Screening Digital Breast Tomosynthesis Performance across Age Groups: Analysis of 302 700 Examinations

Purpose To compare screening digital breast tomosynthesis (DBT) performance metrics across age groups. Materials and Methods In this retrospective study, screening mammograms acquired from January 1, 2013, to June 30, 2019, at an academic medical center were reviewed. Each examination included combined digital two-dimensional mammography and DBT and was categorized as true positive, false positive, true negative, or false negative based on 1-year follow-up. Performance metrics were calculated according to Breast Imaging Reporting and Data System definitions and compared across age groups using multivariable generalized estimating equation models. Results Among 93 617 female individuals (mean age, 58 years ± 12 [SD]) who underwent 302 700 DBT examinations, cancer detection rate (CDR) increased with age, from 2.9 per 1000 examinations (208 of 70 549) at ages 40-49 years to 8.3 per 1000 (399 of 48 205) at ages 70-79 years and 10.6 per 1000 (127 of 12 018) at age 80 years and older. Sensitivity increased from 72.5% among those aged 40-49 years to 91.7% among those aged 70-79 years (P < .001). The abnormal interpretation rate (AIR) was highest among those aged 40-49 years (9.3%) and lowest among those aged 80 years and older (5.5%), with corresponding specificities of 91.0% and 95.5% (all P < .001). Positive predictive value (PPV1) increased with age, from 3.2% among those aged 40-49 years to 19.2% among those aged 80 years and older (P < .001). Conclusion Screening DBT performance improved with advancing age, demonstrating higher CDRs, sensitivity, specificity, and PPV1, along with lower AIRs. Keywords: Age, Breast Cancer, Digital Breast Tomosynthesis, Mammography, Screening, Breast See also the commentary by Hussain in this issue. Supplemental material is available for this article. © RSNA 2026.