Mass General Hospital Study of 300,000 Mammograms Finds 3D Screening Works Better With Age

Three-dimensional mammogram screening works better as women get older, and it already meets national quality benchmarks for women in their 40s, according to a study led by a Massachusetts General Hospital breast radiologist. Dr. Manisha Bahl described the findings on Friday, Nov. 13, in Diagnostic Imaging.^[1]

The research adds to The Boston Report’s Mass General Hospital news coverage of the hospital’s women’s health research.

What the study found

Bahl’s team reviewed more than 300,000 screening digital breast tomosynthesis exams, the 3D form of mammography, in about 94,000 women at a single academic medical center between 2013 and 2019. The study, published in the journal Radiology: Imaging Cancer, compared five age groups from 40–49 to 80 and older and checked each result against one year of follow-up.^[1]

The cancer detection rate rose with age, from 2.9 cancers per 1,000 exams among women in their 40s to 8.3 among women in their 70s and 10.6 among women 80 and older. The rate for women in their 40s exceeds the American College of Radiology’s minimum benchmark of 2.5 per 1,000.^[1]

Sensitivity, the share of cancers the screening caught, rose from 72.5% among women in their 40s to 91.7% in their 70s and stayed high at 88.2% among women 80 and older. The share of exams flagged as abnormal fell from 9.3% to 5.5%, and specificity rose from 91% to 95.5%, meaning older women had more cancers found and fewer false alarms. The trends held after adjusting for race, breast density, prior mammograms and which radiologist read the exam.^[1]

What it means for when to start and stop screening

Bahl said the results support starting screening at age 40, because 3D mammography met established benchmarks for women in their 40s.^[1] For women 75 and older, she said, the high detection rates and low recall rates suggest age alone may not be the best way to decide when to stop. She argued that decisions should instead depend on a woman’s overall health, life expectancy and preferences.^[1]

Limits of the research

The study came from one medical center, which may limit how well it applies elsewhere. Women who keep getting screened at older ages may also be healthier than those who stop. The research measured how well screening performed, not whether it saved lives, and it did not assess overdiagnosis or overtreatment, which Bahl called important considerations for older women.^[1]

Bahl is an associate professor at Harvard Medical School and a breast radiologist at Mass General.^[1] For more on the hospital, see our guide to visiting Mass General Hospital.

Sources

1. Diagnostic Imaging: Breast Imaging in Focus: How Does Digital Breast Tomosynthesis Perform Across Different Age Groups?

Additional sources

• Radiology: Imaging Cancer: Screening Digital Breast Tomosynthesis Performance across Age Groups (study abstract)

About the reporter: Nora Whitfield is an AI reporter covering Boston and Massachusetts news for The Boston Report. This article was produced with AI under our editorial policy. Read our AI and media disclosure.