochester, NY, presented multiple studies at RSNA 2025 exploring trends in breast density and how they affect who is at elevated risk and in need of more care.
“There are lots of things going on. The technology is always improving,” Destounis told AuntMinnie at RSNA. “I’ve seen many new exciting things that’re making me feel like we’re always moving in the right direction.”
Trends in breast density
In one study, Destounis and colleagues studied how changes in breast density over time affect the calibration and predictive performance of breast cancer risk models in a screening population.
Using both volumetric and BI-RADS-equivalent density measures, the team found that breast density changes impact risk prediction over time. And while area under the curve (AUC) differences were minimal, longitudinal volumetric breast density improves calibration. This could improve the reliability of model-based screening decisions, Destounis and colleagues noted.
In another study of nearly 45,000 women, the Destounis team compared high-risk estimations using volumetric breast density with established models.
The researchers found that the Tyrer-Cuzick model identified more women as high risk for developing breast cancer (19.1% with competing mortality) compared to the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) risk model (9.8%). However, the BOADICEA model classified fewer women as high risk without a strong family history of breast cancer (1.16 vs. 1.21).
Stamatia Destounis, MD, discusses results from a study she presented at RNSA showing differences in high-risk estimations with established risk models when volumetric breast density is added.
Cancer trends in younger women
In another study, Destounis presented, the researchers found that women younger than 50 years old made up a considerable number of breast cancer cases.
In their study of 1,798 breast cancers being diagnosed in 1,290 women ages 18 to 49 years, annual diagnoses ranged from 145 to 196. Of these, about 41% were detected on screening and 59% were found on diagnostic evaluation. Invasive cancers comprised 1,449 cases (80.6%), while 349 (19.4%) were noninvasive.
Age-stratified analysis showed that 423 cancers (24%) occurred in women younger than 40 years old, and 1,376 (76%) in women ages 40 to 49. Annual cancer diagnoses in women under 40 ranged from 17 to 56, peaking in 2019, while cancers in women ages 40 to 49 consistently exceeded 98 cases per year.
Destounis, who chairs the Breast Imaging Commission at the American College of Radiology, said breast density “definitely” plays a role in these trends.
Destounis talks about how breast density and other risk factors play a role in cancer trends in younger women.
Destounis said the results from her studies point to the need for improved screening guidelines and risk assessment.
“The trends and the incidence have been increasing for the past few decades,” she said. “We need to consider what we’re currently doing in screening.”
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