COMORBIDITY AND SCREENING OUTCOMES AMONG OLDER WOMEN UNDERGOING MAMMOGRAPHY

接受乳房 X 光检查的老年女性的合并症和筛查结果

• 批准号: 10409330
• 负责人: Dejana K Braithwaite
• 金额: $ 2.56万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409330
• 关键词: COMORBIDITY; SCREENING; OUTCOMES; AMONG; OLDER; COMORBIDITY; SCREENING; OUTCOMES; AMONG; OLDER

Project Summary Breast cancer is a major cause of cancer death in older women and screening mammography has proven to be effective in reducing breast cancer mortality in women aged 50-69 years. However, screening mammography has not been proven beneficial in women aged 70 and older and diminished life expectancy with aging decreases the potential chance of screening benefit and likely increases the risk of harms, which tend to be immediate. Randomized trials of screening mammography cannot provide the answers because the trials excluded women older than age 75 and those with significant comorbidity. To address this clinical and policy conundrum, the proposal makes innovative use of data from the Breast Cancer Surveillance Consortium (BCSC)—the largest collection of breast cancer surveillance data in the nation— and Medicare claims-based data to determine the consequences following screening in older women. The proposal also applies simulation modeling to compare benefits and harms of screening across levels of advancing age, comorbid illness and functional status. We will use data from 351,566 multi-ethnic women aged 66 years and older who underwent screening mammography in the BCSC between 1998 and 2016. This large-scale study enables the evaluation of benefits and harms of screening by including subgroups of women with favorable 10-year life expectancy and women with limited life expectancy. Our specific aims are: 1) Determine cumulative risk of screening outcomes, including benefits and harms, over the course of 10 years of screening mammography among older women across levels of advancing age, comorbidity and functional status. 2) Determine 10-year risk of mortality among older women undergoing screening mammography across levels of advancing age, comorbidity and functional status. 3) Evaluate comparative effectiveness of screening mammography strategies in older women using a simulation model across levels of advancing age, comorbidity and functional status. To optimize the delivery of high quality health care to older women, there is an urgent need to compare the benefits and harms of screening mammography according to age, comorbidity and functional status, which are key predictors of life expectancy. By identifying subgroups of older women most and least likely to benefit from screening mammography, our proposal speaks directly to the National Cancer Institute’s precision cancer screening initiative.

项目摘要 乳腺癌是老年妇女癌症死亡的主要原因，诊断乳房摄影已被证明是 在50-69岁的女性中有效降低乳腺癌死亡率。但是，筛选 乳房X线摄影尚未被证明对70岁及70岁且预期寿命降低的女性有益 随着衰老的降低，筛查收益的潜在机会，并可能增加危害的风险，这 倾向于立即。筛查乳房X线摄影的随机试验无法提供答案，因为 试验排除了75岁以上的妇女和合并症明显的妇女。解决这个临床和 政策难题，该提案是从乳腺癌监视联盟中创新的数据 （BCSC） - 美国乳腺癌监测数据的最大收集以及基于Medicare的索赔 数据以确定老年妇女筛查后的后果。该提案还适用模拟 建模以比较跨年龄，合并症和 功能状态。我们将使用351,566名66岁及以上的多种族妇女的数据 在1998年至2016年之间的BCSC中筛查乳房X线摄影。这项大规模研究可以评估 通过包括有利的10年寿命的妇女的子组，筛查的益处和损害 以及预期寿命有限的妇女。我们的具体目的是：1）确定筛查的累积风险 在10年筛选乳房X线摄影的过程中，结果，包括福利和伤害 跨年龄，合并症和功能状况的妇女。 2）确定10年的风险 在促进年龄级别的乳房X线摄影的老年妇女的死亡率， 合并症和功能状态。 3）评估筛查乳房X线摄影的比较有效性 老年妇女使用模拟模型的策略，跨年龄，合并症和功能 地位。为了优化向老年妇女提供高质量的医疗保健，迫切需要比较 根据年龄，合并症和功能状况的筛查乳房X线摄影的好处和危害， 是预期寿命的关键预测指标。通过确定最大和最不可能受益的老年妇女的亚组 通过筛查乳房X线摄影，我们的建议直接与国家癌症研究所的精度癌进行了交流 筛选计划。