New Risk Assessment Paradigm to Predict Screening Detection, Failures and False Alarms

新的风险评估范式可预测筛查检测、故障和误报

基本信息

批准号：
9279002
负责人：
KARLA M KERLIKOWSKE
金额：
$ 29.69万
依托单位：
UNIVERSITY OF CALIFORNIA AT DAVIS
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-01 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9279002
关键词：
Advisory Committees Age American Cancer Society Benign Biopsy Breast Cancer Detection Breast Cancer Risk Factor Breast Cancer Surveillance Consortium Cancer Biology Cessation of life Clinical Clinical/Radiologic Community Practice Community of Practice Consensus Data Decision Making Detection Digital Breast Tomosynthesis Digital Mammography Disease Early Diagnosis Effectiveness Ethnic Origin Failure Frequencies General Population Goals Guidelines Harm Reduction Health Personnel Heterogeneity High Risk Woman Incidence Individual Life Malignant Neoplasms Mammography Masks Modality Modeling Movement Noninfiltrating Intraductal Carcinoma Outcome Output Population Preventive service Primary Health Care Provider Race Radiation exposure Radiation-Induced Cancer Recommendation Regimen Research Infrastructure Research Personnel Risk Risk Assessment Risk Estimate Risk Factors Statistical Methods Subgroup Surveys Testing Woman Women&apos s Health advanced disease aged base breast density cancer invasiveness cancer risk clinical imaging clinical practice clinically actionable comparative effectiveness compare effectiveness cost digital discrete time experience high risk improved innovation lifetime risk malignant breast neoplasm models and simulation mortality novel personalized decision predictive modeling preference radiologist screening secondary outcome tomosynthesis tumor

项目摘要

PROJECT SUMMARY – Project 1 The 2016 US Preventive Services Task Force and 2015 American Cancer Society guidelines call for reduced screening intensity and for providers to discuss with women their preferences for screening. This push for individualized decision-making has triggered substantial movement toward risk-based screening utilization that does not rely solely on a woman's age to determine when to start and stop screening or screening frequency. Yet, the explicit incorporation of risk assessment into screening guidelines for the general population is in its early stages. Risk prediction is a key aspect of risk-based screening; available models predict breast cancer risk overall, but do not take into account the heterogeneity of breast cancer biology or the ability of screening modalities to detect breast cancer. Project 1 aims to advance a new risk-based screening paradigm that identifies women's absolute cumulative risk of screening detection, failures, and false alarms while explicitly considering screening interval and modality used. Aim 1) Using the existing and expanded Breast Cancer Surveillance Consortium (BCSC) infrastructure, project investigators will develop new risk prediction models to identify women at high risk of: 1) early-stage screen-detected cancer (stage I/IIa invasive cancer), 2) screening failure (interval invasive cancer or screen-detected stage IIb or higher), and 3) false alarms (false-positive tests and benign biopsies). Using BCSC data on over 1,000,000 women aged 40-79 years undergoing digital mammography or tomosynthesis, and over 13,000 invasive breast cancers identified, the project team will identify clinical and imaging factors associated with breast cancer risk that impact screening outcomes, generating six-year risk estimates for each screening outcome for annual, biennial, and triennial screening regimens. Aim 2) The project team will identify actionable levels of clinically-meaningful risk of screening failure and false alarm, and associated long-term screening outcomes using women and clinician surveys and Delphi panels. This proposal will answer: 1) Which women are at high risk of screening failures and require an alternative strategy to biennial mammography, and which women are at low risk and can be screened less often? 2) What risk levels of poor screening outcomes impact women and clinician preferences for screening strategies? This project will provide evidence to guide women, health care providers, and policymakers on screening strategies based on short-term risk of screening failures and false alarms with the goal to improve early detection of aggressive tumors while minimizing harms.

项目摘要 - 项目1 2016年美国预防服务工作队和2015年美国癌症协会指南要求降低筛查强度，并要求提供者与妇女的筛查偏好进行讨论。这项实现决策的推动触发了基于风险的筛查利用的实质性运动，该筛选利用不仅依赖女性的年龄来确定何时开始和停止筛查或筛选频率。但是，将风险评估的明确纳入普通人群的筛查指南处于早期阶段。风险预测是基于风险的筛查的关键方面；可用模型总体上可以预测乳腺癌的风险，但不考虑乳腺癌生物学的异质性或筛查方式检测乳腺癌的能力。项目1旨在推进一个新的基于风险的筛查范式，以确定妇女在筛查检测，失败和虚假警报的绝对累积风险，同时明确考虑使用的筛选间隔和使用方式。目的1）使用现有和扩大的乳腺癌监测财团（BCSC）基础设施，项目研究人员将开发新的风险预测模型，以识别具有高风险的女性：1）早期筛查的癌症（I/IIA阶段IIA侵袭性癌症）（I/IIA侵入性癌症），2）筛查失败（）筛查失败（侵袭性癌症或筛查阶段IIB或较高的IIB或更高率）和ben biign andimit and-biign and-premign andign and-pords and-pords和3）。使用BCSC数据，了解了1,000,000多名40-79岁的女性经历了数字乳房X线摄影或合成的数据，并确定了13,000多名侵入性乳腺癌，该项目团队将确定与乳腺癌风险相关的临床和成像因素，这些临床和成像因素与影响筛查结果相关的临床和成像因素，从而为每种筛查的每年，每年的筛查结果，每年的三年期筛查和三年期筛查均产生六年的风险估算。目标2）项目团队将确定使用妇女和临床调查和Delphi面板的临床上筛查失败和虚假警报的可行风险。该提案将回答：1）哪些女性有筛查失败的高风险，需要两年一次的乳房X线摄影，以及哪些女性处于低风险，并且可以较低筛查？ 2）筛查结果不良的风险水平影响妇女和筛查策略的临床偏好？该项目将提供证据，以指导妇女，卫生保健提供者和决策者根据筛查失败的短期风险和虚假警报的筛查策略，目的是改善对侵略性肿瘤的早期发现，同时最大程度地减少危害。