Breast Cancer Screening Strategies in the Era of New Technologies

新技术时代的乳腺癌筛查策略

基本信息

批准号：
9982826
负责人：
Tracy Onega
金额：
$ 13.92万
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：
2020
资助国家：
美国
起止时间：
2020-06-01 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9982826
关键词：
Accounting Accreditation Address Adopted Adoption Affect Anxiety Biometry Biopsy Breast Breast Cancer Detection Breast Cancer Surveillance Consortium Breast Magnetic Resonance Imaging Cancer Detection Cancer Intervention and Surveillance Modeling Network Cessation of life Characteristics Clinical Community Practice Data Databases Detection Digital Breast Tomosynthesis Digital Mammography Effectiveness Equilibrium Failure Healthcare Market High Risk Woman Image Imaging technology Intervention Knowledge Lead Lesion Life Magnetic Resonance Imaging Malignant - descriptor Malignant Neoplasms Mammographic screening Mammography Modality Modeling Morbidity - disease rate Multimodal Imaging Outcome Performance Population Quality-Adjusted Life Years Recommendation Registries Reporting Risk Risk Factors Sensitivity and Specificity Subgroup System Technology Translations Tumor Subtype Ultrasonography Woman Work base clinical risk community based practice community setting comparative effectiveness contextual factors cost data management data resource imaging facilities improved malignant breast neoplasm models and simulation mortality multimodality new technology radiologist screening screening guidelines sociodemographics supplemental screening tomosynthesis uptake

项目摘要

PROJECT SUMMARY – Project 2 Digital breast tomosynthesis use has rapidly increased for breast cancer screening, outpacing evidence of effectiveness in community settings for women overall and for specific populations. Emerging evidence suggests tomosynthesis may lower recall rates while simultaneously improving cancer detection. However, critical questions remain: whether early reports of improved screening outcomes remain beyond initial screening rounds and are sustainable in community settings; whether tomosynthesis outcomes vary based on women’s characteristics; whether tomosynthesis is equal to or outperforms supplemental MRI screening; and whether additional cancers detected are likely to lead to reduced morbidity and mortality from breast cancer. With the rapid shift to tomosynthesis as the dominant screening modality, a thorough understanding of its effectiveness in community settings across subgroups of women is needed. In our current P01, using the rich data resource of the Breast Cancer Surveillance Consortium (BCSC), we have demonstrated the importance of woman-level characteristics on digital mammography screening outcomes. Given the quick uptake of tomosynthesis in the BCSC, it is now possible to examine outcomes of tomosynthesis screening in relation to woman-level factors and to quantify the benefit-harm balance. Our overall project objective is to identify the most effective screening strategies that incorporate new screening technologies in community practice based on women's risk factors. We hypothesize that tomosynthesis will perform better than digital mammography for some, but not all, women and that there are some women who may benefit from multi-modal screening. We will also evaluate whether tomosynthesis can reduce the need for supplemental magnetic resonance imaging (MRI) in women at high risk of a missed cancer on digital mammography. We specifically aim to: Aim 1) determine the benefits and harms of screening tomosynthesis compared to digital mammography based on women's characteristics Aim 2) determine the observed benefits and harms of multi-modality screening with supplemental MRI versus tomosynthesis alone; and Aim 3) evaluate the long- term benefits and harms from multi-modality screening with supplemental MRI versus tomosynthesis screening alone across risk groups through simulation modeling (in conjunction with the Comparative Effectiveness Core). This project will fill critical knowledge gaps regarding the effectiveness of tomosynthesis and multi-modality screening, which we believe will have direct translation into actionable screening guidelines

项目摘要 - 项目 2 数字乳房断层合成在乳腺癌筛查中的使用迅速增加，超过了社区环境中对整体女性和特定人群的有效性证据表明断层合成可能会降低召回率，同时改善癌症检测。仍然存在：关于筛查结果改善的早期报告是否在初次筛查后仍然存在，并且在社区环境中是否可持续；断层合成结果是否因女性特征而异；补充 MRI 筛查；以及检测到的其他癌症是否可能导致乳腺癌发病率和死亡率降低。随着断层合成作为主要筛查方式的迅速转变，需要全面了解其在社区环境中女性亚群的有效性。在当前的 P01 中，我们利用乳腺癌监测联盟 (BCSC) 的丰富数据资源，证明了女性特征对数字乳房 X 线摄影筛查结果的重要性。 BCSC 中的断层合成，现在可以检查与女性因素相关的断层合成筛查结果，并量化利益-危害平衡，我们的总体项目目标是确定在社区中融入新筛查技术的最有效的筛查策略。我们认为，对于某些（但不是全部）女性来说，断层合成会比数字乳房X光检查效果更好，并且有些女性可能会从多模式筛查中受益，我们还将评估断层合成是否有效。可以减少数字乳房 X 光检查中漏诊癌症高风险女性对补充磁共振成像 (MRI) 的需求，我们的具体目标是：目标 1) 根据女性特征确定断层合成筛查与数字乳房 X 光检查相比的利弊目标 2) 确定使用补充 MRI 的多模态筛查相对于单独的断层合成的观察到的益处和危害；目标 3) 通过模拟建模（与比较有效性核心相结合）评估补充 MRI 多模态筛查与单独断层合成筛查在风险组中的长期益处和危害。该项目将填补有关断层合成和多模态筛查有效性的关键知识空白，我们相信这将直接转化为可操作的筛查指南