Mammographic density assessed using deep learning in women at high risk of developing breast cancer: the effect of weight change on density

<i>Purpose:</i>High mammographic density (MD) and excess weight are both associated with increased risk of breast cancer. Classically defined percentage density measures tend to increase with reduced weight due to disproportionate loss of breast fat, however the effect of weight loss on artificial intelligence-based density scores is unknown. We investigated an artificial intelligence-based density method, reporting density changes in 46 women enrolled in a weight-loss study in a family history breast cancer clinic, using a volumetric density method as a comparison.<i>Methods:</i>We analysed data from women who had weight recorded and mammograms taken at the start and end of the 12-month weight intervention study. MD was assessed at both time points using a deep learning model trained on expert estimates of percent density called pVAS, and the volumetric density software Volpara^TM.<i>Results:</i>Mean (standard deviation) weight of participants at the start and end of the study was 86.0 (12.2) and 82.5 (13.8) respectively; mean (standard deviation) pVAS scores were 35.8 (13.0) and 36.3 (12.4), and Volpara volumetric percent density scores were 7.05 (4.4) and 7.6 (4.4).The Spearman rank correlation between reduction in weight and change in density was 0.17 (-0.13 to 0.43, p = 0.27) for pVAS and 0.59 (0.36 to 0.75, p<0.001) for Volpara volumetric percent density.<i>Conclusion:</i>pVAS percentage density measurements were not significantly affected by change in weight. Percent density measured with Volpara increased as weight decreased, driven by changes in fat volume.