Study: DBT Screening Boosts Cancer Detection in Older Women
Digital Breast Tomosynthesis Outperforms Age Cutoffs in Study of 93,000 Women
Screening digital breast tomosynthesis yields higher cancer detection rates and lower abnormal interpretation rates in older women, according to a study of 93,617 patients published October 23 in Radiology: Imaging Cancer.
Key Clinical Takeaways:
- Cancer detection rates for digital breast tomosynthesis rose from 2.9 per 1,000 exams in women aged 40 to 49 to 10.6 per 1,000 exams in patients aged 80 and older.
- Specificity climbed steadily across older cohorts, reaching 95.5 percent for women 80 and older while abnormal interpretation rates dropped to 5.5 percent.
- Researchers from Massachusetts General Hospital concluded that age alone should not dictate screening eligibility or cessation cutoffs.
Performance Metrics Across Age Groups
Led by Leslie Lamb, MD, and colleagues at Massachusetts General Hospital in Boston, the retrospective analysis examined 302,700 combined digital 2D mammography and DBT exams performed between 2013 and 2019. The team tracked true positives, false positives, true negatives, and false negatives based on one-year follow-up data.
| Measure | Ages 40 to 49 | Ages 50 to 59 | Ages 60 to 69 | Ages 70 to 79 | Ages 80 and Over |
|---|---|---|---|---|---|
| Sensitivity | 72.5% | 82.5% | 90.4% | 91.7% | 88.2% |
| Specificity | 91.0% | 94.0% | 94.9% | 95.1% | 95.5% |
| Positive predictive value | 3.2% | 6.5% | 11.3% | 14.4% | 19.2% |
| Abnormal interpretation rate | 9.3% | 6.4% | 5.7% | 5.7% | 5.5% |
The findings showed that sensitivity improved from 72.5 percent in the youngest cohort to 91.7 percent for women ages 70 to 79. Positive predictive values also scaled upward with age, starting at 3.2 percent for patients in their forties and reaching 19.2 percent for those 80 and older.
Challenging Current Screening Guidelines
Some U.S. screening guidelines recommend cessation at age 74, a cutoff the study authors challenge. While past investigations documented the potential harms of conventional 2D mammography for women 75 and older, data regarding DBT performance across advanced age brackets remained limited prior to this research.
These findings provide a contemporary benchmark for screening DBT performance across age groups and contribute to the ongoing reassessment of age-based screening guidelines,
Lamb and co-authors wrote.
Shahid Hussain, MBBS, from Combined Military Hospital Rawalpindi in Pakistan, noted in an accompanying editorial that the results demonstrate how age alone does not negatively affect screening performance. Hussain wrote that age should not serve as a surrogate for health status or life expectancy.
The researchers advocate for individualized, risk-adapted screening strategies that weigh overall health status and imaging performance rather than relying on age cutoffs. Future evaluations may incorporate artificial intelligence models derived from screening mammography to help clinicians determine personalized intervals, supplemental imaging needs, and optimal cessation timelines.
Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.