The benefits versus harms of breast cancer screening for women under the age of 50 has been the subject of intense debate. New guidelines from the American Cancer Society suggest screening should begin at age 45 and women of ages 40-44 should have the opportunity to begin screening. In this study, we investigate if the addition of tomosynthesis to mammography could improve screening performance outcomes for women under the age of 50.
METHOD AND MATERIALSScreening performance data was collected from a network of community based screening centers from January 1, 2015 to December 31, 2015. Data for women under 50 years of age from 65,457 screening exams (45,320 mammography exams and 20,137 tomosynthesis plus mammography exams) were evaluated. Women screened with tomosynthesis plus mammography paid an out-of-pocket fee. Screening performance parameters including recall rate, cancer detection rate and invasive cancer detection rate were investigated. Chi square test was performed.
RESULTSRates per 1000 women screened are presented. Recall rates were 115 for mammography alone and 108 for tomosynthesis plus mammography; difference 7 (p=0.013). Cancer detection rates were 2.1 for mammography compared to 3.1 with the addition of tomosynthesis; difference 1.0 (p =0.021). Invasive cancer detection rates improved from 1.2 to 1.8 with the addition of tomosynthesis; difference 0.8 (p=0.014). This represented a relative increase in invasive cancer detection of 67%. The positive predictive value for recall increased from 1.8% to 2.8% with the addition of tomosynthesis.
CONCLUSIONThe addition of tomosynthesis to mammography significantly improved recall rates, cancer detection and invasive cancer detection for women under the age of 50. The results confirm that improvements observed with tomosynthesis screening in the general screening population are also observed for the subgroup of women under the age of 50.
CLINICAL RELEVANCE/APPLICATIONFor women less than 50 years of age, the addition of tomosynthesis to mammography provides improved screening performance with significantly lower recall rates and higher invasive cancer detection.