Background: Risk-based screening in women 40–49 years old has not been evaluated in routine screening mammography practice. Purpose: To use a cross-sectional study design to compare the trade-offs of risk-based and age-based screening for women 45 years of age or older to determine short-term outcomes. Materials and Methods: A retrospective cross-sectional study was performed by using a database of 20 539 prospectively interpreted consecutive digital screening mammograms in 10 280 average-risk women aged 40–49 years who were screened at an academic medical center between January 1, 2006, and December 31, 2013. Two hypothetical screening scenarios were compared: an age-based (45 years) scenario versus a risk-based (a 5-year risk of breast cancer greater than that of an average 50-year-old) scenario. Risk factors for risk-based screening included family history, race, age, prior breast biopsy, and breast density. Outcomes included breast cancers detected at mammography, false-positive mammograms, and benign biopsy findings. Short-term outcomes were compared by using the x2 test. Results: The screening population included 71 148 screening mammograms in 24 928 women with a mean age of 55.5 years 6 8.9 (standard deviation) (age range, 40–74 years). In women 40–49 years old, usual care included 50 screening-detected cancers, 1787 false-positive mammograms, and 384 benign biopsy results. The age-based (45 years) screening strategy revealed more cancers than did the risk-based strategy (34 [68%] vs 13 [26%] of 50; P , .001), while prompting more false-positive mammograms (899 [50.3%] vs 216 [12.1%] of 1787; P , .001) and benign biopsy results (175 [45.6%] vs 49 [12.8%] of 384; P , .001). The risk-based strategy demonstrated low levels of eligibility (few screenings) in the 40–44-year age group. Differences in outcomes in the 45–49-year age group explained the overall hypothetical screening strategy differences. Conclusion: Risk-based screening for women 40–49 years old includes few women in the 40–44-year age range. Significant tradeoffs in the 45–49-year age group explain the overall difference between hypothetical screening scenarios, both of which reduce the benefits as well as the harms of mammography for women 40–49 years old.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging