Work

Tumor characteristics associated with tomosynthesis versus digital mammography in older women with screen-detected breast cancer

Year: 2026

Type: article

Abstract: Purpose: Digital breast tomosynthesis (DBT) has demonstrated improved cancer detection compared with digital mammography (DM) in women aged 50-74, identifying more invasive cancers and detecting tumors at smaller sizes. However, its benefits for women aged 75 and older remain unclear. Methods: We conducted a SEER-Medicare retrospective cohort study of women aged ≥67 diagnosed with screen-detected ER+/HER2- breast cancer from 2015-2021. The primary exposure was screening modality (DBT vs. DM). Outcomes included tumor size, nodal involvement, grade, and histology (invasive lobular carcinoma [ILC] vs. non-ILC). Multivariable logistic regression was used to assess the association between screening modality and tumor characteristics among women aged 67-74 and ≥75. Results: Among 17,201 women with screen-detected breast cancer, 43.6% were ≥75 at diagnosis and 60.4% were detected by DBT. In women aged 67-74, DBT was associated with higher odds of smaller tumors (adjusted odds ratio [aOR]=1.18, 95% confidence interval [CI]=1.08-1.29), grade I vs. II or III disease (aOR=1.14, CI=1.04-1.26), node-negative disease (aOR=1.15, CI=1.00-1.31), and ILC histology (aOR=1.29, CI=1.13-1.48) vs. DM. In contrast, among women aged ≥75, DBT remained associated with higher odds of grade I tumors (aOR=1.21, CI=1.08-1.35) and node-negative disease (aOR=1.18, CI=1.00-1.39), but was not significantly associated with smaller tumor size (aOR=0.99, CI=0.90-1.10) or ILC histology (aOR=1.13, CI=0.98-1.32). Conclusions: DBT was associated with favorable tumor biology, including lower grade and node-negative disease in women ≥75, but not with smaller tumor size or ILC histology. The incremental advantage of DBT over DM may diminish with age, making the two modalities more comparable in women ≥75.

Source: Breast Cancer Research and Treatment

DOI: 10.1007/s10549-026-08013-4