New breast magnetic resonance imaging (MRI) research suggests that high background parenchymal enhancement (BPE) is significantly more likely for Black women in comparison to White women.
For the retrospective study, recently published in Radiology, the researchers reviewed breast MRI data for 388 Black women (mean age of 47) and 2,101 White women (mean age of 48). Employing the BI-RADS criteria, the study authors noted that high BPE included marked or moderate BPE whereas low BPE included mild or moderate assessments.
The researchers found that Black women were 10 percent less likely than White women to have extremely dense breasts (11 percent vs. 21 percent).
However, after adjusting for breast density via a causal mediation analysis, the researchers found that Black women had a 31 percent higher likelihood of having high BPE on breast MRI.
“This finding, despite the lower Breast Imaging Reporting and Data System density levels among Black women, highlights the potential for BPE to serve as a predictor of breast cancer risk,” wrote lead study author Mattia A. Mahmoud, MPhil., who is affiliated with the Department of Biostatistics, Epidemiology and Informatics at the Perelman School of Medicine at the University of Pennsylvania, and colleagues.
Citing previous research, the study authors pointed out that Black women are less likely than White women at community-based facilities to have screening MRIs and are less likely to have preoperative MRIs after being diagnosed with breast cancer. The researchers also pointed out that Black women have been under-represented in previous studies looking at the impact of BPE.
Three Key Takeaways
• High BPE is more prevalent among Black women independent of breast density. Despite lower rates of extremely dense breasts, Black women had a 31 percent higher likelihood of high background parenchymal enhancement (BPE) on breast MRI after adjustment, suggesting BPE captures biologic information beyond density alone.
• BPE may represent an important, under-recognized breast cancer risk marker. The discordance between lower density and higher BPE in Black women supports growing evidence that BPE could serve as an independent predictor of breast cancer risk and should be considered in risk stratification discussions.
• Access disparities and underrepresentation may bias existing MRI-based evidence. Lower utilization of screening and preoperative MRI among Black women, combined with historical underrepresentation in BPE research, highlights the need for more inclusive studies to clarify how access, utilization, and BPE relate to cancer risk across diverse populations.
“Future studies should examine selection mechanisms for MRI receipt to better understand how access and utilization patterns may influence observed racial differences in BPE. Given recent laws eliminating or reducing costs for supplemental screening for dense breasts, we have an opportunity and obligation to assess the association between BPE and breast cancer risk among diverse study groups,” added Mahmoud and colleagues.
(Editor’s note: For related content, see “Breast MRI and Background Parenchymal Enhancement: What a Meta-Analysis Reveals,” “Study Questions Utility of Ultrafast Breast MRI for Challenging Lesions and Moderate/Marked BPE” and “Contrast-Enhanced Mammography Study Reveals 24 Percent Lower Sensitivity with Moderate/Marked BPE.”)
In regard to study limitations, the authors acknowledged the possibility of patient selectin bias with limiting the study to women who had a breast MRI and noted the lack of Hispanic and Asian women in the cohort.
