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Recent studies have found that risk prediction might be improved by redefining MDA in effect at higher\u2010than\u2010conventional intensity thresholds. We assessed whether such higher\u2010intensity MDA measures gave stronger prediction of subsequent contralateral breast cancer (CBC) risk using the Women's Environment, Cancer, and Radiation Epidemiology (WECARE) Study, a population\u2010based CBC case\u2010control study of \u22651\u00a0year survivors of unilateral breast cancer diagnosed between 1990 and 2008. Three measures of MDA for the unaffected contralateral breast were made at the conventional intensity threshold (\u201c<jats:italic>Cumulus<\/jats:italic>\u201d) and at two sequentially higher\u2010intensity thresholds (\u201c<jats:italic>Altocumulus\u201d<\/jats:italic> and \u201c<jats:italic>Cirrocumulus\u201d<\/jats:italic>) using the CUMULUS software and mammograms taken up to 3\u2009years prior to the first breast cancer diagnosis. The measures were fitted separately and together in multivariable\u2010adjusted logistic regression models of CBC (252 CBC cases and 271 unilateral breast cancer controls). The strongest association with CBC was MDA defined using the highest intensity threshold, <jats:italic>Cirrocumulus<\/jats:italic> (odds ratio per adjusted SD [OPERA] 1.40, 95% CI 1.13\u20101.73); and the weakest association was MDA defined at the conventional threshold, <jats:italic>Cumulus<\/jats:italic> (1.32, 95% CI 1.05\u20101.66). In a model fitting the three measures together, the association of CBC with <jats:italic>Cirrocumulus<\/jats:italic> was unchanged (1.40, 95% CI 0.97\u20102.05), and the lower brightness measures did not contribute to the CBC model fit. These results suggest that MDA defined at a high\u2010intensity threshold is a better predictor of CBC risk and has the potential to improve CBC risk stratification beyond conventional MDA measures.<\/jats:p>","DOI":"10.1002\/ijc.34001","type":"journal-article","created":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T11:05:13Z","timestamp":1647947113000},"page":"1304-1309","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association of contralateral breast cancer risk with mammographic density defined at higher\u2010than\u2010conventional intensity thresholds"],"prefix":"10.1002","volume":"151","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2024-0015","authenticated-orcid":false,"given":"Gordon P.","family":"Watt","sequence":"first","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center  New York New York 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