Risk-Based Screening Mammography for Women Aged <40: Outcomes From the National Mammography Database |
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| Institution: | 1. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;2. Department of Radiology, New York University Langone Health, Garden City, New York;3. Center for Research and Innovation, ACR, Reston, Virginia;4. Department of Quality and Safety, ACR, Reston, Virginia;5. Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;6. Department of Radiology, Beth Israel Deaconess Medical Center, Cambridge, Massachusetts;1. Radiology Partners, El Segundo, California;2. Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, Georgia;1. Department of Medicine, Mayo Clinic, Rochester, Minnesota;2. Biostatistics, Mayo Clinic, Rochester, Minnesota;3. Medical Physics, Mayo Clinic, Rochester, Minnesota;4. Health Sciences Research, Mayo Clinic, Rochester, Minnesota;1. Department of Radiology Mayo Clinic, Jacksonville, Florida;2. Department of Radiology, Mayo Clinic, Rochester, Minnesota;3. PM Information Technology, Mayo Clinic, Rochester, Minnesota;4. Deloitte Consulting, LLP, Minneapolis, Minnesota;1. Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island;2. Lifespan Biostatistics Core, 593 Eddy Street, Providence, Rhode Island |
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| Abstract: | ObjectiveThere is insufficient large-scale evidence for screening mammography in women <40 years at elevated risk. This study compares risk-based screening of women aged 30 to 39 with risk factors versus women aged 40 to 49 without risk factors in the National Mammography Database (NMD).MethodsThis retrospective, HIPAA-compliant, institutional review board–exempt study analyzed data from 150 NMD mammography facilities in 31 states. Patients were stratified by 5-year age intervals, availability of prior mammograms, and specific risk factors for breast cancer: family history of breast cancer, personal history of breast cancer, and dense breasts. Four screening performance metrics were calculated for each age and risk group: recall rate (RR), cancer detection rate (CDR), and positive predictive values for biopsy recommended (PPV2) and biopsy performed (PPV3).ResultsData from 5,986,131 screening mammograms performed between January 2008 and December 2015 in 2,647,315 women were evaluated. Overall, mean CDR was 3.69 of 1,000 (95% confidence interval: 3.64-3.74), RR was 9.89% (9.87%-9.92%), PPV2 was 20.1% (19.9%-20.4%), and PPV3 was 28.2% (27.0%-28.5%). Women aged 30 to 34 and 35 to 39 had similar CDR, RR, and PPVs, with the presence of the three evaluated risk factors associated with significantly higher CDR. Moreover, compared with a population currently recommended for screening mammography in the United States (aged 40-49 at average risk), incidence screening (at least one prior screening examination) of women aged 30 to 39 with the three evaluated risk factors has similar cancer detection rates and recall rates.DiscussionWomen with one or more of these three specific risk factors likely benefit from screening commencing at age 30 instead of age 40. |
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| Keywords: | Mammography National Mammography Database risk-based screening younger women |
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