The Impact of Lifestyle and Environmental Factors on the Detectability of Breast Cancer by Mammography: Implications for the Personalization of Screening Tests - Literature Review

Introduction and objective: Breast cancer remains the most commonly diagnosed cancer in women worldwide and one of the leading causes of cancer deaths in the female population (Sung et al., 2021). Despite advances in diagnosis and treatment, early detection of the disease remains a key factor in improving prognosis. Mammography is the primary screening method, but its diagnostic effectiveness varies and depends on many biological, hormonal, environmental, and lifestyle factors. Particular importance is attached to mammographic breast density, which simultaneously increases the risk of disease and reduces the sensitivity of the test by masking cancerous changes. A growing body of evidence suggests that lifestyle and environmental exposure can modify the structure of fibro-glandular tissue, affect its quantitative composition and radiological properties, and thus influence the detectability of cancerous changes. The aim of this review was to comprehensively analyze the impact of lifestyle factors and environmental exposures on the detectability of breast cancer in mammography, with a particular focus on potential biological mechanisms and clinical implications. Methods: A literature review was conducted in the PubMed database covering English-language publications from 2000 to 2025. Cohort studies, case-control studies, meta-analyses, and systematic reviews on the relationship between lifestyle, environmental factors, breast density, and mammography effectiveness were analyzed. Publications discussing radiological assessment standards, including the BI-RADS classification, were also included. Conclusions: Available data indicate that lifestyle and environmental factors may influence the structure and composition of breast glandular tissue, modulating mammographic density and thus the sensitivity of screening. Incorporating these factors into personalized screening strategies may improve breast cancer detection, particularly in high-risk populations and women with high breast density.