Study shows older women benefit particularly when screened with DBT

Mammography remains an effective method for breast cancer screening in women ages 65 and older, with tomosynthesis improving screening performances even more, according to a recent study (Bahl M  et al. Digital 2D versus Tomosynthesis Screening Mammography among Women Aged 65 and Older in the United States. Radiology. 2019 Jun;291: 582. doi: 10.1148/radiol.2019181637).

For several years now, the FDA-approved procedure of tomosynthesis (DBT), has increasingly been used as an adjunct to Digital Mammography. (DM)  However the benefits of breast cancer screening in older women have been subject to debate. The United States Preventive Services Task Force recommends screening mammography only until the age of 74,

In a new study, researchers compared screening mammograms from more than 15,000 women (mean age 72.7 years) who underwent DM with those of more than 20,000 women (mean age 72.1 years) who underwent DBT. Both approaches were highly effective at detecting cancer, but tomosynthesis had some advantages over the 2-D approach, including a reduction in false-positive examinations. Tomosynthesis also had a higher PPV, and higher specificity, than DM.

We’ve shown that screening mammography performs well in older women, with high cancer detection rates and low false-positives, and that tomosynthesis leads to even better performance than conventional 2-D mammography,” said study lead Dr. M Bahl, . “For example, the percentage recall rate iss lower with tomosynthesis than with conventional 2-D mammography. We also found that fewer cancers detected with tomosynthesis were lymph node-positive, suggesting that we are detecting cancers at an earlier stage. Detecting breast cancers at an early stage is the goal of screening mammography.

The study results do not support a specific age cutoff age for mammography screening, according to Dr. Bahl. She said that guidelines for screening in older women should be based on individual preferences, life expectancy and health status rather than age alone.

Our research demonstrates that DM and DBT perform well in older women with regard to cancer detection and false-positives,” she said. “So, if a woman is healthy and would want her cancer to be treated if it were detected, then she should continue screening.”

Dr. Bahl expects the combination of DM and tomosynthesis to eventually become the standard for screening at all practices.

Since tomosynthesis is still a relatively new technology, more research is needed to determine its impact on long-term patient outcomes, Dr. Bahl said.

doi: 10.1148/radiol.2019181637