News | Mammography | November 28, 2016

Large Study Finds No Evidence for Age-Based Mammography Cut-Off

Data analysis of more than 5 million mammograms reveals continued increase in cancer detection rate, positive predictive value of mammography for women ages 75-90

mammography, age cut-off, clinical study, RSNA 2016, Cindy Lee

November 28, 2016 — In the largest-ever study on screening mammography outcomes, researchers found that there is no clear cut-off age to stop breast cancer screening. The findings were presented at the annual meeting of the Radiological Society of North America (RSNA), Nov. 27-Dec. 1 in Chicago. This research adds support for guidelines that encourage screening decisions based on individual patients and their health status.

Mammography is the standard imaging exam for breast cancer screening. Guidelines on what age to stop breast cancer screening have been a source of controversy and confusion in recent years. In 2009, the United States Preventive Services Task Force (USPSTF) released new guidelines that stated there was not enough evidence to assess the balance of benefits and harms of screening mammography in women aged 75 years or older.

"All prior randomized, controlled trials excluded women older than 75, limiting available data to small observational studies," said Cindy S. Lee, M.D., assistant professor in residence at the University of California, San Francisco. "There has been a lot of controversy, debate and conversation regarding the different breast cancer screening guidelines, even among major national organizations, over the past few years."

Using data from the National Mammography Database, Lee and her research team analyzed data from more than 5.6 million screening mammograms performed over a seven-year period between January 2008 and December 2014 in 150 facilities across 31 states in the United States. The research team looked at patient demographics, screening mammography results and biopsy results. Data from more than 2.5 million women over age 40 were sorted into patient groups by age in five-year intervals (40-44, 45-49, etc.).

Four standard performance metrics were calculated to evaluate the performance of screening mammography for each age group: cancer detection rate, recall rate, positive predictive value for biopsy recommended (PPV2) and biopsy performed (PPV3). Recall rate is the percentage of patients called back for follow-up testing after a screening exam. Positive predictive value reflects the percentage of cancers found among exams for which biopsy was recommended or performed. Ideal screening performances would have a higher cancer detection rate, PPV2 and PPV3, and a low recall rate.

Overall, researchers found mean cancer detection rate of 3.74 per 1,000 patients, recall rate of 10 percent, PPV2 of 20 percent and PPV3 of 29 percent. Based on increasing age from 40 to 90 years old, these performance metrics demonstrated a gradual upward trend for cancer detection rate, PPV2 and PPV3, but a downward trend in recall rate.

"The continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation," Lee said.

The findings lend support to the argument that the decision whether or not to stop screening should be informed by an individual's personal health history and preferences.

"We know that the risk of breast cancer increases with age," Lee said. "With the uncertainty and controversy about what age to stop breast cancer screening, we want to address this gap in knowledge using a large national database."

For more information: www.rsna.org

Related Content

Rebrand reflects Volpara Health's mission to prevent advanced-stage breast cancer
News | Breast Imaging | October 19, 2020
October 19, 2020 — Volpara Solutions, a leader in AI-powered breast density assessment, announced that it has changed
More than 600,000 women die of advanced breast cancer annually. (1) There is a safe, universally obtainable method to reduce this terrible toll according to MammaCare Foundation scientist Mark Kane Goldstein, Ph.D.

Module 1

News | Women's Health | October 15, 2020
October 15, 2020 — More than 600,000 women die of advanced breast cancer annually. ...
Conducted by the University of Gothenburg, Lund University and the University of South Australia, the preclinical study found that dietary oat bran can offset chronic gastrointestinal damage caused by radiotherapy, contradicting long-held clinical recommendations.

Getty Images

News | Radiation Therapy | October 07, 2020
October 7, 2020 — Loved or hated, the humble oat could be the new superfood for cancer patients as international ...
Released in the lead up to #DenseBreastDay (30 September) and Breast Cancer Awareness Month (October), the animation explains how breast density can complicate mammogram screening and make it harder for medical professionals to detect breast cancer. This highly engaging animation shows a polar bear hiding in a snow globe as an analogy for cancer hiding in dense breast tissue. 

Image provided by Dilon

News | Breast Density | October 07, 2020
October 7, 2020 — A group of Australia’s leading breast can...
A, Sagittal reformatted bone window CT image of thoracic spine shows wedge-shaped deformity at T6 and subtle superior endplate deformities at T5 and T8. Arrows denote deformities. B, Color-coded dual-energy CT shows only T8 deformity is associated with bone marrow edema; T5 and T6 deformities likely represent chronic fractures. Arrows denote deformities.

A, Sagittal reformatted bone window CT image of thoracic spine shows wedge-shaped deformity at T6 and subtle superior endplate deformities at T5 and T8. Arrows denote deformities. B, Color-coded dual-energy CT shows only T8 deformity is associated with bone marrow edema; T5 and T6 deformities likely represent chronic fractures. Arrows denote deformities.

News | Computed Tomography (CT) | October 06, 2020
Microscopic photo of a professionally prepared slide demonstrating breast tissue with ductal carcinoma in situ (DCIS). Immuhistochemistry of estrogen receptor positive. Micrograph of breast cancer. Slide shows corresponding length of 1 mm.

Microscopic photo of a professionally prepared slide demonstrating breast tissue with ductal carcinoma in situ (DCIS). Immuhistochemistry of estrogen receptor positive. Micrograph of breast cancer. Slide shows corresponding length of 1 mm. Getty Images

News | Breast Imaging | October 05, 2020
October 5, 2020 — A major study of women with ductal carcinoma in situ (...