3D mammography’s screening performance improves with patient age
The performance of digital breast tomosynthesis—commonly referred to as 3D mammography—improves steadily with patient age, underlying the effectiveness of screening in an elderly population.
That’s according to new large-scale research from Massachusetts General Hospital, published Friday in RSNA’s Radiology Imaging Cancer.
Current mammography guidelines remain largely age-based, with the influential U.S. Preventive Services Task Force’s last update in 2024 advocating for screening starting at 40. However, USPSTF claimed current evidence was insufficient to weigh the benefit of screening for women 75 and older.
Researchers with the Harvard University-affiliated institution recently sought to address this knowledge gap, analyzing data from over 300,000 mammograms. They found screening to be increasingly effective, particularly among the elderly, based on common quality benchmarks.
“Cancer detection and sensitivity increased, false-positive rates declined, and specificity improved, resulting in particularly strong performance among female individuals aged 70 years and older,” lead author Leslie R. Lamb, MD, MSc, with Boston-based Mass General’s Department of Radiology, and colleagues wrote Oct. 23. “These findings provide a contemporary benchmark for screening DBT performance across age groups and contribute to the ongoing reassessment of age-based screening guidelines,” they added later.
The study’s sample included a total of about 303,000 mammography exams administered to nearly 94,000 women at a single academic medical center between 2013 and mid-2019. Cancer detection rates increased from 2.9 per 1,000 exams among women in their 40s up to 8.3 per 1,000 for those in their 70s—representing “meaningful diagnostic yield.” Screening mammography’s performance was even better among patients 80 and up, at 10.6 cancer cases detected per 1,000 exams.
Sensitivity—or how well a scan performs at correctly identify those who have cancer—increased from 72.5% among women in their 40s up to 91.7% for those in their 70s. Meanwhile, the recall rate was highest among women in their 40s (about 9.3%) and lowest for individuals 80 or older (5.5%). Specificity—or the ability of a mammogram to correctly identify those who don’t have cancer—also rose with age, from 91% to 95.5% among those same two age groups. Positive predictive value similarly rose with age, from 3.2% for women in their 40s up to 19.2% among women 80 or older.
“These findings carry important implications for ongoing debates surrounding the initiation and cessation ages for screening mammography,” the authors charged.
While USPSTF has expressed uncertainty around mammography after age 74, medical societies such as the American College of Radiology recommend screening beyond this age, provided the patient is healthy.
“Our findings support the latter approach,” Lamb and co-authors charged. “However, screening decisions should also consider patient comorbidities, life expectancy, functional status, treatment-related morbidity, and patient preferences.”
Conversely, the “acceptable” performance among women in their 40s also supports the practice of initiating breast cancer screening early in one’s life, they added.
“These findings highlight the limitations of strictly age-based screening paradigms and underscore the need for individualized, risk-adapted screening strategies that consider both health status and imaging performance,” Lamb and colleagues wrote.
Read more, including potential study limitations and future research opportunities, in the Radiological Society of North America’s Radiology: Imaging Cancer.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.