Tomosynthesis vs Conventional Mammography: Breast Cancer Detection in the Elderly
Publication Title: Tumor characteristics associated with tomosynthesis versus digital mammography in older women with screen-detected breast cancer
Summary
- Question
This study evaluated whether digital breast tomosynthesis (DBT), a 3D imaging technique for breast cancer screening, offers advantages over conventional digital mammography (DM) in detecting more favorable tumor characteristics, such as smaller size, lower grade, and absence of lymph node involvement, in women aged 75 and older compared to those aged 67–74.
- Why it Matters
- Breast cancer screening aims to identify cancers at an early, treatable stage. DBT has shown promise in improving detection of invasive and smaller tumors in women under 75, but its benefits for older women remain unclear. Understanding whether DBT improves outcomes for women 75 and older is crucial, as this age group often faces unique risks like overdiagnosis and overtreatment. The findings could inform screening guidelines and enhance care for aging populations.
- Methods
- Researchers conducted a retrospective study using SEER-Medicare data from 2015 to 2021. They analyzed 17,201 women aged 67 and older diagnosed with estrogen receptor-positive (ER+)/HER2-negative breast cancer through routine screening. Participants were grouped by age (67–74 and 75+), and the screening modality (DBT vs. DM) was compared for tumor size, grade, lymph node involvement, and histology (invasive lobular carcinoma vs. other types).
- Key Findings
Among women aged 67–74, DBT was associated with detecting smaller tumors, lower-grade cancers, absence of lymph node involvement, and more invasive lobular carcinoma (ILC) cases compared to DM. However, for women aged 75 and older, DBT was only linked to lower-grade and node-negative tumors. It was not associated with detection of smaller tumors or ILC in this age group. These results suggest DBT's incremental benefits may diminish with age.
- Implications
The findings indicate that while DBT enhances detection of favorable tumor characteristics in women aged 67–74, its benefits for women 75 and older may be more limited. Tailored screening strategies might better balance the benefits and risks for older women.
- Next Steps
Future research should assess whether DBT’s detection of favorable tumor characteristics in older women translates into improved clinical outcomes, such as survival or reduced treatment burden. Additional studies are needed to explore the impact of breast density and comorbidities on DBT’s effectiveness in this age group.
- Funding Information
- This research was supported by grant PASD-RSG-23-1155786-01 from the American Cancer Society. Yale University also provided funding and support for this research.
Full Citation
Authors
Michaela Dinan, PhD
Last AuthorProfessor of Epidemiology (Chronic Diseases)