No Clear Cut-Off Age To Stop Screening Mammograms Interview with:
Cindy Lee, MD

Assistant Professor
Department of Radiology and Biomedical Imaging
University of California San Francisco
San Francisco, CA What’s new about the research? How is it different than what’s come before?

• The largest study on the topic, including national data from 31 states in the United States. Including 5.7 million screening mammograms with follow up.
• All exams using digital techniques, up to date data, more representative of community practices in the U.S. Why do you feel this study is newsworthy? Public impact (if any)?

• All prior randomized control trials excluded women older than 75, limiting available data to small observational studies. Risk of breast cancer increases with age. There is uncertainty and controversy about when to stop breast cancer screening.
• This study addresses this gap in knowledge. Explain in laymen’s terms the methodology of the study:

Response: We analyzed 5.7 millions mammograms performed between 1/08-12/14 (7 years period) in 150 facilities across 31 U.S. states. We looked at patient demographics, screening mammogram results, and biopsy results. We separated the women by their ages in 5 years interval (40-44, 45-49, 50-54 years etc). Then we calculated 4 standard performance metrics to evaluate performance of screening mammography for each age group:
i. cancer detection rate (CDR) = number of cancers found per 1000 screening exams.
ii. Recall rate (RR) = % of screening exams followed by call-back for additional workup
iii. PPV2 = % of cancers found among cases recommended for biopsy
iv. PPV3 = % of cancers found among cases where biopsy was performed
An ideal screening performance would have a higher CDR and PPV, with a lower RR Explain in laymen’s terms the results of the study:

Response: Based on increasing age, there is an upward trend for CDR, PPV2 and PPV3, downward trend in recall rate, until age 90. Was funding provided for this research? If so, by whom?

Response: ACR staff. my time at UCSF. What is the single most exciting finding of this study?

Response: This study supports guidelines that base screening decisions on individual patient values, co-morbidities and health status. There is no clear age cut off to stop screening. Thank you for your contribution to the community.

Citation: RSNA 2016 Abstract
Current Era Screening Mammography Outcomes from the National Mammography Database, Involving Nearly 7 Million Examinations

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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