Age-Related Controversy in Breast Cancer Screening: Unveiling the Impact on Interpretation Rates
The age-old question of breast cancer screening just got more complex. Recent research presented at RSNA 2025 reveals a surprising twist in abnormal interpretation rates for combined digital breast tomosynthesis (DBT) and whole-breast ultrasound (WBUS) among women of different ages.
Here's the intriguing part: For women under 65, the abnormal interpretation rate is lower when combining DBT with WBUS compared to DBT alone. But, and this is where it gets controversial, for women 65 and older, the rates are similar regardless of the screening method.
Dr. Liane Philpotts from Yale University shared her team's findings, emphasizing that same-day WBUS can detect significant cancers missed by DBT without drastically changing abnormal interpretation rates, and even improving them in some cases.
Breast density and cancer rates are known to vary with age, with older women often having less dense breasts. However, the risk of breast cancer increases with age, and screening ultrasound is a recommended supplemental method for women with dense breasts.
The FDA's 2023 mandate requires breast density disclosure, yet Medicare denies coverage for supplemental ultrasound in these cases. This discrepancy raises questions about access to comprehensive screening.
Philpotts and her colleagues delved into this issue by studying abnormal interpretation rates and supplemental cancer detection using WBUS alongside DBT, comparing these findings with women not receiving WBUS, all categorized by age.
Their study analyzed an impressive 93,189 DBT screenings over three years. Among women under 65, 60,152 screenings were conducted, with 39% being dense breasts, and 62% undergoing same-day DBT and WBUS. In the 65 and older group, 33,037 screenings were performed, with 26% being dense, and 69% receiving same-day DBT and WBUS.
Interestingly, the younger group had higher abnormal interpretation rates for DBT alone, but this difference vanished in the older group when DBT was combined with WBUS.
But here's where it gets even more intriguing:
| Cohort | DBT Alone | DBT + WBUS | p-value |
| ------ | --------- | --------- | ------ |
| < 65 years | 16.6% | 12.5% | < 0.0001 |
| 65 years and older | 8.1% | 9.1% | 0.13 |
WBUS detected an additional 24 cancers, with a supplemental cancer detection rate of 1.1 per 1,000 screenings. This included 23 invasive cancers and one ductal carcinoma in situ (DCIS), evenly split between the younger and older cohorts.
The positive predictive value was significantly higher in older women (p = 0.024), indicating a more accurate detection of supplemental cancers when combined with DBT.
In conclusion, while combined DBT and WBUS in older women with dense breasts may not significantly change abnormal interpretation rates, it excels in accurately identifying supplemental cancers. This finding adds a new layer to the ongoing debate on age-specific screening strategies and the importance of comprehensive detection methods.
What are your thoughts on this controversial topic? Do you think age should play a more significant role in determining screening methods, or should other factors be considered? Share your insights in the comments below!
