What Your Mammogram Might Not Be Telling You

Dense breast tissue has long been linked to an increased risk of breast cancer, but new research suggests that the texture within that density may carry even more predictive value.

According to a recent study published in Radiology, researchers from Mayo Clinic, Columbia University, and the University of California San Francisco identified six distinct texture patterns in breast tissue that may influence a woman's likelihood of developing breast cancer. These patterns were discovered by analyzing over 30,000 mammograms using 390 radiomic features, which reflect the structural composition of the tissue.

When these findings were tested in a separate group of more than 3,500 women, certain patterns emerged as strong indicators of elevated breast cancer risk. According to Celine Vachon of Mayo Clinic, these texture-based markers could explain why women with similar breast density often face very different outcomes. Radiologists have historically focused on how dense the tissue appears, but this study shows that how it is arranged might matter just as much.

According to Despina Kontos of Columbia University, the predictive value of texture was even more pronounced in Black women, who are disproportionately affected by aggressive cancers and delayed diagnoses. This highlights a growing need for risk models that consider more than just age and density.

The study also looked at interval cancers, which are aggressive tumors that arise between scheduled screenings and are more likely to be missed during a routine mammogram. According to the authors, certain texture patterns correlated with a higher incidence of these difficult-to-detect cancers. This opens the door to using texture as a tool for identifying women who might benefit from earlier or more frequent imaging.

Karla Kerlikowske of UCSF noted that understanding these patterns could also help predict which women are more likely to develop invasive disease. The research team now aims to combine these phenotypes with genetic, hormonal, and lifestyle factors, and eventually expand the findings to 3D mammography for even greater accuracy.