Risk Assessment of Breast Cancer Through BI-RADS Category Using Digital Mammography Technique Among Symptomatic and Asymptomatic Women: Digital Mammography-Based BI-RADS Risk Assessment

Um e Roman Azam; Zunaira Rafaqat; Zubia Saleem

doi:10.54393/pjhs.v6i8.2911

Authors

Um e Roman Azam Department of Medical Imaging Technology, School of Allied Health Sciences, Combined Military Hospital, Medical College, and Institute of Dentistry, Lahore, Pakistan
Zunaira Rafaqat Department of Medical Imaging Technology, School of Allied Health Sciences, Combined Military Hospital, Medical College, and Institute of Dentistry, Lahore, Pakistan
Zubia Saleem Department of Medical Imaging Technology, School of Allied Health Sciences, Combined Military Hospital, Medical College, and Institute of Dentistry, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i8.2911

Keywords:

BI-RADS, Digital Mammography, Symptomatic, Breast Cancer

Abstract

Breast cancer is the second leading cause of death among women globally. Risk factors include BRCA1 gene mutations, age, early menopause, and family history. Digital mammography is the gold standard for symptomatic women presenting with chest pain, lumps, nipple discharge, or skin changes, while asymptomatic women undergo routine screening from age 45. Risk assessment is based on correlating BI-RADS findings with patient history and socioeconomic factors. Objectives: To assess breast cancer risk through BI-RADS categories using digital mammography among symptomatic and asymptomatic women. Methods: This comparative cross-sectional study included 384 women aged 15–75 years. Data were collected using a structured questionnaire covering demographics, lifestyle, reproductive history, family cancer history, breast tissue density, and BI-RADS category. Non-probability convenience sampling was used, and analysis was performed via IBM SPSS version 26.0. Results: Most participants were aged 46–65 years, housewives, and postmenopausal. Moderate physical activity (59%), symptoms (80.3%), and prior screening mammography (61.3%) were common. While 88.1% performed self-examinations and 82.1% had professional exams, 53.2% had never undergone a mammogram. Family history of breast cancer (34.3%) was notable. Scattered fibro-glandular breast tissue predominated. Awareness of BI-RADS (43.1%) and digital mammography (62.1%) was limited. Most had no prior cancer treatment (77.4%) or radiation exposure (92.7%), with 29.9% diagnosed with breast cancer. Conclusions: Menstrual changes and early post-menopause influenced malignancy risk, with increasing age being a significant factor. Higher parity correlated with benign categories.

References

Parmar V. Organization of Breast Cancer Management Group. In: Breast Cancer: Comprehensive Management. 2022 Jan; 601–605. Singapore: Springer Nature Singapore. doi: 10.1007/978-981-16-4546-4_30. DOI: https://doi.org/10.1007/978-981-16-4546-4_30

Geller BM, Barlow WE, Ballard-Barbash R, Ernster VL, Yankaskas BC, Sickles EA, et al. Use of the American College of Radiology BI-RADS to Report on the Mammographic Evaluation of Women with Signs and Symptoms of Breast Disease. Radiology. 2002 Feb; 222(2): 536–42. doi: 10.1148/radiol.2222010620. DOI: https://doi.org/10.1148/radiol.2222010620

Huang SY, Murray M, Rubio A, Okoro N, Sedrak MS, McCloskey SA, et al. Impact of Screening Mammography on Breast Cancer Outcomes in Women Aged 80 Years and Over. Annals of Surgical Oncology. 2025 Sep; 13: 1–9. doi: 10.1245/s10434-025-18288-4. DOI: https://doi.org/10.1245/s10434-025-18288-4

Murphy S, Mooney T, Phelan N, Smith A, Campbell L, Connors A, et al. Evaluation of Recall Rates in the Irish National Breast Screening Programme: Insights from Two Million Screening Mammograms. European Journal of Radiology. 2025 May; 17: 112179. doi: 10.1016/j.ejrad.2025.112179. DOI: https://doi.org/10.1016/j.ejrad.2025.112179

Fazeli S, Stepenosky J, Guirguis MS, Adrada B, Rakow-Penner R, Ojeda-Fournier H. Understanding BI-RADS Category 3. RadioGraphics. 2024 Dec; 45(1): e240169. doi: 10.1148/rg.240169. DOI: https://doi.org/10.1148/rg.240169

Rasheed ME, Youseffi M. Breast Cancer and Medical Imaging. IOP Publishing. 2024 Mar. doi: 10.1088/978-0-7503-5709-8. DOI: https://doi.org/10.1088/978-0-7503-5709-8

Hussein H, Abbas E, Keshavarzi S, Fazelzad R, Bukhanov K, Kulkarni S, et al. Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis. Radiology. 2023 Jan; 306(3): e221785. doi: 10.1148/radiol.221785. DOI: https://doi.org/10.1148/radiol.221785

Giorgi Rossi P, Djuric O, Hélin V, Astley S, Mantellini P, Nitrosi A, et al. Validation of a New Fully Automated Software for 2D Digital Mammographic Breast Density Evaluation in Predicting Breast Cancer Risk. Scientific Reports. 2021 Oct; 11(1): 19884. doi: 10.1038/s41598-021-99433-3. DOI: https://doi.org/10.1038/s41598-021-99433-3

Seryasat OR, Haddadnia J. Evaluation of a New Ensemble Learning Framework for Mass Classification in Mammograms. Clinical Breast Cancer. 2018 Jun; 18(3): e407–20. doi: 10.1016/j.clbc.2017.05.009. DOI: https://doi.org/10.1016/j.clbc.2017.05.009

Lin F, Sun H, Han L, Li J, Bao N, Li H, et al. An Effective Fine Grading Method of BI-RADS Classification in Mammography. International Journal of Computer Assisted Radiology and Surgery. 2022 Feb; 17(2): 239–47. doi: 10.1007/s11548-021-02541-8. DOI: https://doi.org/10.1007/s11548-021-02541-8

Yashima S, Chida K. Awareness of Medical Radiologic Technologists of Ionizing Radiation and Radiation Protection. International Journal of Environmental Research and Public Health. 2022 Dec; 20(1): 497. doi: 10.3390/ijerph20010497. DOI: https://doi.org/10.3390/ijerph20010497

Wang Y. Screening in High-Risk Women: Results from Cancer Screening Program in China. In: Cancer Epidemiology in China: What We Have Learnt So Far?. 2020 Apr; 370083.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2018 Nov; 68(6): 394–424. doi: 10.3322/caac.21492. DOI: https://doi.org/10.3322/caac.21492

Ezeana CF, Puppala M, Wang L, Chang JC, Wong ST. A Comparative Efficacy Study of Diagnostic Digital Breast Tomosynthesis and Digital Mammography in BI-RADS 4 Breast Cancer Diagnosis. European Journal of Radiology. 2022 Aug; 153: 110361. doi: 10.1016/j.ejrad.2022.110361. DOI: https://doi.org/10.1016/j.ejrad.2022.110361

Naeim RM, Marouf RA, Nasr MA, Abd El-Rahman ME. Comparing the Diagnostic Efficacy of Digital Breast Tomosynthesis with Full-Field Digital Mammography using BI-RADS Scoring. Egyptian Journal of Radiology and Nuclear Medicine. 2021 Feb; 52(1): 44. doi: 10.1186/s43055-021-00421-4. DOI: https://doi.org/10.1186/s43055-021-00421-4

Eriksson M, Czene K, Strand F, Zackrisson S, Lindholm P, Lång K, et al. Identification of Women at High Risk of Breast Cancer who Need Supplemental Screening. Radiology. 2020 Nov; 297(2): 327–33. doi: 10.1148/radiol.2020201620. DOI: https://doi.org/10.1148/radiol.2020201620

He C, Xie Q, Zhou Y. Influence of Flange on Seismic Performance of 1,100-kV Ultra-High Voltage Transformer Bushing. Earthquake Spectra. 2019 Feb; 35(1): 447–69. doi: 10.1193/122517EQS266M. DOI: https://doi.org/10.1193/122517EQS266M

Offit LR, Chikarmane SA, Lacson RC, Giess CS. Frequency and Outcomes of BI-RADS Category 3 Assessments in Patients with a Personal History of Breast Cancer: Full-Field Digital Mammography versus Digital Breast Tomosynthesis. American Journal of Roentgenology. 2023 Sep; 221(3): 313–22. doi: 10.2214/AJR.23.29067. DOI: https://doi.org/10.2214/AJR.23.29067

Tran TX, Kim S, Song H, Park B. Family History of Breast Cancer, Mammographic Breast Density and Breast Cancer Risk: Findings from a Cohort Study of Korean Women. The Breast. 2022 Oct; 65: 180–6. doi: 10.1016/j.breast.2022.08.008. DOI: https://doi.org/10.1016/j.breast.2022.08.008

Nguyen HT, Tran SB, Nguyen DB, Pham HH, Nguyen HQ. A Novel Multi-View Deep Learning Approach for BI-RADS and Density Assessment of Mammograms. In: 44th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). 2022 Jul; pp. 2144–2148. IEEE. doi: 10.1109/EMBC48229.2022.9871564. DOI: https://doi.org/10.1109/EMBC48229.2022.9871564