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

Prenatal MRI of a Zika fetus showing enlarged cerebral fluid space, dilation of the cerebral ventricles, thinning of brain tissue, poorly developed cerebellum and the absence of brain cortical gyri. (Image coutesy of RSNA)

Feature | Women's Health | January 23, 2017 | Dave Fornell
The rapid spread of Zika virus in the Western Hemisphere in the past year has caused great alarm in the United States
RSNA 2016, annual meeting highlights
News | Imaging | January 20, 2017
The Radiological Society of North America’s 102nd Scientific Assembly and Annual Meeting (RSNA 2016), held Nov. 27-Dec...
Materialise, AnatomyPrint, 3-D printing service, RSNA 2016, RSNA 2017, Carestream
Technology | 3-D Printing | January 19, 2017
Materialise NV has launched AnatomyPrint, an easy-to-use service for medical professionals that delivers 3-D printed...
breast cancer screening, substantial overdiagnosis, Annals of Internal Medicine study
News | Mammography | January 19, 2017
Breast cancer screening in Denmark was associated with a substantial increase in the incidence of nonadvanced tumors...
automated volumetric breast density, Elizabeth Wende Breast Care, EWBC, American Journal of Roentgenology, mammographic sensitivity
News | Breast Density | January 18, 2017
Researchers from Elizabeth Wende Breast Care (EWBC) have demonstrated that automated volumetric breast density has a...
Sponsored Content | Videos | Digital Radiography (DR) | January 18, 2017
Digital radiology is on the move like never before with the Carestream DRX-Revolution Mobile X-ray System.
Sponsored Content | Videos | Enterprise Imaging | January 18, 2017
Contributing Editor Greg Freiherr offers an overview of enterprise imaging advances at the Radiological Society of...
Sponsored Content | Videos | Enterprise Imaging | January 18, 2017
Agfa gathers digital data, processes it, then turns it into a sum greater than its parts.
Sponsored Content | Videos | Enterprise Imaging | January 18, 2017
Sectra provides industry-leading enterprise image management solutions comprising PACS for radiology, cardiology, and...
stress, brain activity, cardiovascular risk, PET-CT, MGH, ISSMS, The Lancet study
News | Neuro Imaging | January 18, 2017
A study led by Massachusetts General Hospital (MGH) and Icahn School of Medicine at Mount Sinai (ISSMS) investigators...
Overlay Init