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Risk-Based Screening Mammography for Women Aged <40: Outcomes From the National Mammography Database.

Cindy S Lee¹, Heidi Ashih², Debapriya Sengupta³

¹Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; Department of Radiology, New York University Langone Health, Garden City, New York.

Journal of the American College of Radiology : JACR

|September 22, 2019

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Women aged 30-39 with specific breast cancer risk factors show similar cancer detection rates and recall rates as average-risk women aged 40-49. This suggests screening mammography may benefit younger women with risk factors starting at age 30.

Area of Science:

Radiology
Oncology
Public Health

Background:

Evidence for screening mammography in women under 40 with elevated risk is limited.
Current guidelines often recommend initiating screening at age 40 for average-risk women.

Purpose of the Study:

To compare risk-based screening mammography in women aged 30-39 with risk factors against women aged 40-49 without risk factors.
To evaluate screening performance metrics in different age and risk groups.

Main Methods:

Retrospective analysis of 5,986,131 screening mammograms from the National Mammography Database (NMD).
Stratification by age (30-39 vs. 40-49), prior mammograms, and risk factors (family history, personal history, dense breasts).
Calculation of recall rate (RR), cancer detection rate (CDR), and positive predictive values (PPV2, PPV3).

Keywords:

Mammography National Mammography Database risk-based screening younger women

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Main Results:

Women aged 30-39 with specific risk factors demonstrated comparable cancer detection rates and recall rates to average-risk women aged 40-49.
The presence of evaluated risk factors (family history, personal history, dense breasts) was associated with significantly higher cancer detection rates.
Screening performance metrics were similar between women aged 30-34 and 35-39.

Conclusions:

Women aged 30 and above with one or more of the studied risk factors may benefit from earlier screening mammography.
Risk-based screening may be a viable strategy for identifying breast cancer in younger women.