Breast Cancer Research and Treatment

, Volume 164, Issue 3, pp 659–666 | Cite as

Effect of age on breast cancer screening using tomosynthesis in combination with digital mammography

  • Elizabeth A. Rafferty
  • Stephen L. Rose
  • Dave P. Miller
  • Melissa A. Durand
  • Emily F. Conant
  • Debra S. Copit
  • Sarah M. Friedewald
  • Donna M. Plecha
  • Ingrid L. Ott
  • Mary K. Hayes
  • Kara L. Carlson
  • Thomas M. Cink
  • Lora D. Barke
  • Linda N. Greer
  • Loren T. Niklason
Clinical trial



To determine the effect of tomosynthesis imaging as a function of age for breast cancer screening.


Screening performance metrics from 13 institutions were examined for 12 months prior to introduction of tomosynthesis (period 1) and compared to those after introduction of tomosynthesis (period 2, range 3–22 months). Screening metrics for women ages 40–49, 50–59, 60–69, and 70+ , included rates per 1000 screens for recalls, biopsies, cancers, and invasive cancers detected.


Performance parameters were compared for women screened with digital mammography alone (n = 278,908) and digital mammography + tomosynthesis (n = 173,414). Addition of tomosynthesis to digital mammography produced significant reductions in recall rates for all age groups and significant increases in cancer detection rates for women 40–69. Largest recall rate reduction with tomosynthesis was for women 40–49, decreasing from 137 (95% CI 117–156) to 115 (95% CI 95–135); difference, −22 (95% CI −26 to −18; P < .001). Simultaneous increase in invasive cancer detection rate for women 40–49 from 1.6 (95% CI 1.2–1.9) to 2.7 (95% CI 2.2–3.1) with tomosynthesis (difference, 1.1; 95% CI 0.6–1.6; P < .001) was observed.


Addition of tomosynthesis to digital mammography increased invasive cancer detection rates for women 40–69 and decreased recall rates for all age groups with largest performance gains seen in women 40–49. The similar performance seen with tomosynthesis screening for women in their 40s compared to digital mammography for women in their 50s argues strongly for commencement of mammography screening at age 40 using tomosynthesis.


Breast neoplasms Mammography Mass screening Cancer detection rate Biopsy 



Elizabeth A. Rafferty, Stephen L. Rose, Melissa A. Durand, Debra Somers Copit, Sarah M. Friedewald, Donna M. Plecha, Ingrid L. Ott, Mary K. Hayes, Kara L. Carlson, Thomas M. Cink, Lora D. Barke, and Linda N. Greer received a research Grant from Hologic, Inc. Emily F. Conant received a research grant 5U54CA163316-03 from the National Cancer Institute.

Compliance with ethical standard

Conflict of interest

Dr. Rafferty, Dr. Rose, and Mr. Miller are consultants to Hologic, Inc. Drs. Friedewald, Plecha, Hayes, and Greer are consultants to Hologic, Inc. and on the Hologic, Inc. Scientific Advisory Board. Drs. Conant, Copit, and Carlson are on the Hologic, Inc. Scientific Advisory Board. Dr. Cink is Board Member Wellmark Blue Cross/Blue Shield for Iowa and South Dakota. Dr. Niklason is a former employee of Hologic, Inc., now retired.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Elizabeth A. Rafferty
    • 1
    • 2
  • Stephen L. Rose
    • 3
    • 4
  • Dave P. Miller
    • 5
  • Melissa A. Durand
    • 6
  • Emily F. Conant
    • 7
  • Debra S. Copit
    • 8
  • Sarah M. Friedewald
    • 9
    • 10
  • Donna M. Plecha
    • 11
  • Ingrid L. Ott
    • 12
  • Mary K. Hayes
    • 13
  • Kara L. Carlson
    • 14
  • Thomas M. Cink
    • 15
  • Lora D. Barke
    • 16
  • Linda N. Greer
    • 17
  • Loren T. Niklason
    • 18
  1. 1.Department of RadiologyMassachusetts General HospitalBostonUSA
  2. 2.L&M RadiologyWest ActonUSA
  3. 3.TOPS Comprehensive Breast CenterHoustonUSA
  4. 4.Solis Women’s HealthDallasUSA
  5. 5.Genomic HealthRedwood CityUSA
  6. 6.Yale University School of MedicineNew HavenUSA
  7. 7.Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  8. 8.Albert Einstein Healthcare NetworkPhiladelphiaUSA
  9. 9.Caldwell Breast CenterAdvocate Lutheran General HospitalPark RidgeUSA
  10. 10.Lynn Sage Comprehensive Breast CenterNorthwestern University Feinberg School of MedicineChicagoUSA
  11. 11.University Hospitals Case Medical CenterClevelandUSA
  12. 12.Washington Radiology AssociatesFairfaxUSA
  13. 13.Radiology Associates of Hollywood and Memorial Healthcare SystemHollywoodUSA
  14. 14.Evergreen Health Breast Center and Radia IncKirklandUSA
  15. 15.Edith Sanford Breast Health InstituteSioux FallsUSA
  16. 16.Invision Sally Jobe Breast Centers and Radiology Imaging AssociatesDenverUSA
  17. 17.HonorHealth Breast Health and Research CenterPhoenixUSA
  18. 18.TetoniaUSA

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