Assessment of Glandularity-Adipose Ratio for Breast Density Using Digital Mammography: A Study on Population-Specific Turkish Women Breast Images and Implications for Phantom Production

This study is aimed to determine the G/A ratios of healthy breast tissue among Turkish women and to present age-specific breast density profiles. Furthermore, tissue-equivalent phantoms replicating the observed G/A ratios were fabricated for use in mammography system testing and calibration.Digital mammographic images were obtained from women aged 30 to 84 years, and a custom MATLAB algorithm was used to evaluate a total of 2,000 images. The algorithm utilized intensity-based thresholding to identify and segment glandular and total breast areas, allowing the calculation of G/A ratios based on pixel counts.The average G/A ratios were found to be: 36/64% for ages 30–39, 31/69% for ages 40–49, 24/76% for ages 50–59, and 17/83% for women over 60. These findings confirmed an age-related decline in glandular content, in agreement with global trends. However, the study also highlighted significant deviations from the standard 50/50% ratio often used in simulations and phantom designs. For instance, the 30–39 age group showed a 28% deviation from this standard, emphasizing the need for population-specific breast models in clinical practice and imaging research.Since breast density defined by the G/A ratio is an established indicator of breast cancer risk, accurate and population specific determination is essential for effective risk assessment and clinical imaging. [5]. In this context, this case study conducted on healthy Turkish women shows that breast tissue composition, consisting of glandular and adipose components, varies among individuals depending on factors such as mainly age, body composition, and race.