Estimating the impact of mammography screening disruptions during the COVID-19 pandemic

估计 COVID-19 大流行期间乳房 X 光检查筛查中断的影响

基本信息

批准号：
10171213
负责人：
Brian L Sprague
金额：
$ 18万
依托单位：
UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10171213
关键词：
Address Advanced Malignant Neoplasm Advisory Committees Age Biopsy Breast Breast Cancer Detection Breast Cancer Risk Factor Breast Cancer Surveillance Consortium COVID-19 COVID-19 pandemic Cancer Control Cancer Detection Cancer Intervention and Surveillance Modeling Network Characteristics Chicago Clinical Containment Data Data Analyses Decision Making Detection Diagnostic Diagnostic Imaging Digital Breast Tomosynthesis Digital Mammography Effectiveness Epidemiologist Evaluation Expert Opinion Failure Funding Future Geography Guidelines Health Insurance Health Personnel Health Services High Risk Woman Home environment Incidence Infrastructure Interruption Intervention Laws Malignant Neoplasms Mammary Gland Parenchyma Mammographic screening Mammography Medical Medical Care Costs Modeling Outcome Pattern Performance Phase Positioning Attribute Preventive service Provider Public Health Recording of previous events Registries Regulation Research Personnel Risk Risk Factors San Francisco Services Social Distance Source Stage at Diagnosis System Techniques Time Ultrasonography United States Universities Variant Vermont Wisconsin Woman advanced breast cancer aged base breast cancer diagnosis breast cancer registry breast density breast imaging care providers clinical practice clinical risk computerized data processing cost experience high risk imaging detection imaging facilities improved interdisciplinary collaboration malignant breast neoplasm mammography registry models and simulation mortality neoplasm registry network models pandemic disease performance tests population based racial diversity radiologist screening screening guidelines supplemental screening tool trend willingness

项目摘要

PROJECT SUMMARY/ABSTRACT Breast density is a risk factor for developing breast cancer and decreases the accuracy of screening mammography. An estimated 27 million women aged 40-74 in the U.S. have dense breasts and they experience elevated rates of advanced stage breast cancer diagnoses associated with poor outcomes. Thirty- seven states now require mammography facilities to notify women with dense breasts of the limitations of mammography and recommend discussion of screening options with their healthcare providers, and a national law is pending. In the absence of screening guidelines for women with dense breasts, there has been a dramatic increase in use of supplemental ultrasound screening, which is widely available and has low direct medical costs. Early studies of supplemental ultrasound performance suggest increased cancer detection but high rates of false positive exams leading to unnecessary biopsies. The United States Preventive Services Task Force has called for studies that evaluate the impact of supplemental ultrasound screening on meaningful clinical outcomes, such as advanced cancer rates, to inform screening guidelines for women with dense breasts. We recently demonstrated that mammography screening failure rates (i.e., advanced cancers and interval cancers after a normal mammogram) among women with dense breasts vary widely according to clinical risk factors. Therefore, we propose to assess supplemental ultrasound screening performance within a new risk-based framework. We hypothesize that supplemental ultrasound screening targeted to the subset of women with dense breasts at high risk of mammography screening failures will yield a favorable benefit-to- harm profile. We will use observational data from more than 100,000 screening ultrasound exams and 2 million mammography screening exams collected via the Breast Cancer Surveillance Consortium to (Aim 1) examine the test performance of supplemental screening ultrasound according to technique (handheld vs. automated) and type of primary screening (digital mammography vs. digital breast tomosynthesis); and (Aim 2) evaluate supplemental screening ultrasound outcomes across levels of risk for mammography screening failures. These results will be used as inputs in two simulation models from the Cancer Intervention and Surveillance Modeling Network to (Aim 3) evaluate the long-term benefits, harms, and costs of supplemental ultrasound strategies targeted to women at high risk of mammography screening failures. Our study will be the largest evaluation of supplemental ultrasound and the first to evaluate rates of interval and advanced cancers according to risk of mammography screening failures. Our results will provide urgently needed, actionable evidence for women, healthcare providers, and guideline-makers evaluating screening options for women with dense breasts. This evidence will support effective supplemental screening strategies that reduce the burden of breast cancer among women for whom mammography screening is not adequate, while minimizing potential harms.

项目摘要/摘要乳房密度是患乳腺癌的危险因素，并降低了筛查的准确性乳房X线摄影。美国估计有2700万妇女在美国有40-74岁的乳房，她们与结果不佳有关的晚期乳腺癌诊断率升高。三十- 现在，七个州需要乳房X线摄影设施来通知乳房密集的妇女的局限性乳房X线摄影并建议与他们的医疗保健提供者讨论筛查选项，以及一个国家法律正在等待。在没有针对乳房密集的女性筛查指南的情况下，已经有一个补充超声筛选的使用急剧增加，该筛选可广泛可用，直接较低医疗费用。补充超声表现的早期研究表明癌症的检测增加了高阳性考试的高率导致不必要的活检。美国预防服务工作队呼吁进行研究，以评估补充超声筛选对有意义的影响临床结果，例如晚期癌症，以告知筛查指南乳房。我们最近证明了乳房X线摄影筛查衰竭率（即高级癌症和正常乳房X线照片后的间隔癌）在乳房密集的女性中差异很大临床风险因素。因此，我们建议评估在基于风险的新框架。我们假设针对子集的补充超声筛选具有乳房X线摄影筛查失败风险高的乳房的妇女将带来有利的收益。危害概况。我们将使用超过100,000次筛选超声考试和200万次筛选的观察数据通过乳腺癌监视联盟收集的乳房X线摄影检查检查（目标1）检查根据技术（手持式与自动化）的补充筛查超声检查的测试性能和主要筛查类型（数字乳房摄影与数字乳房间隔）；（目标2）评估跨乳房X线摄影筛查失败风险范围的补充筛查超声结果。这些结果将用作癌症干预和监视模型的两个模拟模型中的输入网络以（目标3）评估补充超声策略的长期收益，危害和成本针对具有乳房X线摄影筛查失败风险的女性。我们的研究将是对补充超声波和第一个根据风险评估间隔和高级癌症发生率的风险乳房X线摄影筛查失败。我们的结果将为妇女提供急需的，可行的证据，医疗保健提供者和指南制定者评估乳房密集的妇女的筛查选择。这证据将支持有效的补充筛查策略，以减轻乳腺癌的负担在乳房X线摄影筛查不足的女性中，同时最大程度地减少了潜在危害。