Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy: results of the MEDICI study

Sarah L Savaridas; Andrea Marshall; Kulsam Ali; Susan M Astley; Andrew J Evans; Mark Halling-Brown; Sarah Vinnicombe; Violet R Warwick; Patsy Whelehan; Sonya Drummond; Raja Ebsim; Nuala A Healy; Jonathan Nash; Elizabeth Muscat; Sreenivas Muthyala; Ashwini Sharma; Marianna Telesca; Janet Dunn

doi:10.1186/s13058-026-02239-2

Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy: results of the MEDICI study

Sarah L Savaridas^*, Andrea Marshall, Kulsam Ali, Susan M Astley, Andrew J Evans, Mark Halling-Brown, Sarah Vinnicombe, Violet R Warwick, Patsy Whelehan, Sonya Drummond, Raja Ebsim, Nuala A Healy, Jonathan Nash, Elizabeth Muscat, Sreenivas Muthyala, Ashwini Sharma, Marianna Telesca, Janet Dunn

^*Corresponding author for this work

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Oestrogen-receptor positive breast cancer patients are typically treated with adjuvant endocrine therapy (AET), some develop AET resistance. Previous research suggests mammographic density (MD) may represent an imaging biomarker, with fewer local or distant recurrences occurring with decreasing MD. We investigate whether reduction in MD after 1 and/or 3 years is associated with improved breast cancer specific survival (BCSS), metastasis-free survival (MFS) or disease-free survival (DFS).

Methods: This retrospective cohort study was generated from a Mammo-50 trial subset. Participants taking AET (cases) and controls were included. MD was assessed in the AET group using a 0-100% visual analogue scale (VAS). Readers scored mammograms at diagnosis, 1 year and 3 years post-surgery. A decrease in MD was defined as ≥10% reduction from diagnosis. A second reader reviewed paired mammograms and assessed whether there had been a temporal change in MD.

Results: Data from 1364 cases and 367 controls were included. Median VAS MD was approximately 30% for cases and controls at all time-points; 20% showed decreased MD at 1 year and 21% at 3 years for both cases and controls. Of the AET group, 23 died from breast cancer and 33 developed metastases during follow-up (median 8.7 years post-surgery). The 5-year BCSS rate was 99.6% (95%CI:97.4-99.9) versus 98.3% (95%CI:97.2-98.9) for those with and without a ≥10% reduction in MD at 1 year, p=0.35. The 5-year MFS rate for those with and without a ≥10% reduction in MD at 1 year was 94.2% (95%CI:90.7-96.4) versus 93.6% (95%CI:92.0-95.0) respectively; p=0.47. The 5-year DFS rate for those with a ≥10% reduction in MD at 1year was 92.4% (95% CI:88.5-94.9) versus 92.6% (95%CI:90.8-94.0); p= 0.47. Similar results for BCSS, MFS and DFS were seen for those with and without a ≥10% reduction in MD at 3 years and for those assessed as having a definite reduction in MD compared to those who had not at both 1 and 3 years.

Conclusion: Reduction in MD had no significant association with rates of BCSS, MFS or DFS. Change in MD was not shown to be a useful prognostic indicator in women over 50 years, treated with AET.

Original language	English
Article number	62
Pages (from-to)	1-10
Number of pages	10
Journal	Breast Cancer Research
Volume	28
Early online date	19 Feb 2026
DOIs	https://doi.org/10.1186/s13058-026-02239-2
Publication status	E-pub ahead of print - 19 Feb 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Humans
Female
Breast neoplasms/pathology
Middle aged
Breast density
Neoplasm recurrence, Local/pathology
Mammography
Mastectomy, Segmental
Retrospective studies
Aged
Adult
Chemotherapy, Adjuvant
Antineoplastic agents, Hormonal/therapeutic use
Prognosis
Disease-free survival

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Savaridas, S. L., Marshall, A., Ali, K., Astley, S. M., Evans, A. J., Halling-Brown, M., Vinnicombe, S., Warwick, V. R., Whelehan, P., Drummond, S., Ebsim, R., Healy, N. A., Nash, J., Muscat, E., Muthyala, S., Sharma, A., Telesca, M., & Dunn, J. (2026). Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy: results of the MEDICI study. Breast Cancer Research, 28, 1-10. Article 62. Advance online publication. https://doi.org/10.1186/s13058-026-02239-2

@article{ea729bb8f8134feab487f65ae2a423ec,

title = "Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy: results of the MEDICI study",

abstract = "Background: Oestrogen-receptor positive breast cancer patients are typically treated with adjuvant endocrine therapy (AET), some develop AET resistance. Previous research suggests mammographic density (MD) may represent an imaging biomarker, with fewer local or distant recurrences occurring with decreasing MD. We investigate whether reduction in MD after 1 and/or 3 years is associated with improved breast cancer specific survival (BCSS), metastasis-free survival (MFS) or disease-free survival (DFS).Methods: This retrospective cohort study was generated from a Mammo-50 trial subset. Participants taking AET (cases) and controls were included. MD was assessed in the AET group using a 0-100\% visual analogue scale (VAS). Readers scored mammograms at diagnosis, 1 year and 3 years post-surgery. A decrease in MD was defined as ≥10\% reduction from diagnosis. A second reader reviewed paired mammograms and assessed whether there had been a temporal change in MD.Results: Data from 1364 cases and 367 controls were included. Median VAS MD was approximately 30\% for cases and controls at all time-points; 20\% showed decreased MD at 1 year and 21\% at 3 years for both cases and controls. Of the AET group, 23 died from breast cancer and 33 developed metastases during follow-up (median 8.7 years post-surgery). The 5-year BCSS rate was 99.6\% (95\%CI:97.4-99.9) versus 98.3\% (95\%CI:97.2-98.9) for those with and without a ≥10\% reduction in MD at 1 year, p=0.35. The 5-year MFS rate for those with and without a ≥10\% reduction in MD at 1 year was 94.2\% (95\%CI:90.7-96.4) versus 93.6\% (95\%CI:92.0-95.0) respectively; p=0.47. The 5-year DFS rate for those with a ≥10\% reduction in MD at 1year was 92.4\% (95\% CI:88.5-94.9) versus 92.6\% (95\%CI:90.8-94.0); p= 0.47. Similar results for BCSS, MFS and DFS were seen for those with and without a ≥10\% reduction in MD at 3 years and for those assessed as having a definite reduction in MD compared to those who had not at both 1 and 3 years.Conclusion: Reduction in MD had no significant association with rates of BCSS, MFS or DFS. Change in MD was not shown to be a useful prognostic indicator in women over 50 years, treated with AET.",

keywords = "Humans, Female, Breast neoplasms/pathology, Middle aged, Breast density, Neoplasm recurrence, Local/pathology, Mammography, Mastectomy, Segmental, Retrospective studies, Aged, Adult, Chemotherapy, Adjuvant, Antineoplastic agents, Hormonal/therapeutic use, Prognosis, Disease-free survival",

author = "Savaridas, \{Sarah L\} and Andrea Marshall and Kulsam Ali and Astley, \{Susan M\} and Evans, \{Andrew J\} and Mark Halling-Brown and Sarah Vinnicombe and Warwick, \{Violet R\} and Patsy Whelehan and Sonya Drummond and Raja Ebsim and Healy, \{Nuala A\} and Jonathan Nash and Elizabeth Muscat and Sreenivas Muthyala and Ashwini Sharma and Marianna Telesca and Janet Dunn",

note = "Funding: Breast Cancer Now (Grant number: 2018JULPR1125).",

year = "2026",

month = feb,

day = "19",

doi = "10.1186/s13058-026-02239-2",

language = "English",

volume = "28",

pages = "1--10",

journal = "Breast Cancer Research",

issn = "1465-5411",

publisher = "BioMed Central",

}

Savaridas, SL, Marshall, A, Ali, K, Astley, SM, Evans, AJ, Halling-Brown, M, Vinnicombe, S, Warwick, VR, Whelehan, P, Drummond, S, Ebsim, R, Healy, NA, Nash, J, Muscat, E, Muthyala, S, Sharma, A, Telesca, M & Dunn, J 2026, 'Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy: results of the MEDICI study', Breast Cancer Research, vol. 28, 62, pp. 1-10. https://doi.org/10.1186/s13058-026-02239-2

TY - JOUR

T1 - Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy

T2 - results of the MEDICI study

AU - Savaridas, Sarah L

AU - Marshall, Andrea

AU - Ali, Kulsam

AU - Astley, Susan M

AU - Evans, Andrew J

AU - Halling-Brown, Mark

AU - Vinnicombe, Sarah

AU - Warwick, Violet R

AU - Whelehan, Patsy

AU - Drummond, Sonya

AU - Ebsim, Raja

AU - Healy, Nuala A

AU - Nash, Jonathan

AU - Muscat, Elizabeth

AU - Muthyala, Sreenivas

AU - Sharma, Ashwini

AU - Telesca, Marianna

AU - Dunn, Janet

N1 - Funding: Breast Cancer Now (Grant number: 2018JULPR1125).

PY - 2026/2/19

Y1 - 2026/2/19

N2 - Background: Oestrogen-receptor positive breast cancer patients are typically treated with adjuvant endocrine therapy (AET), some develop AET resistance. Previous research suggests mammographic density (MD) may represent an imaging biomarker, with fewer local or distant recurrences occurring with decreasing MD. We investigate whether reduction in MD after 1 and/or 3 years is associated with improved breast cancer specific survival (BCSS), metastasis-free survival (MFS) or disease-free survival (DFS).Methods: This retrospective cohort study was generated from a Mammo-50 trial subset. Participants taking AET (cases) and controls were included. MD was assessed in the AET group using a 0-100% visual analogue scale (VAS). Readers scored mammograms at diagnosis, 1 year and 3 years post-surgery. A decrease in MD was defined as ≥10% reduction from diagnosis. A second reader reviewed paired mammograms and assessed whether there had been a temporal change in MD.Results: Data from 1364 cases and 367 controls were included. Median VAS MD was approximately 30% for cases and controls at all time-points; 20% showed decreased MD at 1 year and 21% at 3 years for both cases and controls. Of the AET group, 23 died from breast cancer and 33 developed metastases during follow-up (median 8.7 years post-surgery). The 5-year BCSS rate was 99.6% (95%CI:97.4-99.9) versus 98.3% (95%CI:97.2-98.9) for those with and without a ≥10% reduction in MD at 1 year, p=0.35. The 5-year MFS rate for those with and without a ≥10% reduction in MD at 1 year was 94.2% (95%CI:90.7-96.4) versus 93.6% (95%CI:92.0-95.0) respectively; p=0.47. The 5-year DFS rate for those with a ≥10% reduction in MD at 1year was 92.4% (95% CI:88.5-94.9) versus 92.6% (95%CI:90.8-94.0); p= 0.47. Similar results for BCSS, MFS and DFS were seen for those with and without a ≥10% reduction in MD at 3 years and for those assessed as having a definite reduction in MD compared to those who had not at both 1 and 3 years.Conclusion: Reduction in MD had no significant association with rates of BCSS, MFS or DFS. Change in MD was not shown to be a useful prognostic indicator in women over 50 years, treated with AET.

AB - Background: Oestrogen-receptor positive breast cancer patients are typically treated with adjuvant endocrine therapy (AET), some develop AET resistance. Previous research suggests mammographic density (MD) may represent an imaging biomarker, with fewer local or distant recurrences occurring with decreasing MD. We investigate whether reduction in MD after 1 and/or 3 years is associated with improved breast cancer specific survival (BCSS), metastasis-free survival (MFS) or disease-free survival (DFS).Methods: This retrospective cohort study was generated from a Mammo-50 trial subset. Participants taking AET (cases) and controls were included. MD was assessed in the AET group using a 0-100% visual analogue scale (VAS). Readers scored mammograms at diagnosis, 1 year and 3 years post-surgery. A decrease in MD was defined as ≥10% reduction from diagnosis. A second reader reviewed paired mammograms and assessed whether there had been a temporal change in MD.Results: Data from 1364 cases and 367 controls were included. Median VAS MD was approximately 30% for cases and controls at all time-points; 20% showed decreased MD at 1 year and 21% at 3 years for both cases and controls. Of the AET group, 23 died from breast cancer and 33 developed metastases during follow-up (median 8.7 years post-surgery). The 5-year BCSS rate was 99.6% (95%CI:97.4-99.9) versus 98.3% (95%CI:97.2-98.9) for those with and without a ≥10% reduction in MD at 1 year, p=0.35. The 5-year MFS rate for those with and without a ≥10% reduction in MD at 1 year was 94.2% (95%CI:90.7-96.4) versus 93.6% (95%CI:92.0-95.0) respectively; p=0.47. The 5-year DFS rate for those with a ≥10% reduction in MD at 1year was 92.4% (95% CI:88.5-94.9) versus 92.6% (95%CI:90.8-94.0); p= 0.47. Similar results for BCSS, MFS and DFS were seen for those with and without a ≥10% reduction in MD at 3 years and for those assessed as having a definite reduction in MD compared to those who had not at both 1 and 3 years.Conclusion: Reduction in MD had no significant association with rates of BCSS, MFS or DFS. Change in MD was not shown to be a useful prognostic indicator in women over 50 years, treated with AET.

KW - Humans

KW - Female

KW - Breast neoplasms/pathology

KW - Middle aged

KW - Breast density

KW - Neoplasm recurrence, Local/pathology

KW - Mammography

KW - Mastectomy, Segmental

KW - Retrospective studies

KW - Aged

KW - Adult

KW - Chemotherapy, Adjuvant

KW - Antineoplastic agents, Hormonal/therapeutic use

KW - Prognosis

KW - Disease-free survival

U2 - 10.1186/s13058-026-02239-2

DO - 10.1186/s13058-026-02239-2

M3 - Article

C2 - 41715137

SN - 1465-5411

VL - 28

SP - 1

EP - 10

JO - Breast Cancer Research

JF - Breast Cancer Research

M1 - 62

ER -

Change in mammographic density as a potential predictor of cancer recurrence after breast conservation surgery and adjuvant endocrine therapy: results of the MEDICI study

Abstract

UN SDGs

Keywords

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