Yale School of Medicine, New Haven, CT, USA.
Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA.
J Gen Intern Med. 2022 Jun;37(8):1870-1876. doi: 10.1007/s11606-021-07132-6. Epub 2021 Sep 30.
Digital breast tomosynthesis (DBT) has become a prevalent mode of breast cancer screening in recent years. Although older women are commonly screened for breast cancer, little is known about screening outcomes using DBT among older women.
To assess proximal screening outcomes with DBT compared to traditional two-dimensional(2-D) mammography among women 67-74 and women 75 and older.
Cohort study.
Medicare fee-for-service beneficiaries aged 67 years and older with no history of prior cancer who received a screening mammogram in 2015.
Use of subsequent imaging (ultrasound and diagnostic mammography) as an indication of recall, breast cancer detection, and characteristics of breast cancer at the time of diagnosis. Analyses used weighted logistic regression to adjust for potential confounders.
Our study included 26,406 women aged 67-74 and 17,001 women 75 and older who were screened for breast cancer. Among women 75 and older, the rate of subsequent imaging among women screened with DBT did not differ significantly from 2-D mammography (91.8 versus 97.0 per 1,000 screening mammograms, p=0.37). In this age group, DBT was associated with 2.1 additional cancers detected per 1,000 screening mammograms compared to 2D (11.5 versus 9.4, p=0.003), though these additional cancers were almost exclusively in situ and stage I invasive cancers. For women 67-74 years old, DBT was associated with a higher rate of subsequent imaging than 2-D mammography (113.9 versus 100.3, p=0.004) and a higher rate of stage I invasive cancer detection (4.7 versus 3.7, p=0.002), but not other stages.
Breast cancer screening with DBT was not associated with lower rates of subsequent imaging among older women. Most additional cancers detected with DBT were early stage. Whether detecting these additional early-stage cancers among older women improves health outcomes remains uncertain.
数字乳腺断层摄影术（DBT）近年来已成为乳腺癌筛查的主要模式。尽管老年女性通常接受乳腺癌筛查，但关于 DBT 在老年女性中的筛查结果知之甚少。
评估与传统二维（2-D）乳房 X 线摄影相比，DBT 在 67-74 岁和 75 岁及以上女性中的近端筛查结果。
队列研究。
2015 年接受筛查性乳房 X 线摄影的无既往癌症史的 Medicare 按服务项目付费的 67 岁及以上受益人群。
后续影像学（超声和诊断性乳房 X 线摄影）的使用作为召回、乳腺癌检出和诊断时乳腺癌特征的指标。分析使用加权逻辑回归来调整潜在混杂因素。
我们的研究纳入了 26406 名 67-74 岁和 17001 名 75 岁及以上接受乳腺癌筛查的女性。在 75 岁及以上的女性中，DBT 筛查组与 2-D 乳房 X 线摄影组的后续影像学检查率无显著差异（每 1000 次筛查性乳房 X 线摄影分别为 91.8 次和 97.0 次，p=0.37）。在这个年龄组中，与 2D 相比，DBT 每 1000 次筛查性乳房 X 线摄影可多检出 2.1 例癌症（11.5 例比 9.4 例，p=0.003），但这些额外的癌症几乎全部为原位癌和 I 期浸润性癌。对于 67-74 岁的女性，DBT 与 2-D 乳房 X 线摄影相比，后续影像学检查率更高（113.9 次比 100.3 次，p=0.004），I 期浸润性癌检出率也更高（4.7 例比 3.7 例，p=0.002），但其他分期没有差异。
DBT 乳腺癌筛查并未降低老年女性的后续影像学检查率。用 DBT 检测到的大多数额外癌症均为早期。在老年女性中检测到这些额外的早期癌症是否能改善健康结局尚不确定。
