title: Performance of digital screening mammography among older women in the United States.
abstract: BACKGROUND
  Although healthy women aged 65 years have a life expectancy of 20 years, there is a paucity of data on the performance of digital screening mammography among these women. The authors examined the performance and outcomes of digital screening mammography among a national group of women aged ≥65 years.
  
  
  METHODS
  From Breast Cancer Surveillance Consortium data for the years 2005 to 2011, the authors included 296,496 full-field digital screening mammograms among 133,042 women ages ≥65 years without a history of breast cancer. Sensitivity, specificity, positive predictive value (PPV1 ), recall rates, and 95% confidence intervals (95% CIs) were calculated across the spectrum of age and breast density. Multivariate logistic regression was used to compare mammography accuracy, cancer-detection rates (CDRs), and tumor characteristics by age and breast density.
  
  
  RESULTS
  Multivariate analyses revealed a significant decrease in the recall rate with age (P for linear trend [Ptrend ] < .001) and significant increases in specificity, PPV1 , and CDR with age (Ptrend  < .001, Ptrend  < .001, and Ptrend  = .01, respectively). Sensitivity did not vary significantly with age. Among women with cancer, the proportion with invasive disease increased with age from 76% at ages 65 to 74 years to 81% at ages ≥80 years. There was a higher proportion of late stage cancers and positive lymph nodes among women ages 65 to 74 years compared with women in the older age groups.
  
  
  CONCLUSIONS
  The specificity, PPV1 , recall rate, and CDR of digital screening mammography improved with increased age. In addition, as age increased, the proportion of women with invasive versus ductal carcinoma in situ rose, whereas the proportion of women with positive lymph nodes decreased.
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Henderson
authors.forename: Ellen S
authors.initials: ES
authors.lastname: O'Meara
authors.forename: Dejana
authors.initials: D
authors.lastname: Braithwaite
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D014481:United States
keywords: breast cancer; cancer-detection rate; digital mammography; older women; positive predictive value; screening; sensitivity; specificity