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Background Higher categories of background parenchymal enhancement (BPE) increase breast cancer risk. However, current clinical BPE categorization is subjective. Objective Using a semi-automated segmentation algorithm, we calculated quantitative BPE measures and investigated the utility of individual features and feature pairs to significantly predict subsequent breast cancer risk, compared to radiologist-assigned BPE category. Methods In this retrospective case control study, we identified 95 high risk women without a personal history