Performance of Digital Screening Mammography Among Older Women in the United States

BACKGROUNDAlthough healthy women aged 65 years have a life expectancy of 20 years, there is a paucity of data on the performance of digital screening mammography among these women. The authors examined the performance and outcomes of digital screening mammography among a national group of women aged 65 years. METHODSFrom Breast Cancer Surveillance Consortium data for the years 2005 to 2011, the authors included 296,496 full-field digital screening mammograms among 133,042 women ages 65 years without a history of breast cancer. Sensitivity, specificity, positive predictive value (PPV1), recall rates, and 95% confidence intervals (95% CIs) were calculated across the spectrum of age and breast density. Multivariate logistic regression was used to compare mammography accuracy, cancer-detection rates (CDRs), and tumor characteristics by age and breast density. RESULTSMultivariate analyses revealed a significant decrease in the recall rate with age (P for linear trend [P-trend]<.001) and significant increases in specificity, PPV1, and CDR with age (P-trend<.001, P-trend<.001, and P-trend=.01, respectively). Sensitivity did not vary significantly with age. Among women with cancer, the proportion with invasive disease increased with age from 76% at ages 65 to 74 years to 81% at ages 80 years. There was a higher proportion of late stage cancers and positive lymph nodes among women ages 65 to 74 years compared with women in the older age groups. CONCLUSIONSThe specificity, PPV1, recall rate, and CDR of digital screening mammography improved with increased age. In addition, as age increased, the proportion of women with invasive versus ductal carcinoma in situ rose, whereas the proportion of women with positive lymph nodes decreased. Cancer 2015;121:1379-1386. (c) 2014 American Cancer Society. The specificity, positive predictive value, recall rate, and cancer-detection rate of digital screening mammography all improve with increasing age. The current results indicate that, as age increases, the proportion of women with invasive breast cancer versus ductal carcinoma in situ rises, whereas the proportion of women with positive lymph nodes decreases.