1
|
Trentham-Dietz A, Chapman CH, Jayasekera J, Lowry KP, Heckman-Stoddard BM, Hampton JM, Caswell-Jin JL, Gangnon RE, Lu Y, Huang H, Stein S, Sun L, Gil Quessep EJ, Yang Y, Lu Y, Song J, Muñoz DF, Li Y, Kurian AW, Kerlikowske K, O'Meara ES, Sprague BL, Tosteson ANA, Feuer EJ, Berry D, Plevritis SK, Huang X, de Koning HJ, van Ravesteyn NT, Lee SJ, Alagoz O, Schechter CB, Stout NK, Miglioretti DL, Mandelblatt JS. Collaborative Modeling to Compare Different Breast Cancer Screening Strategies: A Decision Analysis for the US Preventive Services Task Force. JAMA 2024:2818285. [PMID: 38687505 DOI: 10.1001/jama.2023.24766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Importance The effects of breast cancer incidence changes and advances in screening and treatment on outcomes of different screening strategies are not well known. Objective To estimate outcomes of various mammography screening strategies. Design, Setting, and Population Comparison of outcomes using 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses. Exposures Thirty-six screening strategies with varying start ages (40, 45, 50 years) and stop ages (74, 79 years) with digital mammography or digital breast tomosynthesis (DBT) annually, biennially, or a combination of intervals. Strategies were evaluated for all women and for Black women, assuming 100% screening adherence and "real-world" treatment. Main Outcomes and Measures Estimated lifetime benefits (breast cancer deaths averted, percent reduction in breast cancer mortality, life-years gained), harms (false-positive recalls, benign biopsies, overdiagnosis), and number of mammograms per 1000 women. Results Biennial screening with DBT starting at age 40, 45, or 50 years until age 74 years averted a median of 8.2, 7.5, or 6.7 breast cancer deaths per 1000 women screened, respectively, vs no screening. Biennial DBT screening at age 40 to 74 years (vs no screening) was associated with a 30.0% breast cancer mortality reduction, 1376 false-positive recalls, and 14 overdiagnosed cases per 1000 women screened. Digital mammography screening benefits were similar to those for DBT but had more false-positive recalls. Annual screening increased benefits but resulted in more false-positive recalls and overdiagnosed cases. Benefit-to-harm ratios of continuing screening until age 79 years were similar or superior to stopping at age 74. In all strategies, women with higher-than-average breast cancer risk, higher breast density, and lower comorbidity level experienced greater screening benefits than other groups. Annual screening of Black women from age 40 to 49 years with biennial screening thereafter reduced breast cancer mortality disparities while maintaining similar benefit-to-harm trade-offs as for all women. Conclusions This modeling analysis suggests that biennial mammography screening starting at age 40 years reduces breast cancer mortality and increases life-years gained per mammogram. More intensive screening for women with greater risk of breast cancer diagnosis or death can maintain similar benefit-to-harm trade-offs and reduce mortality disparities.
Collapse
Affiliation(s)
- Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Christina Hunter Chapman
- Department of Radiation Oncology and Center for Innovations in Quality, Safety, and Effectiveness, Baylor College of Medicine, Houston, Texas
| | - Jinani Jayasekera
- Health Equity and Decision Sciences (HEADS) Research Laboratory, Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | | | - Brandy M Heckman-Stoddard
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | | | - Ronald E Gangnon
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Ying Lu
- Stanford University, Stanford, California
| | - Hui Huang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah Stein
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Liyang Sun
- Stanford University, Stanford, California
| | | | | | - Yifan Lu
- Department of Industrial and Systems Engineering and Carbone Cancer Center, University of Wisconsin-Madison
| | - Juhee Song
- University of Texas MD Anderson Cancer Center, Houston
| | | | - Yisheng Li
- University of Texas MD Anderson Cancer Center, Houston
| | - Allison W Kurian
- Departments of Medicine and Epidemiology and Population Health, Stanford University, Stanford, California
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Anna N A Tosteson
- Dartmouth Institute for Health Policy and Clinical Practice and Departments of Medicine and Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Donald Berry
- University of Texas MD Anderson Cancer Center, Houston
| | - Sylvia K Plevritis
- Departments of Biomedical Data Science and Radiology, Stanford University, Stanford, California
| | - Xuelin Huang
- University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Sandra J Lee
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering and Carbone Cancer Center, University of Wisconsin-Madison
| | | | - Natasha K Stout
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Public Health Sciences, University of California Davis
| | - Jeanne S Mandelblatt
- Departments of Oncology and Medicine, Georgetown University Medical Center, and Georgetown Lombardi Comprehensive Institute for Cancer and Aging Research at Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| |
Collapse
|
2
|
Rashidi A, Lowry KP, Sadigh G. Breast Cancer Supplemental Screening: Contrast-Enhanced Mammography or Contrast-Enhanced MRI? J Am Coll Radiol 2024; 21:589-590. [PMID: 37839693 DOI: 10.1016/j.jacr.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Ali Rashidi
- Department of Radiological Sciences, University of California, Irvine, Orange, California
| | - Kathryn P Lowry
- Department of Radiology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle, Washington; and is an Assistant Editor for JACR
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California, Irvine, Orange, California; is an Associate Editor for JACR; and is Director of Health Services and Comparative Outcome Research at the University of California, Irvine.
| |
Collapse
|
3
|
Hubbard RA, Su YR, Bowles EJ, Ichikawa L, Kerlikowske K, Lowry KP, Miglioretti DL, Tosteson ANA, Wernli KJ, Lee JM. Predicting five-year interval second breast cancer risk in women with prior breast cancer. J Natl Cancer Inst 2024:djae063. [PMID: 38466940 DOI: 10.1093/jnci/djae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Annual surveillance mammography is recommended for women with a personal history of breast cancer. Risk prediction models that estimate mammography failures such as interval second breast cancers could help to tailor surveillance imaging regimens to women's individual risk profiles. METHODS In a cohort of women with a history of breast cancer receiving surveillance mammography in the Breast Cancer Surveillance Consortium in 1996-2019, we used LASSO-penalized regression to estimate the probability of an interval second cancer (invasive cancer or ductal carcinoma in situ) in the one-year following a negative surveillance mammogram. Based on predicted risks from this one-year risk model, we generated cumulative risks of an interval second cancer for the five-year period following each mammogram. Model performance was evaluated using cross-validation in the overall cohort and within race and ethnicity strata. RESULTS In 173,290 surveillance mammograms, we observed 496 interval cancers. One-year risk models were well-calibrated (expected/observed ratio = 1.00) with good accuracy (area under the receiver operating characteristic curve = 0.64). Model performance was similar across race and ethnicity groups. The median five-year cumulative risk was 1.20% (interquartile range 0.93-1.63%). Median five-year risks were highest in women who were under age 40 or pre- or peri-menopausal at diagnosis and those with estrogen receptor-negative primary breast cancers. CONCLUSIONS Our risk model identified women at high risk of interval second breast cancers who may benefit from additional surveillance imaging modalities. Risk models should be evaluated to determine if risk-guided supplemental surveillance imaging improves early detection and decreases surveillance failures.
Collapse
Affiliation(s)
- Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Erin Ja Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| |
Collapse
|
4
|
Schopf CM, Ramwala OA, Lowry KP, Hofvind S, Marinovich ML, Houssami N, Elmore JG, Dontchos BN, Lee JM, Lee CI. Artificial Intelligence-Driven Mammography-Based Future Breast Cancer Risk Prediction: A Systematic Review. J Am Coll Radiol 2024; 21:319-328. [PMID: 37949155 PMCID: PMC10926179 DOI: 10.1016/j.jacr.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To summarize the literature regarding the performance of mammography-image based artificial intelligence (AI) algorithms, with and without additional clinical data, for future breast cancer risk prediction. MATERIALS AND METHODS A systematic literature review was performed using six databases (medRixiv, bioRxiv, Embase, Engineer Village, IEEE Xplore, and PubMed) from 2012 through September 30, 2022. Studies were included if they used real-world screening mammography examinations to validate AI algorithms for future risk prediction based on images alone or in combination with clinical risk factors. The quality of studies was assessed, and predictive accuracy was recorded as the area under the receiver operating characteristic curve (AUC). RESULTS Sixteen studies met inclusion and exclusion criteria, of which 14 studies provided AUC values. The median AUC performance of AI image-only models was 0.72 (range 0.62-0.90) compared with 0.61 for breast density or clinical risk factor-based tools (range 0.54-0.69). Of the seven studies that compared AI image-only performance directly to combined image + clinical risk factor performance, six demonstrated no significant improvement, and one study demonstrated increased improvement. CONCLUSIONS Early efforts for predicting future breast cancer risk based on mammography images alone demonstrate comparable or better accuracy to traditional risk tools with little or no improvement when adding clinical risk factor data. Transitioning from clinical risk factor-based to AI image-based risk models may lead to more accurate, personalized risk-based screening approaches.
Collapse
Affiliation(s)
- Cody M Schopf
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Ojas A Ramwala
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Kathryn P Lowry
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Solveig Hofvind
- Section Head of Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - M Luke Marinovich
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; National Breast Cancer Foundation Chair in Breast Cancer Prevention at the University of Sydney and Coeditor of The Breast
| | - Joann G Elmore
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Director of UCLA's National Clinician Scholars Program and Editor-in-Chief of Adult Primary Care at Up-To-Date. https://twitter.com/JoannElmoreMD
| | - Brian N Dontchos
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Clinical Director of Breast Imaging at Fred Hutchinson Cancer Center
| | - Janie M Lee
- Section Chief of Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Director of Breast Imaging at Fred Hutchinson Cancer Center
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, and Department of Health Systems & Population Health, University of Washington School of Public Health, Seattle, WA; Director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington and Deputy Editor of Journal of the American College of Radiology.
| |
Collapse
|
5
|
Sprague BL, Ichikawa L, Eavey J, Lowry KP, Rauscher G, O’Meara ES, Miglioretti DL, Chen S, Lee JM, Stout NK, Mandelblatt JS, Alsheik N, Herschorn SD, Perry H, Weaver DL, Kerlikowske K. Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Cancer 2023; 129:2456-2468. [PMID: 37303202 PMCID: PMC10506533 DOI: 10.1002/cncr.34768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND There are no consensus guidelines for supplemental breast cancer screening with whole-breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone. METHODS A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014-2020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5-year breast cancer risk ≥2.5% or extremely dense breasts and BCSC 5-year breast cancer risk ≥1.67%. Intermediate/high advanced cancer risk was defined as BCSC 6-year advanced breast cancer risk ≥0.38%. RESULTS A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p < .0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio, 1.35; 95% CI, 1.30-1.39); intermediate/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio, 0.91; 95% CI, 0.89-0.94). CONCLUSIONS Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk.
Collapse
Affiliation(s)
- Brian L. Sprague
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Joanna Eavey
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Kathryn P. Lowry
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Janie M. Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jeanne S. Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Nila Alsheik
- Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL
| | - Sally D. Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Hannah Perry
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Donald L. Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
| |
Collapse
|
6
|
Lawson MB, Partridge SC, Hippe DS, Rahbar H, Lam DL, Lee CI, Lowry KP, Scheel JR, Parsian S, Li I, Biswas D, Bryant ML, Lee JM. Comparative Performance of Contrast-enhanced Mammography, Abbreviated Breast MRI, and Standard Breast MRI for Breast Cancer Screening. Radiology 2023; 308:e230576. [PMID: 37581498 PMCID: PMC10481328 DOI: 10.1148/radiol.230576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 08/16/2023]
Abstract
Background Contrast-enhanced mammography (CEM) and abbreviated breast MRI (ABMRI) are emerging alternatives to standard MRI for supplemental breast cancer screening. Purpose To compare the diagnostic performance of CEM, ABMRI, and standard MRI. Materials and Methods This single-institution, prospective, blinded reader study included female participants referred for breast MRI from January 2018 to June 2021. CEM was performed within 14 days of standard MRI; ABMRI was produced from standard MRI images. Two readers independently interpreted each CEM and ABMRI after a washout period. Examination-level performance metrics calculated were recall rate, cancer detection, and false-positive biopsy recommendation rates per 1000 examinations and sensitivity, specificity, and positive predictive value of biopsy recommendation. Bootstrap and permutation tests were used to calculate 95% CIs and compare modalities. Results Evaluated were 492 paired CEM and ABMRI interpretations from 246 participants (median age, 51 years; IQR, 43-61 years). On 49 MRI scans with lesions recommended for biopsy, nine lesions showed malignant pathology. No differences in ABMRI and standard MRI performance were identified. Compared with standard MRI, CEM demonstrated significantly lower recall rate (14.0% vs 22.8%; difference, -8.7%; 95% CI: -14.0, -3.5), lower false-positive biopsy recommendation rate per 1000 examinations (65.0 vs 162.6; difference, -97.6; 95% CI: -146.3, -50.8), and higher specificity (87.8% vs 80.2%; difference, 7.6%; 95% CI: 2.3, 13.1). Compared with standard MRI, CEM had significantly lower cancer detection rate (22.4 vs 36.6; difference, -14.2; 95% CI: -28.5, -2.0) and sensitivity (61.1% vs 100%; difference, -38.9%; 95% CI: -66.7, -12.5). The performance differences between CEM and ABMRI were similar to those observed between CEM and standard MRI. Conclusion ABMRI had comparable performance to standard MRI and may support more efficient MRI screening. CEM had lower recall and higher specificity compared with standard MRI or ABMRI, offset by lower cancer detection rate and sensitivity compared with standard MRI. These trade-offs warrant further consideration of patient population characteristics before widespread screening with CEM. Clinical trial registration no. NCT03517813 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Chang in this issue.
Collapse
Affiliation(s)
- Marissa B. Lawson
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Savannah C. Partridge
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Daniel S. Hippe
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Habib Rahbar
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Diana L. Lam
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Christoph I. Lee
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Kathryn P. Lowry
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - John R. Scheel
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Sana Parsian
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Isabella Li
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Debosmita Biswas
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Mary Lynn Bryant
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Janie M. Lee
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| |
Collapse
|
7
|
Lee JM, Ichikawa LE, Wernli KJ, Bowles EJA, Specht JM, Kerlikowske K, Miglioretti DL, Lowry KP, Tosteson ANA, Stout NK, Houssami N, Onega T, Buist DSM. Impact of Surveillance Mammography Intervals Less Than One Year on Performance Measures in Women With a Personal History of Breast Cancer. Korean J Radiol 2023; 24:729-738. [PMID: 37500574 PMCID: PMC10400369 DOI: 10.3348/kjr.2022.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE When multiple surveillance mammograms are performed within an annual interval, the current guidance for one-year follow-up to determine breast cancer status results in shared follow-up periods in which a single breast cancer diagnosis can be attributed to multiple preceding examinations, posing a challenge for standardized performance assessment. We assessed the impact of using follow-up periods that eliminate the artifactual inflation of second breast cancer diagnoses. MATERIALS AND METHODS We evaluated surveillance mammograms from 2007-2016 in women with treated breast cancer linked with tumor registry and pathology outcomes. Second breast cancers included ductal carcinoma in situ or invasive breast cancer diagnosed during one-year follow-up. The cancer detection rate, interval cancer rate, sensitivity, and specificity were compared using different follow-up periods: standard one-year follow-up per the American College of Radiology versus follow-up that was shortened at the next surveillance mammogram if less than one year (truncated follow-up). Performance measures were calculated overall and by indication (screening, evaluation for breast problem, and short interval follow-up). RESULTS Of 117971 surveillance mammograms, 20% (n = 23533) were followed by another surveillance mammogram within one year. Standard follow-up identified 1597 mammograms that were associated with second breast cancers. With truncated follow-up, the breast cancer status of 179 mammograms (11.2%) was revised, resulting in 1418 mammograms associated with unique second breast cancers. The interval cancer rate decreased with truncated versus standard follow-up (3.6 versus 4.9 per 1000 mammograms, respectively), with a difference (95% confidence interval [CI]) of -1.3 (-1.6, -1.1). The overall sensitivity increased to 70.4% from 63.7%, for the truncated versus standard follow-up, with a difference (95% CI) of 6.6% (5.6%, 7.7%). The specificity remained stable at 98.1%. CONCLUSION Truncated follow-up, if less than one year to the next surveillance mammogram, enabled second breast cancers to be associated with a single preceding mammogram and resulted in more accurate estimates of diagnostic performance for national benchmarks.
Collapse
Affiliation(s)
- Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Laura E Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer M Specht
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Karla Kerlikowske
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Veterans Affairs, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
| | - Nehmat Houssami
- The Daffodil Centre, University of Sydney and Cancer Council New South Wales, Kings Cross, New South Wales, Australia
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, USA
| |
Collapse
|
8
|
Sprague BL, Coley RY, Lowry KP, Kerlikowske K, Henderson LM, Su YR, Lee CI, Onega T, Bowles EJA, Herschorn SD, diFlorio-Alexander RM, Miglioretti DL. Digital Breast Tomosynthesis versus Digital Mammography Screening Performance on Successive Screening Rounds from the Breast Cancer Surveillance Consortium. Radiology 2023; 307:e223142. [PMID: 37249433 DOI: 10.1148/radiol.223142] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background Prior cross-sectional studies have observed that breast cancer screening with digital breast tomosynthesis (DBT) has a lower recall rate and higher cancer detection rate compared with digital mammography (DM). Purpose To evaluate breast cancer screening outcomes with DBT versus DM on successive screening rounds. Materials and Methods In this retrospective cohort study, data from 58 breast imaging facilities in the Breast Cancer Surveillance Consortium were collected. Analysis included women aged 40-79 years undergoing DBT or DM screening from 2011 to 2020. Absolute differences in screening outcomes by modality and screening round were estimated during the study period by using generalized estimating equations with marginal standardization to adjust for differences in women's risk characteristics across modality and round. Results A total of 523 485 DBT examinations (mean age of women, 58.7 years ± 9.7 [SD]) and 1 008 123 DM examinations (mean age, 58.4 years ± 9.8) among 504 863 women were evaluated. DBT and DM recall rates decreased with successive screening round, but absolute recall rates in each round were significantly lower with DBT versus DM (round 1 difference, -3.3% [95% CI: -4.6, -2.1] [P < .001]; round 2 difference, -1.8% [95% CI: -2.9, -0.7] [P = .003]; round 3 or above difference, -1.2% [95% CI: -2.4, -0.1] [P = .03]). DBT had significantly higher cancer detection (difference, 0.6 per 1000 examinations [95% CI: 0.2, 1.1]; P = .009) compared with DM only for round 3 and above. There were no significant differences in interval cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.24, 0.30] [P = .96]; round 2 or above difference, 0.04 [95% CI: -0.19, 0.31] [P = .76]) or total advanced cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.15, 0.19] [P = .94]; round 2 or above difference, -0.06 [95% CI: -0.18, 0.11] [P = .43]). Conclusion DBT had lower recall rates and could help detect more cancers than DM across three screening rounds, with no difference in interval or advanced cancer rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Skaane in this issue.
Collapse
Affiliation(s)
- Brian L Sprague
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Rebecca Yates Coley
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Kathryn P Lowry
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Karla Kerlikowske
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Louise M Henderson
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Yu-Ru Su
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Christoph I Lee
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Tracy Onega
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Erin J A Bowles
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Sally D Herschorn
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Roberta M diFlorio-Alexander
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| | - Diana L Miglioretti
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, Calif (D.L.M.)
| |
Collapse
|
9
|
Lowry KP, Ichikawa L, Hubbard RA, Buist DSM, Bowles EJA, Henderson LM, Kerlikowske K, Specht JM, Sprague BL, Wernli KJ, Lee JM. Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer 2023; 129:1173-1182. [PMID: 36789739 PMCID: PMC10409444 DOI: 10.1002/cncr.34679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/01/2022] [Accepted: 12/30/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND In women with previously treated breast cancer, occurrence and timing of second breast cancers have implications for surveillance. The authors examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. METHODS Women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer were identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected at primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. The authors examined cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis. RESULTS At 10 years, the cumulative second breast cancer incidence was 11.8% (95% confidence interval [CI], 10.7%-13.1%) for women with ER-negative disease and 7.5% (95% CI, 7.0%-8.0%) for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up (16.0 per 1000 person-years [PY]; 95% CI, 14.2-17.9 per 1000 PY; vs. 7.8 per 1000 PY; 95% CI, 7.3-8.4 per 1000 PY, respectively). After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer (12.1 per 1000 PY; 95% CI, 9.9-14.7; vs. 9.3 per 1000 PY; 95% CI, 8.4-10.3 per 1000 PY, respectively). CONCLUSIONS ER-negative primary breast cancers are associated with a higher risk of second breast cancers than ER-positive cancers during the first 5 years after diagnosis. Further study is needed to examine the potential benefit of more intensive surveillance targeting these women in the early postdiagnosis period.
Collapse
Affiliation(s)
- Kathryn P. Lowry
- Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diana S. M. Buist
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Erin J. A. Bowles
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Louise M. Henderson
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jennifer M. Specht
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Brian L. Sprague
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Karen J. Wernli
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Janie M. Lee
- Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| |
Collapse
|
10
|
Su YR, Buist DSM, Lee JM, Ichikawa L, Miglioretti DL, Bowles EJA, Wernli KJ, Kerlikowske K, Tosteson A, Lowry KP, Henderson LM, Sprague BL, Hubbard RA. Performance of Statistical and Machine Learning Risk Prediction Models for Surveillance Benefits and Failures in Breast Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2023; 32:561-571. [PMID: 36697364 PMCID: PMC10073265 DOI: 10.1158/1055-9965.epi-22-0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/02/2022] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Machine learning (ML) approaches facilitate risk prediction model development using high-dimensional predictors and higher-order interactions at the cost of model interpretability and transparency. We compared the relative predictive performance of statistical and ML models to guide modeling strategy selection for surveillance mammography outcomes in women with a personal history of breast cancer (PHBC). METHODS We cross-validated seven risk prediction models for two surveillance outcomes, failure (breast cancer within 12 months of a negative surveillance mammogram) and benefit (surveillance-detected breast cancer). We included 9,447 mammograms (495 failures, 1,414 benefits, and 7,538 nonevents) from years 1996 to 2017 using a 1:4 matched case-control samples of women with PHBC in the Breast Cancer Surveillance Consortium. We assessed model performance of conventional regression, regularized regressions (LASSO and elastic-net), and ML methods (random forests and gradient boosting machines) by evaluating their calibration and, among well-calibrated models, comparing the area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CI). RESULTS LASSO and elastic-net consistently provided well-calibrated predicted risks for surveillance failure and benefit. The AUCs of LASSO and elastic-net were both 0.63 (95% CI, 0.60-0.66) for surveillance failure and 0.66 (95% CI, 0.64-0.68) for surveillance benefit, the highest among well-calibrated models. CONCLUSIONS For predicting breast cancer surveillance mammography outcomes, regularized regression outperformed other modeling approaches and balanced the trade-off between model flexibility and interpretability. IMPACT Regularized regression may be preferred for developing risk prediction models in other contexts with rare outcomes, similar training sample sizes, and low-dimensional features.
Collapse
Affiliation(s)
- Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Diana SM Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
| | - Anna Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Kathryn P Lowry
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA, USA
| | | | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington, VT
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
11
|
Crary IL, Parker EU, Lowry KP, Patwardhan PP, Soong TR, Javid SH, Calhoun KE, Flanagan MR. ASO Visual Abstract: Risk of Lobular Neoplasia Upgrade with Synchronous Carcinoma. Ann Surg Oncol 2022; 29:6360. [PMID: 35857198 DOI: 10.1245/s10434-022-12213-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Elizabeth U Parker
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Pranav P Patwardhan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thing Rinda Soong
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sara H Javid
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Meghan R Flanagan
- Department of Surgery, University of Washington, Seattle, WA, USA.
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| |
Collapse
|
12
|
Hendrix N, Lowry KP, Elmore JG, Lotter W, Sorensen G, Hsu W, Liao GJ, Parsian S, Kolb S, Naeim A, Lee CI. Radiologist Preferences for Artificial Intelligence-Based Decision Support During Screening Mammography Interpretation. J Am Coll Radiol 2022; 19:1098-1110. [PMID: 35970474 PMCID: PMC9840464 DOI: 10.1016/j.jacr.2022.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Artificial intelligence (AI) may improve cancer detection and risk prediction during mammography screening, but radiologists' preferences regarding its characteristics and implementation are unknown. PURPOSE To quantify how different attributes of AI-based cancer detection and risk prediction tools affect radiologists' intentions to use AI during screening mammography interpretation. MATERIALS AND METHODS Through qualitative interviews with radiologists, we identified five primary attributes for AI-based breast cancer detection and four for breast cancer risk prediction. We developed a discrete choice experiment based on these attributes and invited 150 US-based radiologists to participate. Each respondent made eight choices for each tool between three alternatives: two hypothetical AI-based tools versus screening without AI. We analyzed samplewide preferences using random parameters logit models and identified subgroups with latent class models. RESULTS Respondents (n = 66; 44% response rate) were from six diverse practice settings across eight states. Radiologists were more interested in AI for cancer detection when sensitivity and specificity were balanced (94% sensitivity with <25% of examinations marked) and AI markup appeared at the end of the hanging protocol after radiologists complete their independent review. For AI-based risk prediction, radiologists preferred AI models using both mammography images and clinical data. Overall, 46% to 60% intended to adopt any of the AI tools presented in the study; 26% to 33% approached AI enthusiastically but were deterred if the features did not align with their preferences. CONCLUSION Although most radiologists want to use AI-based decision support, short-term uptake may be maximized by implementing tools that meet the preferences of dissuadable users.
Collapse
Affiliation(s)
- Nathaniel Hendrix
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington.
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - William Lotter
- Chief Technology Officer, DeepHealth Inc, RadNet AI Solutions, Cambridge, Massachusetts
| | - Gregory Sorensen
- Chief Technology Officer, DeepHealth Inc, RadNet AI Solutions, Cambridge, Massachusetts
| | - William Hsu
- Department of Radiological Sciences, Data Integration, Architecture, and Analytics Group, University of California, Los Angeles, California; American Medical Informatics Association: Member, Governance Committee; RSNA: Deputy Editor, Radiology: Artificial Intelligence
| | - Geraldine J Liao
- Department of Radiology, Virginia Mason Medical Center, Seattle, Washington
| | - Sana Parsian
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington; Department of Radiology, Kaiser Permanente Washington, Seattle, Washington
| | - Suzanne Kolb
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Arash Naeim
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; Chief Medical Officer for Clinical Research, UCLA Health; Codirector: Clinical and Translational Science Institute and Center for SMART Health; Associate Director: Institute for Precision Health, Jonsson Comprehensive Cancer Center, Garrick Institute for Risk Sciences
| | - Christoph I Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; and Deputy Editor, JACR
| |
Collapse
|
13
|
Crary IL, Parker EU, Lowry KP, Patwardhan PP, Soong TR, Javid SH, Calhoun KE, Flanagan MR. Risk of Lobular Neoplasia Upgrade with Synchronous Carcinoma. Ann Surg Oncol 2022; 29:6350-6358. [PMID: 35802213 DOI: 10.1245/s10434-022-12129-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atypical lobular hyperplasia (ALH) and classic lobular carcinoma in situ encompass a spectrum of proliferative lesions known as lobular neoplasia (LN). When imaging-concordant and found in isolation on core needle biopsy (CNB), LN infrequently upgrades to carcinoma on surgical excision, and routine excision is not indicated. Upgrade rates in the setting of synchronous carcinoma are not well studied. PATIENTS AND METHODS Patients with radiology-pathology concordant synchronous LN and separately biopsied ipsilateral (n = 35) or contralateral (n = 15) carcinoma who underwent excision between 2010 and 2021 were retrospectively identified. Frequency of upgrade, to either invasive or in situ carcinoma, was quantified, and factors associated with upgrade were assessed using Fisher's exact test. RESULTS The median age was 55 (range 33-74) years. The upgrade rate of LN was 6% and not significantly different between ipsilateral (2.9%) and contralateral (13.3%) carcinoma (p = 0.15). All upgraded LN lesions were ALH on CNB and detected as non-mass enhancement on magnetic resonance imaging (MRI). No additional disease was demonstrated after excision at the site of the original LN CNB in 22.9% (8 out of 35) of ipsilateral and 13.3% (2 out of 15) of contralateral patients. Upgrade was not associated with family history, menopausal status, imaging modality used to detect LN, or extent of LN on CNB (p > 0.05). CONCLUSIONS Our results demonstrate a low upgrade rate (6%) in our study cohort of LN with synchronous ipsilateral or contralateral carcinoma, which suggests that not all LN mandates excision with synchronous carcinoma. Larger, multi-institution studies are needed to validate these findings.
Collapse
Affiliation(s)
| | - Elizabeth U Parker
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Pranav P Patwardhan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thing Rinda Soong
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sara H Javid
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Meghan R Flanagan
- Department of Surgery, University of Washington, Seattle, WA, USA. .,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| |
Collapse
|
14
|
Jayasekera J, Lowry KP, Yeh JM, Schwartz MD, Wernli KJ, Isaacs C, Kurian AW, Stout NK. Simulation modeling as a tool to support clinical guidelines and care for breast cancer prevention and early detection in high-risk women. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10525 Background: To evaluate the incremental short- and long-term benefits and harms of primary prevention with risk reducing medication in high-risk women receiving screening mammography. Methods: We adapted an established, validated Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer discrete event microsimulation model developed to synthesize data the impact of using risk-reducing medication and annual mammography among women with a 3% or higher five-year risk of developing breast cancer. We also examined the effects of supplemental MRI. The model follows a simulated cohort of millions of US women from birth to death. We used large observational and clinical trial data to derive input parameters for cohort-specific birth rates, breast cancer risk, incidence and stage, screening performance, survival by age, stage, and subtype, treatment efficacy, and other cause mortality. Breast cancer risk was modeled based on family history, breast density, age and history of past breast biopsy. We compared two strategies, annual 3D mammography alone vs. annual 3D mammography and a 5-year course of risk reducing medication at various starting ages, and adding MRI to each approach. Outcomes included the benefits of risk-reducing drugs (avoiding breast cancer) and screening (stage, breast cancer death). Harms included drug side effects and screening false positives and overdiagnosis. Sensitivity analysis tested the impact of uncertainty in model inputs and assumptions on results. Results: Compared to mammography alone, adding risk reducing medication could decrease invasive breast cancer incidence by 30%, and breast cancer deaths by 30% (Table). However, due to reduction in breast cancer incidence, risk reducing medication could result in a 3% increase in false positive results; adding MRI increases benefits but also increases false-positive results. Benefits and harms of risk reducing medication and breast cancer screening strategies for women at high-risk of developing breast cancer. Conclusions: Risk-reducing mediation reduces the risk of hormone-receptor positive breast cancer, and combining this with mammography (and/or MRI) improves earlier detection. Additional work is ongoing to incorporate adverse effects of therapy. Simulation modeling can be used to provide individualized data to facilitate discussions about breast cancer prevention and early detection among high-risk women seen in clinical practice.[Table: see text]
Collapse
Affiliation(s)
- Jinani Jayasekera
- Lombardi Cancer Center MedStar Georgetown University Hospital, Washington, DC
| | - Kathryn P. Lowry
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Jennifer M Yeh
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | | | | | - Natasha K. Stout
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| |
Collapse
|
15
|
Lowry KP, Bissell MCS, Miglioretti DL, Kerlikowske K, Alsheik N, Macarol T, Bowles EJA, Buist DSM, Tosteson ANA, Henderson L, Herschorn SD, Wernli KJ, Weaver DL, Stout NK, Sprague BL. Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic. Radiology 2022; 303:287-294. [PMID: 34665032 PMCID: PMC8544262 DOI: 10.1148/radiol.2021211808] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Abstract
Background The COVID-19 pandemic reduced mammography use, potentially delaying breast cancer diagnoses. Purpose To examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection (screen detected vs symptomatic) and women's characteristics. Materials and Methods In this secondary analysis of prospectively collected data, monthly breast biopsy recommendations after mammography, US, or both with subsequent biopsy performed were examined from 66 facilities of the Breast Cancer Surveillance Consortium between January 2019 and September 2020. The number of monthly and cumulative biopsies recommended and performed and the number of subsequent cancers diagnosed during the pandemic period (March 2020 to September 2020) were compared with data from the prepandemic period using Wald χ2 tests. Analyses were stratified by mode of detection and race or ethnicity. Results From January 2019 to September 2020, 17 728 biopsies were recommended and performed, with 6009 cancers diagnosed. From March to September 2020, there were substantially fewer breast biopsy recommendations with cancer diagnoses when compared with the same period in 2019 (1650 recommendations in 2020 vs 2171 recommendations in 2019 [24% fewer], P < .001), predominantly due to fewer screen-detected cancers (722 cancers in 2020 vs 1169 cancers in 2019 [38% fewer], P < .001) versus symptomatic cancers (895 cancers in 2020 vs 965 cancers in 2019 [7% fewer], P = .27). The decrease in cancer diagnoses was largest in Asian (67 diagnoses in 2020 vs 142 diagnoses in 2019 [53% fewer], P = .06) and Hispanic (82 diagnoses in 2020 vs 145 diagnoses in 2019 [43% fewer], P = .13) women, followed by Black women (210 diagnoses in 2020 vs 287 diagnoses in 2019 [27% fewer], P = .21). The decrease was smallest in non-Hispanic White women (1128 diagnoses in 2020 vs 1357 diagnoses in 2019 [17% fewer], P = .09). Conclusion There were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared with the same period in 2019, with Asian and Hispanic women experiencing the largest declines, followed by Black women. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Heller in this issue.
Collapse
Affiliation(s)
- Kathryn P. Lowry
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Michael C. S. Bissell
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Nila Alsheik
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Tere Macarol
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Erin J. A. Bowles
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana S. M. Buist
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Anna N. A. Tosteson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Louise Henderson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Sally D. Herschorn
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karen J. Wernli
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Donald L. Weaver
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Natasha K. Stout
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| |
Collapse
|
16
|
Lowry KP, Callaway KA, Lee JM, Zhang F, Ross-Degnan D, Wharam JF, Kerlikowske K, Wernli KJ, Kurian AW, Henderson LM, Stout NK. Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016. J Natl Compr Canc Netw 2022; 20:379-386.e9. [PMID: 35390766 DOI: 10.6004/jnccn.2021.7081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. METHODS We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40-49 vs 50-64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. RESULTS Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, -3.4% to -2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, -1.9% to -1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, -1.7%; 95% CI, -2.1% to -1.4%) or a primary care provider (APC, -1.6%; 95% CI, -2.1% to -1.2%) in the prior year. CONCLUSIONS Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.
Collapse
Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Katherine A Callaway
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Janie M Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - J Frank Wharam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Karla Kerlikowske
- Department of Medicine, and.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; and
| | - Natasha K Stout
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
17
|
Lowry KP, Geuzinge HA, Stout NK, Alagoz O, Hampton J, Kerlikowske K, de Koning HJ, Miglioretti DL, van Ravesteyn NT, Schechter C, Sprague BL, Tosteson ANA, Trentham-Dietz A, Weaver D, Yaffe MJ, Yeh JM, Couch FJ, Hu C, Kraft P, Polley EC, Mandelblatt JS, Kurian AW, Robson ME. Breast Cancer Screening Strategies for Women With ATM, CHEK2, and PALB2 Pathogenic Variants: A Comparative Modeling Analysis. JAMA Oncol 2022; 8:587-596. [PMID: 35175286 PMCID: PMC8855312 DOI: 10.1001/jamaoncol.2021.6204] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Screening mammography and magnetic resonance imaging (MRI) are recommended for women with ATM, CHEK2, and PALB2 pathogenic variants. However, there are few data to guide screening regimens for these women. OBJECTIVE To estimate the benefits and harms of breast cancer screening strategies using mammography and MRI at various start ages for women with ATM, CHEK2, and PALB2 pathogenic variants. DESIGN, SETTING, AND PARTICIPANTS This comparative modeling analysis used 2 established breast cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate different screening strategies. Age-specific breast cancer risks were estimated using aggregated data from the Cancer Risk Estimates Related to Susceptibility (CARRIERS) Consortium for 32 247 cases and 32 544 controls in 12 population-based studies. Data on screening performance for mammography and MRI were estimated from published literature. The models simulated US women with ATM, CHEK2, or PALB2 pathogenic variants born in 1985. INTERVENTIONS Screening strategies with combinations of annual mammography alone and with MRI starting at age 25, 30, 35, or 40 years until age 74 years. MAIN OUTCOMES AND MEASURES Estimated lifetime breast cancer mortality reduction, life-years gained, breast cancer deaths averted, total screening examinations, false-positive screenings, and benign biopsies per 1000 women screened. Results are reported as model mean values and ranges. RESULTS The mean model-estimated lifetime breast cancer risk was 20.9% (18.1%-23.7%) for women with ATM pathogenic variants, 27.6% (23.4%-31.7%) for women with CHEK2 pathogenic variants, and 39.5% (35.6%-43.3%) for women with PALB2 pathogenic variants. Across pathogenic variants, annual mammography alone from 40 to 74 years was estimated to reduce breast cancer mortality by 36.4% (34.6%-38.2%) to 38.5% (37.8%-39.2%) compared with no screening. Screening with annual MRI starting at 35 years followed by annual mammography and MRI at 40 years was estimated to reduce breast cancer mortality by 54.4% (54.2%-54.7%) to 57.6% (57.2%-58.0%), with 4661 (4635-4688) to 5001 (4979-5023) false-positive screenings and 1280 (1272-1287) to 1368 (1362-1374) benign biopsies per 1000 women. Annual MRI starting at 30 years followed by mammography and MRI at 40 years was estimated to reduce mortality by 55.4% (55.3%-55.4%) to 59.5% (58.5%-60.4%), with 5075 (5057-5093) to 5415 (5393-5437) false-positive screenings and 1439 (1429-1449) to 1528 (1517-1538) benign biopsies per 1000 women. When starting MRI at 30 years, initiating annual mammography starting at 30 vs 40 years did not meaningfully reduce mean mortality rates (0.1% [0.1%-0.2%] to 0.3% [0.2%-0.3%]) but was estimated to add 649 (602-695) to 650 (603-696) false-positive screenings and 58 (41-76) to 59 (41-76) benign biopsies per 1000 women. CONCLUSIONS AND RELEVANCE This analysis suggests that annual MRI screening starting at 30 to 35 years followed by annual MRI and mammography at 40 years may reduce breast cancer mortality by more than 50% for women with ATM, CHEK2, and PALB2 pathogenic variants. In the setting of MRI screening, mammography prior to 40 years may offer little additional benefit.
Collapse
Affiliation(s)
- Kathryn P. Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | - H. Amarens Geuzinge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison
| | - John Hampton
- Carbone Cancer Center, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Harry J. de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis
| | | | - Clyde Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Brian L. Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
- Department of Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Amy Trentham-Dietz
- Carbone Cancer Center, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison
| | - Donald Weaver
- Department of Pathology, University of Vermont Larner College of Medicine, Burlington
| | - Martin J. Yaffe
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M. Yeh
- Department of Pediatrics, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, New York
| | - Chunling Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, New York
| | - Peter Kraft
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Eric C. Polley
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Allison W. Kurian
- Department of Medicine, Stanford University, Stanford, California
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Mark E. Robson
- Department of Breast Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
18
|
Miller TI, Flanagan MR, Lowry KP, Kilgore MR. Error Reduction and Diagnostic Concordance in Breast Pathology. Surg Pathol Clin 2022; 15:1-13. [PMID: 35236626 DOI: 10.1016/j.path.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Errors in anatomic pathology can result in patients receiving inappropriate treatment and poor patient outcomes. Policies and procedures are necessary to decrease error and improve diagnostic concordance. Breast pathology may be more prone to diagnostic errors than other surgical pathology subspecialties due to inherit borderline diagnostic categories such as atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Mandatory secondary review of internal and outside referral cases before treatment is effective in reducing diagnostic errors and improving concordance. Assessment of error through amendment/addendum tracking, implementing an incident reporting system, and multidisciplinary tumor boards can establish procedures to prevent future error.
Collapse
Affiliation(s)
- Timothy Isaac Miller
- Department of Laboratory Medicine and Pathology, University of Washington, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357100, Seattle, WA 98195, USA.
| | - Meghan R Flanagan
- Department of Surgery, University of Washington, 1100 Fairview Avenue, M4-B874, Seattle, WA 98109, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG-215, Seattle, WA 98109, USA
| | - Mark R Kilgore
- Department of Laboratory Medicine and Pathology, University of Washington, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357100, Seattle, WA 98195, USA
| |
Collapse
|
19
|
Anderson AW, Marinovich ML, Houssami N, Lowry KP, Elmore JG, Buist DS, Hofvind S, Lee CI. Independent External Validation of Artificial Intelligence Algorithms for Automated Interpretation of Screening Mammography: A Systematic Review. J Am Coll Radiol 2022; 19:259-273. [PMID: 35065909 PMCID: PMC8857031 DOI: 10.1016/j.jacr.2021.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to describe the current state of science regarding independent external validation of artificial intelligence (AI) technologies for screening mammography. METHODS A systematic review was performed across five databases (Embase, PubMed, IEEE Explore, Engineer Village, and arXiv) through December 10, 2020. Studies that used screening examinations from real-world settings to externally validate AI algorithms for mammographic cancer detection were included. The main outcome was diagnostic accuracy, defined by area under the receiver operating characteristic curve (AUC). Performance was also compared between radiologists and either stand-alone AI or combined radiologist and AI interpretation. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS After data extraction, 13 studies met the inclusion criteria (148,361 total patients). Most studies (77% [n = 10]) evaluated commercially available AI algorithms. Studies included retrospective reader studies (46% [n = 6]), retrospective simulation studies (38% [n = 5]), or both (15% [n = 2]). Across 5 studies comparing stand-alone AI with radiologists, 60% (n = 3) demonstrated improved accuracy with AI (AUC improvement range, 0.02-0.13). All 5 studies comparing combined radiologist and AI interpretation with radiologists alone demonstrated improved accuracy with AI (AUC improvement range, 0.028-0.115). Most studies had risk for bias or applicability concerns for patient selection (69% [n = 9]) and the reference standard (69% [n = 9]). Only two studies obtained ground-truth cancer outcomes through regional cancer registry linkage. CONCLUSIONS To date, external validation efforts for AI screening mammographic technologies suggest small potential diagnostic accuracy improvements but have been retrospective in nature and suffer from risk for bias and applicability concerns.
Collapse
Affiliation(s)
- Anna W. Anderson
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - M. Luke Marinovich
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Nehmat Houssami
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kathryn P. Lowry
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Joann G. Elmore
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Diana S.M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
20
|
Lowry KP, Lee CI, Grimm LJ. Finding Inspiration in the Future of Radiology: Looking Beyond the Pandemic. J Am Coll Radiol 2022; 19:319-320. [PMID: 35152955 PMCID: PMC8830910 DOI: 10.1016/j.jacr.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
|
21
|
Alagoz O, Lowry KP, Kurian AW, Mandelblatt JS, Ergun MA, Huang H, Lee SJ, Schechter CB, Tosteson ANA, Miglioretti DL, Trentham-Dietz A, Nyante SJ, Kerlikowske K, Sprague BL, Stout NK. Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling. J Natl Cancer Inst 2021; 113:1484-1494. [PMID: 34258611 PMCID: PMC8344930 DOI: 10.1093/jnci/djab097] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. METHODS Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. RESULTS By 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic's disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months. CONCLUSIONS Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.
Collapse
Affiliation(s)
- Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Allison W Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Mehmet A Ergun
- Department of Industrial Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Hui Huang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandra J Lee
- Department of Data Science, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Diana L Miglioretti
- Department of Public Health Sciences, University of California at Davis, Davis, CA, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and the Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Sarah J Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology/Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Brian L Sprague
- Department of Surgery and the University of Vermont Cancer Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | |
Collapse
|
22
|
Sprague BL, Lowry KP, Miglioretti DL, Alsheik N, Bowles EJA, Tosteson ANA, Rauscher G, Herschorn SD, Lee JM, Trentham-Dietz A, Weaver DL, Stout NK, Kerlikowske K. Changes in Mammography Use by Women's Characteristics During the First 5 Months of the COVID-19 Pandemic. J Natl Cancer Inst 2021; 113:1161-1167. [PMID: 33778894 PMCID: PMC8083761 DOI: 10.1093/jnci/djab045] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/08/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to prepandemic levels and whether use has varied by women's characteristics. METHODS We collected data on 461 083 screening mammograms and 112 207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium. We compared monthly screening and diagnostic mammography volumes before and during the pandemic stratified by age, race and ethnicity, breast density, and family history of breast cancer. RESULTS Screening and diagnostic mammography volumes in April 2020 were 1.1% (95% confidence interval [CI] = 0.5% to 2.4%) and 21.4% (95% CI = 18.7% to 24.4%) of the April 2019 prepandemic volumes, respectively, but by July 2020 had rebounded to 89.7% (95% CI = 79.6% to 101.1%) and 101.6% (95% CI = 93.8% to 110.1%) of the July 2019 prepandemic volumes, respectively. The year-to-date cumulative volume of screening and diagnostic mammograms performed through July 2020 was 66.2% (95% CI = 60.3% to 72.6%) and 79.9% (95% CI = 75.4% to 84.6%), respectively, of year-to-date volume through July 2019. Screening mammography rebound was similar across age groups and by family history of breast cancer. Monthly screening mammography volume in July 2020 for Black, White, Hispanic, and Asian women reached 96.7% (95% CI = 88.1% to 106.1%), 92.9% (95% CI = 82.9% to 104.0%), 72.7% (95% CI = 56.5% to 93.6%), and 51.3% (95% CI = 39.7% to 66.2%) of the July 2019 prepandemic volume, respectively. CONCLUSIONS Despite a strong overall rebound in mammography volume by July 2020, the rebound lagged among Asian and Hispanic women, and a substantial cumulative deficit in missed mammograms accumulated, which may have important health consequences.
Collapse
Affiliation(s)
- Brian L Sprague
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Kathryn P Lowry
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Nila Alsheik
- Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Janie M Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
| |
Collapse
|
23
|
Lowry KP, Bell S, Fendrick AM, Carlos RC. Out-of-Pocket Costs of Diagnostic Breast Imaging Services After Screening Mammography Among Commercially Insured Women From 2010 to 2017. JAMA Netw Open 2021; 4:e2121347. [PMID: 34402892 PMCID: PMC8371567 DOI: 10.1001/jamanetworkopen.2021.21347] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This cross-sectional study evaluates the out-of-pocket costs of diagnostic breast imaging services incurred by commercially insured women who underwent additional imaging evaluation and procedures after screening mammography.
Collapse
Affiliation(s)
- Kathryn P. Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | - Sarah Bell
- Program for Women’s Health Effectiveness Research, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | | | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor
| |
Collapse
|
24
|
Lee JM, Ichikawa LE, Wernli KJ, Bowles E, Specht JM, Kerlikowske K, Miglioretti DL, Lowry KP, Tosteson ANA, Stout NK, Houssami N, Onega T, Buist DSM. Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007-2016. Radiology 2021; 300:290-300. [PMID: 34003059 PMCID: PMC8328154 DOI: 10.1148/radiol.2021204581] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023]
Abstract
Background Since 2007, digital mammography and digital breast tomosynthesis (DBT) replaced screen-film mammography. Whether these technologic advances have improved diagnostic performance has, to the knowledge of the authors, not yet been established. Purpose To evaluate the performance and outcomes of surveillance mammography (digital mammography and DBT) performed from 2007 to 2016 in women with a personal history of breast cancer and compare with data from 1996 to 2007 and the performance of digital mammography screening benchmarks. Materials and Methods In this observational cohort study, five Breast Cancer Surveillance Consortium registries provided prospectively collected mammography data linked with tumor registry and pathologic outcomes. This study identified asymptomatic women with American Joint Committee on Cancer anatomic stages 0-III primary breast cancer who underwent surveillance mammography from 2007 to 2016. The primary outcome was a second breast cancer diagnosis within 1 year of mammography. Performance measures included the recall rate, cancer detection rate, interval cancer rate, positive predictive value of biopsy recommendation, sensitivity, and specificity. Results Among 32 331 women who underwent 117 971 surveillance mammographic examinations (112 269 digital mammographic examinations and 5702 DBT examinations), the mean age at initial diagnosis was 59 years ± 12 (standard deviation). Of 1418 second breast cancers diagnosed, 998 were surveillance-detected cancers and 420 were interval cancers. The recall rate was 8.8% (10 365 of 117 971; 95% CI: 8.6%, 9.0%), the cancer detection rate was 8.5 per 1000 examinations (998 of 117 971; 95% CI: 8.0, 9.0), the interval cancer rate was 3.6 per 1000 examinations (420 of 117 971; 95% CI: 3.2, 3.9), the positive predictive value of biopsy recommendation was 31.0% (998 of 3220; 95% CI: 29.4%, 32.7%), the sensitivity was 70.4% (998 of 1418; 95% CI: 67.9%, 72.7%), and the specificity was 98.1% (114 331 of 116 553; 95% CI: 98.0%, 98.2%). Compared with previously published studies, interval cancer rate was comparable with rates from 1996 to 2007 in women with a personal history of breast cancer and was higher than the published digital mammography screening benchmarks. Conclusion In transitioning from screen-film to digital mammography and digital breast tomosynthesis, surveillance mammography performance demonstrated minimal improvement over time and remained inferior to the performance of screening mammography benchmarks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Moy and Gao in this issue.
Collapse
Affiliation(s)
- Janie M. Lee
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Laura E. Ichikawa
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Karen J. Wernli
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Erin Bowles
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Jennifer M. Specht
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Karla Kerlikowske
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Diana L. Miglioretti
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Kathryn P. Lowry
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Anna N. A. Tosteson
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Natasha K. Stout
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Nehmat Houssami
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Tracy Onega
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Diana S. M. Buist
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| |
Collapse
|
25
|
Yeh JM, Lowry KP, Schechter CB, Diller LR, O'Brien G, Alagoz O, Armstrong GT, Hampton JM, Hudson MM, Leisenring W, Liu Q, Mandelblatt JS, Miglioretti DL, Moskowitz CS, Nathan PC, Neglia JP, Oeffinger KC, Trentham-Dietz A, Stout NK. Breast Cancer Screening Among Childhood Cancer Survivors Treated Without Chest Radiation: Clinical Benefits and Cost-Effectiveness. J Natl Cancer Inst 2021; 114:235-244. [PMID: 34324686 DOI: 10.1093/jnci/djab149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/22/2021] [Accepted: 07/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early initiation of breast cancer screening is recommended for high-risk women, including survivors of childhood cancer treated with chest radiation. Recent studies suggest that female survivors of childhood leukemia or sarcoma treated without chest radiation are also at elevated early onset breast cancer risk. However, the potential clinical benefits and cost-effectiveness of early breast cancer screening among these women are uncertain. METHODS Using data from the Childhood Cancer Survivor Study, we adapted two Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer simulation models to reflect the elevated risks of breast cancer and competing mortality among leukemia and sarcoma survivors. Costs and utility weights were based on published studies and databases. Outcomes included breast cancer deaths averted, false-positive-screening results, benign biopsies, and incremental cost-effectiveness ratios (ICERs). RESULTS In the absence of screening, the lifetime risk of dying from breast cancer among survivors was 6.8% to 7.0% across models. Early initiation of annual mammography with MRI screening between ages 25 and 40 would avert 52.6% to 64.3% of breast cancer deaths. When costs and quality of life impacts were considered, screening starting at age 40 was the only strategy with an ICER below the $100,000 per quality-adjusted life-year (QALY) gained cost-effectiveness threshold ($27,680 to $44,380 per QALY gained across models). CONCLUSIONS Among survivors of childhood leukemia or sarcoma, early initiation of breast cancer screening at age 40 may reduce breast cancer deaths by half and is cost-effective. These findings could help inform screening guidelines for survivors treated without chest radiation.
Collapse
Affiliation(s)
- Jennifer M Yeh
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA.,Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kathryn P Lowry
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Lisa R Diller
- Department of Pediatrics, Harvard Medical School, Boston, MA.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Grace O'Brien
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
| | | | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Qi Liu
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Diana L Miglioretti
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY
| | | | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota Medical School
| | | | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| |
Collapse
|
26
|
Lowry KP, Geuzinge HA, Stout NK, Alagoz O, Hampton JM, Kerlikowske K, Miglioretti DL, Schecter C, Sprague BL, Trentham-Dietz A, Tosteson AN, Van Ravesteyn N, Yaffe M, Yeh J, Couch F, Kraft P, Polley E, Mandelblatt JS, Kurian AW, Robson ME. Breast cancer screening for carriers of ATM, CHEK2, and PALB2 pathogenic variants: A comparative modeling analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10500 Background: Inherited pathogenic variants in ATM, CHEK2, and PALB2 confer moderate to high risks of breast cancer. The optimal approach to screening in these women has not been established. Methods: We used two simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) and data from the Cancer Risk Estimates Related to Susceptibility consortium (CARRIERS) to project lifetime breast cancer incidence and mortality in ATM, CHEK2, and PALB2 carriers. We simulated screening with annual mammography from ages 40-74 alone and with annual magnetic resonance imaging (MRI) starting at ages 40, 35, 30, and 25. Joint and separate mammography and MRI screening performance was based on published literature. Lifetime outcomes per 1,000 women were reported as means and ranges across both models. Results: Estimated risk of breast cancer by age 80 was 22% (21-23%) for ATM, 28% (26-30%) for CHEK2, and 40% (38-42%) for PALB2. Screening with MRI and mammography reduced breast cancer mortality by 52-60% across variants (Table). Compared to no screening, starting MRI at age 30 increased life years (LY)/1000 women by 501 (478-523) in ATM, 620 (587-652) in CHEK2, and 1,025 (998-1,051) in PALB2. Starting MRI at age 25 versus 30 gained 9-12 LY/1000 women with 517-518 additional false positive screens and 197-198 benign biopsies. Conclusions: For women with ATM, CHEK2, and PALB2 pathogenic variants, breast cancer screening with MRI and mammography halves breast cancer mortality. These mortality benefits are similar to those for MRI screening for BRCA1/2 mutation carriers and should inform practice guidelines.[Table: see text]
Collapse
Affiliation(s)
- Kathryn P. Lowry
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | | | - Natasha K. Stout
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | | | | | | | - Clyde Schecter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | - Martin Yaffe
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer Yeh
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | |
Collapse
|
27
|
Alagoz O, Lowry KP, Kurian AW, Mandelblatt JS, Ergun MA, Huang H, Lee SJ, Schecter C, Tosteson AN, Miglioretti DL, Trentham-Dietz A, Nyante S, Kerlikowske K, Sprague BL, Stout NK. Impact of disruptions in breast cancer control due to the COVID-19 pandemic on breast cancer mortality in the United States: Estimates from collaborative simulation modeling. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6562 Background: The COVID-19 pandemic has disrupted breast cancer control through short-term declines in screening, delays in diagnosis and reduced/delayed treatments. We projected the impact of COVID-19 on future breast cancer mortality.Methods: Three established Cancer Intervention and Surveillance Modeling Network (CISNET) models projected the impact of pandemic-related care disruptions on breast cancer mortality between 2020 and 2030 vs. pre-pandemic care patterns. Based on Breast Cancer Surveillance Consortium data, we modeled reductions in mammography screening utilization, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first six months of the pandemic with return to pre-pandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. Results: By 2030, the models project 1,297 (model range: 1,054-1,900) cumulative excess deaths related to reduced screening; 1,325 (range: 266-2,628) deaths from delayed diagnosis of symptomatic women, and 207 (range: 146-301) deaths from reduced chemotherapy use for early-stage cancer. Overall, the models predict 2,487 (range 1,713-4,875) excess deaths, representing a 0.56% (range: 0.36%-0.99%) cumulative increase over deaths that would be expected by 2030 in the absence of the pandemic’s disruptions. Sensitivity analyses indicated that the impact on mortality would approximately double if the disruptions lasted for a 12-month period. Conclusions: The impact of the initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. The impact of the initial pandemic-related disruptions on breast cancer mortality will largely be mitigated by the rapid return to usual care. As the pandemic continues it will be important to monitor trends in care and reassess the mortality impact.[Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | - Hui Huang
- Dana-Farber Cancer Institute, Boston, MA
| | - Sandra J. Lee
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | - Clyde Schecter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Sarah Nyante
- University of North Carolina-Chapel Hill, Chapel Hill, NC
| | | | | | - Natasha K. Stout
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| |
Collapse
|
28
|
Lowry KP, Trentham-Dietz A, Schechter CB, Alagoz O, Barlow WE, Burnside ES, Conant EF, Hampton JM, Huang H, Kerlikowske K, Lee SJ, Miglioretti DL, Sprague BL, Tosteson ANA, Yaffe MJ, Stout NK. Long-Term Outcomes and Cost-Effectiveness of Breast Cancer Screening With Digital Breast Tomosynthesis in the United States. J Natl Cancer Inst 2021; 112:582-589. [PMID: 31503283 DOI: 10.1093/jnci/djz184] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Digital breast tomosynthesis (DBT) is increasingly being used for routine breast cancer screening. We projected the long-term impact and cost-effectiveness of DBT compared to conventional digital mammography (DM) for breast cancer screening in the United States. METHODS Three Cancer Intervention and Surveillance Modeling Network breast cancer models simulated US women ages 40 years and older undergoing breast cancer screening with either DBT or DM starting in 2011 and continuing for the lifetime of the cohort. Screening performance estimates were based on observational data; in an alternative scenario, we assumed 4% higher sensitivity for DBT. Analyses used federal payer perspective; costs and utilities were discounted at 3% annually. Outcomes included breast cancer deaths, quality-adjusted life-years (QALYs), false-positive examinations, costs, and incremental cost-effectiveness ratios (ICERs). RESULTS Compared to DM, DBT screening resulted in a slight reduction in breast cancer deaths (range across models 0-0.21 per 1000 women), small increase in QALYs (1.97-3.27 per 1000 women), and a 24-28% reduction in false-positive exams (237-268 per 1000 women) relative to DM. ICERs ranged from $195 026 to $270 135 per QALY for DBT relative to DM. When assuming 4% higher DBT sensitivity, ICERs decreased to $130 533-$156 624 per QALY. ICERs were sensitive to DBT costs, decreasing to $78 731 to $168 883 and $52 918 to $118 048 when the additional cost of DBT was reduced to $36 and $26 (from baseline of $56), respectively. CONCLUSION DBT reduces false-positive exams while achieving similar or slightly improved health benefits. At current reimbursement rates, the additional costs of DBT screening are likely high relative to the benefits gained; however, DBT could be cost-effective at lower screening costs.
Collapse
Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | | | - Clyde B Schechter
- University of Wisconsin-Madison, Madison, WI; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Oguzhan Alagoz
- Carbone Cancer Center and Department of Population Health Sciences.,School of Medicine and Public Health, and Department of Industrial and Systems Engineering
| | - William E Barlow
- Cancer Research and Biostatistics, University of Washington, Seattle, WA
| | | | - Emily F Conant
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John M Hampton
- Carbone Cancer Center and Department of Population Health Sciences
| | - Hui Huang
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Sandra J Lee
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA.,Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Martin J Yaffe
- Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Canada
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| |
Collapse
|
29
|
Yeh JM, Lowry KP, Schechter CB, Diller LR, Alagoz O, Armstrong GT, Hampton JM, Leisenring W, Liu Q, Mandelblatt JS, Miglioretti DL, Moskowitz CS, Oeffinger KC, Trentham-Dietz A, Stout NK. Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study. Ann Intern Med 2020; 173:331-341. [PMID: 32628531 PMCID: PMC7510774 DOI: 10.7326/m19-3481] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Surveillance with annual mammography and breast magnetic resonance imaging (MRI) is recommended for female survivors of childhood cancer treated with chest radiation, yet benefits, harms, and costs are uncertain. OBJECTIVE To compare the benefits, harms, and cost-effectiveness of breast cancer screening strategies in childhood cancer survivors. DESIGN Collaborative simulation modeling using 2 Cancer Intervention and Surveillance Modeling Network breast cancer models. DATA SOURCES Childhood Cancer Survivor Study and published data. TARGET POPULATION Women aged 20 years with a history of chest radiotherapy. TIME HORIZON Lifetime. PERSPECTIVE Payer. INTERVENTION Annual MRI with or without mammography, starting at age 25, 30, or 35 years. OUTCOME MEASURES Breast cancer deaths averted, false-positive screening results, benign biopsy results, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS Lifetime breast cancer mortality risk without screening was 10% to 11% across models. Compared with no screening, starting at age 25 years, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62%. Both strategies had the most screening tests, false-positive screening results, and benign biopsy results. For an ICER threshold of less than $100 000 per quality-adjusted life-year gained, screening beginning at age 30 years was preferred. RESULTS OF SENSITIVITY ANALYSIS Assuming lower screening performance, the benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged. LIMITATION Elevated breast cancer risk was based on survivors diagnosed with childhood cancer between 1970 and 1986. CONCLUSION Early initiation (at ages 25 to 30 years) of annual breast cancer screening with MRI, with or without mammography, might reduce breast cancer mortality by half or more in survivors of childhood cancer. PRIMARY FUNDING SOURCE American Cancer Society and National Institutes of Health.
Collapse
Affiliation(s)
- Jennifer M. Yeh
- Department of Pediatrics, Harvard Medical School and Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Kathryn P. Lowry
- University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave. E., Seattle, WA 98109
| | - Clyde B. Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block Building 406, Bronx, NY 10461
| | - Lisa R. Diller
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02115
| | - Oguzhan Alagoz
- University of Wisconsin–Madison, 1513 University Avenue, Madison, WI 53706
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - John M. Hampton
- University of Wisconsin Carbone Cancer Center, 610 Walnut Street, WARF Room 307, Madison, WI 53726
| | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA, 98109
| | - Qi Liu
- University of Alberta, 11405 87th Avenue, Edmonton, Alberta, Canada T6G 1C9
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street Northwest, Suite 4100, Washington, DC 20007
| | - Diana L. Miglioretti
- Department of Public Health Sciences, University of California Davis School of Medicine, One Shields Avenue, Med-Sci 1C, Room 145, Davis, CA 95616
| | - Chaya S. Moskowitz
- Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2nd floor, NY, NY 10017
| | | | - Amy Trentham-Dietz
- University of Wisconsin Carbone Cancer Center, 610 Walnut Street, WARF Room 307, Madison, WI 53726
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401, Boston, MA 02215
| |
Collapse
|
30
|
Lowry KP, Coley RY, Miglioretti DL, Kerlikowske K, Henderson LM, Onega T, Sprague BL, Lee JM, Herschorn S, Tosteson ANA, Rauscher G, Lee CI. Screening Performance of Digital Breast Tomosynthesis vs Digital Mammography in Community Practice by Patient Age, Screening Round, and Breast Density. JAMA Netw Open 2020; 3:e2011792. [PMID: 32721031 PMCID: PMC7388021 DOI: 10.1001/jamanetworkopen.2020.11792] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Importance Digital mammography (DM) and digital breast tomosynthesis (DBT) are used for routine breast cancer screening. There is minimal evidence on performance outcomes by age, screening round, and breast density in community practice. Objective To compare DM vs DBT performance by age, baseline vs subsequent screening round, and breast density category. Design, Setting, and Participants This comparative effectiveness study assessed 1 584 079 screening examinations of women aged 40 to 79 years without prior history of breast cancer, mastectomy, or breast augmentation undergoing screening mammography at 46 participating Breast Cancer Surveillance Consortium facilities from January 2010 to April 2018. Exposures Age, Breast Imaging Reporting and Data System breast density category, screening round, and modality. Main Outcomes and Measures Absolute rates and relative risks (RRs) of screening recall and cancer detection. Results Of 1 273 492 DM and 310 587 DBT examinations analyzed, 1 028 891 examinations (65.0%) were of white non-Hispanic women; 399 952 women (25.2%) were younger than 50 years; and 671 136 women (42.4%) had heterogeneously dense or extremely dense breasts. Adjusted differences in DM vs DBT performance were largest on baseline examinations: for example, per 1000 baseline examinations in women ages 50 to 59, recall rates decreased from 241 examinations for DM to 204 examinations for DBT (RR, 0.84; 95% CI, 0.73-0.98), and cancer detection rates increased from 5.9 with DM to 8.8 with DBT (RR, 1.50; 95% CI, 1.10-2.08). On subsequent examinations, women aged 40 to 79 years with heterogeneously dense breasts had improved recall rates and improved cancer detection with DBT. For example, per 1000 examinations in women aged 50 to 59 years, the number of recall examinations decreased from 102 with DM to 93 with DBT (RR, 0.91; 95% CI, 0.84-0.98), and cancer detection increased from 3.7 with DM to 5.3 with DBT (RR, 1.42; 95% CI, 1.23-1.64). Women aged 50 to 79 years with scattered fibroglandular density also had improved recall and cancer detection rates with DBT. Women aged 40 to 49 years with scattered fibroglandular density and women aged 50 to 79 years with almost entirely fatty breasts benefited from improved recall rates without change in cancer detection rates. No improvements in recall or cancer detection rates were observed in women with extremely dense breasts on subsequent examinations for any age group. Conclusions and Relevance This study found that improvements in recall and cancer detection rates with DBT were greatest on baseline mammograms. On subsequent screening mammograms, the benefits of DBT varied by age and breast density. Women with extremely dense breasts did not benefit from improved recall or cancer detection with DBT on subsequent screening rounds.
Collapse
Affiliation(s)
- Kathryn P. Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | | | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Brian L. Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
- Department of Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
| | - Janie M. Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | - Sally Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hamsphire
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago
| | - Christoph I. Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| |
Collapse
|
31
|
Carlos RC, Lowry KP, Sadigh G. The Coronavirus Disease 2019 (COVID-19) Pandemic: A Patient-Centered Model of Systemic Shock and Cancer Care Adherence. J Am Coll Radiol 2020; 17:927-930. [PMID: 32631494 PMCID: PMC7266758 DOI: 10.1016/j.jacr.2020.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ruth C Carlos
- University of Michigan, Rogel Cancer Center, Ann Arbor, Michigan.
| | - Kathryn P Lowry
- University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | | |
Collapse
|
32
|
Bahl M, Mercaldo S, Dang PA, McCarthy AM, Lowry KP, Lehman CD. Breast Cancer Screening with Digital Breast Tomosynthesis: Are Initial Benefits Sustained? Radiology 2020; 295:529-539. [PMID: 32255414 DOI: 10.1148/radiol.2020191030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Performance metrics with digital breast tomosynthesis (DBT) are based on early experiences. There is limited research on whether the benefits of DBT are sustained. Purpose To determine whether improved screening performance metrics with DBT are sustained over time at the population level and after the first screening round at the individual level. Materials and Methods A retrospective review was conducted of screening mammograms that had been obtained before DBT implementation (March 2008 to February 2011, two-dimensional digital mammography [DM] group) and for 5 years after implementation (January 2013 to December 2017, DBT1-DBT5 groups, respectively). Patients who underwent DBT were also categorized according to the number of previous DBT examinations they had undergone. Performance metrics were compared between DM and DBT groups and between patients with no previous DBT examinations and those with at least one prior DBT examination by using multivariable logistic regression models. Results The DM group consisted of 99 582 DM examinations in 55 086 women (mean age, 57.3 years ± 11.6 [standard deviation]). The DBT group consisted of 205 048 examinations in 76 276 women (mean age, 58.2 years ± 11.2). There were no differences in the cancer detection rate (CDR) between DM and DBT groups (4.6-5.8 per 1000 examinations, P = .08 to P = .95). The highest CDR was observed with a woman's first DBT examination (6.1 per 1000 examinations vs 4.4-5.7 per 1000 examinations with at least one prior DBT examination, P = .001 to P = .054). Compared with the DM group, the DBT1 group had a lower abnormal interpretation rate (AIR) (adjusted odds ratio [AOR], 0.85; P < .001), which remained reduced in the DBT2, DBT3, and DBT5 groups (P < .001 to P = .02). The reduction in AIR was also sustained after the first examination (P < .001 to P = .002). Compared with the DM group, the DBT1 group had a higher specificity (AOR, 1.20; P < .001), which remained increased in DBT2, DBT3, and DBT5 groups (P < .001 to P = .004). The increase in specificity was also sustained after the first examination (P < .001 to P = .01). Conclusion The benefits of reduced false-positive examinations and higher specificity with screening tomosynthesis were sustained after the first screening round at the individual level. © RSNA, 2020 See also the editorial by Taourel in this issue.
Collapse
Affiliation(s)
- Manisha Bahl
- From the Department of Radiology (M.B., P.A.D., K.P.L., C.D.L.), Institute for Technology Assessment (S.M.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Sarah Mercaldo
- From the Department of Radiology (M.B., P.A.D., K.P.L., C.D.L.), Institute for Technology Assessment (S.M.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Pragya A Dang
- From the Department of Radiology (M.B., P.A.D., K.P.L., C.D.L.), Institute for Technology Assessment (S.M.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Anne Marie McCarthy
- From the Department of Radiology (M.B., P.A.D., K.P.L., C.D.L.), Institute for Technology Assessment (S.M.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Kathryn P Lowry
- From the Department of Radiology (M.B., P.A.D., K.P.L., C.D.L.), Institute for Technology Assessment (S.M.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Constance D Lehman
- From the Department of Radiology (M.B., P.A.D., K.P.L., C.D.L.), Institute for Technology Assessment (S.M.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| |
Collapse
|
33
|
Lee JM, Lowry KP, Cott Chubiz JE, Swan JS, Motazedi T, Halpern EF, Tosteson ANA, Gazelle GS, Donelan K. Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results. Breast 2020; 50:104-112. [PMID: 32135458 PMCID: PMC7375679 DOI: 10.1016/j.breast.2020.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/18/2019] [Accepted: 02/06/2020] [Indexed: 12/19/2022] Open
Abstract
Objective The impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall. Methods Women participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0–100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments. Results The final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p < 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p < 0.05). Conclusions Women with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen. Impact of screening recall on quality-of-life does not vary by breast cancer risk. Breast cancer worry predicts lower quality-of-life ratings while awaiting results. Quality-of-life ratings improve after receipt of benign results. High trait anxiety predicts lower quality-of-life after benign results are known.
Collapse
Affiliation(s)
- Janie M Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA.
| | | | - J Shannon Swan
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tina Motazedi
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elkan F Halpern
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - G Scott Gazelle
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Donelan
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
34
|
Conant EF, Barlow WE, Herschorn SD, Weaver DL, Beaber EF, Tosteson ANA, Haas JS, Lowry KP, Stout NK, Trentham-Dietz A, diFlorio-Alexander RM, Li CI, Schnall MD, Onega T, Sprague BL. Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density. JAMA Oncol 2020; 5:635-642. [PMID: 30816931 DOI: 10.1001/jamaoncol.2018.7078] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance Breast cancer screening examinations using digital breast tomosynthesis (DBT) has been shown to be associated with decreased false-positive test results and increased breast cancer detection compared with digital mammography (DM). Little is known regarding the size and stage of breast cancer types detected and their association with age and breast density. Objective To determine whether screening examinations using DBT detect breast cancers that are associated with an improved prognosis and to compare the detection rates by patient age and breast density. Design, Setting, and Participants This retrospective analysis of prospective cohort data from 3 research centers in the Population-based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium included data of women aged 40 to 74 years who underwent screening examinations using DM and DBT from January 1, 2011, through September 30, 2014. Statistical analysis was performed from November 8, 2017, to August 14, 2018. Exposures Use of DBT as a supplement to DM at breast cancer screening examination. Main Outcomes and Measures Recall rate, cancer detection rate, positive predictive value, biopsy rate, and distribution of invasive cancer subtypes. Results Among 96 269 women (mean [SD] patient age for all examinations, 55.9 [9.0] years), patient age was 56.4 (9.0) years for DM and 54.6 (8.9) years for DBT. Of 180 340 breast cancer screening examinations, 129 369 examinations (71.7%) used DM and 50 971 examinations (28.3%) used DBT. Screening examination with DBT (73 of 99 women [73.7%]) was associated with the detection of smaller, more often node-negative, HER2-negative, invasive cancers compared with DM (276 of 422 women [65.4%]). Screening examination with DBT was also associated with lower recall (odds ratio, 0.64; 95% CI, 0.57-0.72; P < .001) and higher cancer detection (odds ratio, 1.41; 95% CI, 1.05-1.89; P = .02) compared with DM for all age groups even when stratified by breast density. The largest increase in cancer detection rate and the greatest shift toward smaller, node-negative invasive cancers detected with DBT was for women aged 40 to 49 years. For women aged 40 to 49 years with nondense breasts, the cancer detection rate for examinations using DBT was 1.70 per 1000 women higher compared with the rate using DM; for women with dense breasts, the cancer detection rate was 2.27 per 1000 women higher for DBT. For these younger women, screening with DBT was associated with only 7 of 28 breast cancers (25.0%) categorized as poor prognosis compared with 19 of 47 breast cancers (40.4%) when screening with DM. Conclusions and Relevance The findings suggest that screening with DBT is associated with increased specificity and an increased proportion of breast cancers detected with better prognosis compared with DM. In the subgroup of women aged 40 to 49 years, routine DBT screening may have a favorable risk-benefit ratio.
Collapse
Affiliation(s)
- Emily F Conant
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Sally D Herschorn
- Department of Radiology, University of Vermont, Burlington.,University of Vermont Cancer Center, University of Vermont, Burlington
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont, Burlington.,Department of Pathology, University of Vermont, Burlington
| | - Elisabeth F Beaber
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna N A Tosteson
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin, Madison
| | | | - Christopher I Li
- Translational Research Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mitchell D Schnall
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tracy Onega
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Brian L Sprague
- Department of Radiology, University of Vermont, Burlington.,University of Vermont Cancer Center, University of Vermont, Burlington.,Department of Surgery, University of Vermont, Burlington
| | | |
Collapse
|
35
|
Yeh J, Lowry KP, Schechter CB, Diller L, Alagoz O, Armstrong GT, Hampton JM, Leisenring W, Liu Q, Mandelblatt JS, Miglioretti DL, Moskowitz CS, Oeffinger KC, Trentham-Dietz A, Stout NK. Clinical outcomes and cost-effectiveness of breast cancer screening for childhood cancer survivors treated with chest radiation: A comparative modeling study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6525 Background: Survivors of childhood cancer previously treated with chest radiation face elevated breast cancer risk similar to BRCA1 carriers. Children’s Oncology Group (COG) guidelines recommend annual mammography with breast MRI, yet the benefits and costs of various screening strategies are uncertain. Methods: We used two breast cancer simulation models (Model 1 and 2) from the Cancer Intervention and Surveillance Modeling Network (CISNET) and data from the Childhood Cancer Survivor Study to reflect high breast cancer and competing mortality risks among survivors. We simulated 3 screening strategies: annual mammography with MRI starting at age 25 (COG25), annual MRI starting at 25 (MRI25), and biennial mammography starting at 50 (Mammo50). Performance of mammography+/-MRI was based on published studies in BRCA1/2 carriers who have similar cancer risk. Costs and quality of life weights were based on US averages and published studies. Results: Among a simulated cohort of 25-year-old survivors treated with chest radiation, the lifetime breast cancer mortality risk in the absence of screening was 10-11% across models. Compared to no screening, Mammo50, MRI25, and COG25 screening avert approximately 23-25%, 56-62% and 56-71% of deaths, respectively; averted deaths for COG25 compared to MRI25 were higher in Model 1 than Model 2 (9% vs. <1%). In Model 1, both MRI25 and COG25 were cost-effective; in Model 2, MRI25 was preferable (more effective, less costly than COG25). Conclusions: Compared to no screening, initiating annual screening at younger ages for at-risk survivors averts >50% of breast cancer deaths and is cost-effective. Additional data on test performance are needed to inform recommendations on screening modality. [Table: see text]
Collapse
Affiliation(s)
- Jennifer Yeh
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Clyde B. Schechter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
| | - Lisa Diller
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | | | | | - Qi Liu
- University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | | | - Natasha K. Stout
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| |
Collapse
|
36
|
Bahl M, Gaffney S, McCarthy AM, Lowry KP, Dang PA, Lehman CD. Breast Cancer Characteristics Associated with 2D Digital Mammography versus Digital Breast Tomosynthesis for Screening-detected and Interval Cancers. Radiology 2018; 287:49-57. [DOI: 10.1148/radiol.2017171148] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manisha Bahl
- From the Division of Breast Imaging, Department of Radiology (M.B., S.G., K.P.L., P.A.D., C.D.L.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Shannon Gaffney
- From the Division of Breast Imaging, Department of Radiology (M.B., S.G., K.P.L., P.A.D., C.D.L.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Anne Marie McCarthy
- From the Division of Breast Imaging, Department of Radiology (M.B., S.G., K.P.L., P.A.D., C.D.L.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Kathryn P. Lowry
- From the Division of Breast Imaging, Department of Radiology (M.B., S.G., K.P.L., P.A.D., C.D.L.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Pragya A. Dang
- From the Division of Breast Imaging, Department of Radiology (M.B., S.G., K.P.L., P.A.D., C.D.L.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Constance D. Lehman
- From the Division of Breast Imaging, Department of Radiology (M.B., S.G., K.P.L., P.A.D., C.D.L.), and Department of Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| |
Collapse
|
37
|
Pandharipande PV, Lowry KP, Reinhold C, Atri M, Benson CB, Bhosale PR, Green ED, Kang SK, Lakhman Y, Maturen KE, Nicola R, Salazar GM, Shipp TD, Simpson L, Sussman BL, Uyeda J, Wall DJ, Whitcomb B, Zelop CM, Glanc P. ACR Appropriateness Criteria ® Ovarian Cancer Screening. J Am Coll Radiol 2017; 14:S490-S499. [DOI: 10.1016/j.jacr.2017.08.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/27/2022]
|
38
|
Affiliation(s)
- Theodore S Hong
- From the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Phillip J Gray
- From the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Jill N Allen
- From the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Paul C Shellito
- From the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Kathryn P Lowry
- From the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Lawrence R Zukerberg
- From the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Radiation Oncology (T.S.H., P.J.G.), Hematology (J.N.A.), Surgery (P.C.S.), Radiology (K.P.L.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| |
Collapse
|
39
|
Manian FA, Barshak MB, Lowry KP, Basnet KM, Stowell CP. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 27-2016. N Engl J Med 2016; 375:981-91. [PMID: 27602671 DOI: 10.1056/nejmcpc1607091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Farrin A Manian
- From the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Massachusetts General Hospital, and the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Harvard Medical School - both in Boston
| | - Miriam B Barshak
- From the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Massachusetts General Hospital, and the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Harvard Medical School - both in Boston
| | - Kathryn P Lowry
- From the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Massachusetts General Hospital, and the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Harvard Medical School - both in Boston
| | - Kristen M Basnet
- From the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Massachusetts General Hospital, and the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Harvard Medical School - both in Boston
| | - Christopher P Stowell
- From the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Massachusetts General Hospital, and the Departments of Medicine (F.A.M., M.B.B.), Radiology (K.P.L.), and Pathology (K.M.B., C.P.S.), Harvard Medical School - both in Boston
| |
Collapse
|
40
|
Lowry KP, Gazelle GS, Gilmore ME, Johanson C, Munshi V, Choi SE, Tramontano AC, Kong CY, McMahon PM. Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis. Cancer 2015; 121:1556-62. [PMID: 25652107 PMCID: PMC4492436 DOI: 10.1002/cncr.29225] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 11/15/2014] [Accepted: 11/19/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds. METHODS We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy. RESULTS Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility. CONCLUSIONS Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population.
Collapse
Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Institute for Technology Assessment, Boston, Massachusetts
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Cott Chubiz JE, Lee JM, Gilmore ME, Kong CY, Lowry KP, Halpern EF, McMahon PM, Ryan PD, Gazelle GS. Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers. Cancer 2012. [PMID: 23184400 DOI: 10.1002/cncr.27864] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Current clinical guidelines recommend earlier, more intensive breast cancer screening with both magnetic resonance imaging (MRI) and mammography for women with breast cancer susceptibility gene (BRCA) mutations. Unspecified details of screening schedules are a challenge for implementing guidelines. METHODS A Markov Monte Carlo computer model was used to simulate screening in asymptomatic women who were BRCA1 and BRCA2 mutation carriers. Three dual-modality strategies were compared with digital mammography (DM) alone: 1) DM and MRI alternating at 6-month intervals beginning at age 25 years (Alt25), 2) annual MRI beginning at age 25 years with alternating DM added at age 30 years (MRI25/Alt30), and 3) DM and MRI alternating at 6-month intervals beginning at age 30 years (Alt30). Primary outcomes were quality-adjusted life years (QALYs), lifetime costs (in 2010 US dollars), and incremental cost-effectiveness (dollars per QALY gained). Additional outcomes included potential harms of screening, and lifetime costs stratified into component categories (screening and diagnosis, treatment, mortality, and patient time costs). RESULTS All 3 dual-modality screening strategies increased QALYs and costs. Alt30 screening had the lowest incremental costs per additional QALY gained (BRCA1, $74,200 per QALY; BRCA2, $215,700 per QALY). False-positive test results increased substantially with dual-modality screening and occurred more frequently in BRCA2 carriers. Downstream savings in both breast cancer treatment and mortality costs were outweighed by increases in up-front screening and diagnosis costs. The results were influenced most by estimates of breast cancer risk and MRI costs. CONCLUSIONS Alternating MRI and DM screening at 6-month intervals beginning at age 30 years was identified as a clinically effective approach to applying current guidelines, and was more cost-effective in BRCA1 gene mutation carriers compared with BRCA2 gene mutation carriers.
Collapse
Affiliation(s)
- Jessica E Cott Chubiz
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Kong CY, Lee JM, McMahon PM, Lowry KP, Omer ZB, Eisenberg JD, Pandharipande PV, Gazelle GS. Using radiation risk models in cancer screening simulations: important assumptions and effects on outcome projections. Radiology 2012; 262:977-84. [PMID: 22357897 DOI: 10.1148/radiol.11110352] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of incorporating radiation risk into microsimulation (first-order Monte Carlo) models for breast and lung cancer screening to illustrate effects of including radiation risk on patient outcome projections. MATERIALS AND METHODS All data used in this study were derived from publicly available or deidentified human subject data. Institutional review board approval was not required. The challenges of incorporating radiation risk into simulation models are illustrated with two cancer screening models (Breast Cancer Model and Lung Cancer Policy Model) adapted to include radiation exposure effects from mammography and chest computed tomography (CT), respectively. The primary outcome projected by the breast model was life expectancy (LE) for BRCA1 mutation carriers. Digital mammographic screening beginning at ages 25, 30, 35, and 40 years was evaluated in the context of screenings with false-positive results and radiation exposure effects. The primary outcome of the lung model was lung cancer-specific mortality reduction due to annual screening, comparing two diagnostic CT protocols for lung nodule evaluation. The Metropolis-Hastings algorithm was used to estimate the mean values of the results with 95% uncertainty intervals (UIs). RESULTS Without radiation exposure effects, the breast model indicated that annual digital mammography starting at age 25 years maximized LE (72.03 years; 95% UI: 72.01 years, 72.05 years) and had the highest number of screenings with false-positive results (2.0 per woman). When radiation effects were included, annual digital mammography beginning at age 30 years maximized LE (71.90 years; 95% UI: 71.87 years, 71.94 years) with a lower number of screenings with false-positive results (1.4 per woman). For annual chest CT screening of 50-year-old females with no follow-up for nodules smaller than 4 mm in diameter, the lung model predicted lung cancer-specific mortality reduction of 21.50% (95% UI: 20.90%, 22.10%) without radiation risk and 17.75% (95% UI: 16.97%, 18.41%) with radiation risk. CONCLUSION Because including radiation exposure risk can influence long-term projections from simulation models, it is important to include these risks when conducting modeling-based assessments of diagnostic imaging.
Collapse
Affiliation(s)
- Chung Y Kong
- Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Lowry KP, Lee JM, Kong CY, McMahon PM, Gilmore ME, Cott Chubiz JE, Pisano ED, Gatsonis C, Ryan PD, Ozanne EM, Gazelle GS. Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis. Cancer 2012; 118:2021-30. [PMID: 21935911 PMCID: PMC3245774 DOI: 10.1002/cncr.26424] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/10/2011] [Accepted: 06/20/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although breast cancer screening with mammography and magnetic resonance imaging (MRI) is recommended for breast cancer-susceptibility gene (BRCA) mutation carriers, there is no current consensus on the optimal screening regimen. METHODS The authors used a computer simulation model to compare 6 annual screening strategies (film mammography [FM], digital mammography [DM], FM and magnetic resonance imaging [MRI] or DM and MRI contemporaneously, and alternating FM/MRI or DM/MRI at 6-month intervals) beginning at ages 25 years, 30 years, 35 years, and 40 years, and 2 strategies of annual MRI with delayed alternating DM/FM versus clinical surveillance alone. Strategies were evaluated without and with mammography-induced breast cancer risk using 2 models of excess relative risk. Input parameters were obtained from the medical literature, publicly available databases, and calibration. RESULTS Without radiation risk effects, alternating DM/MRI starting at age 25 years provided the highest life expectancy (BRCA1, 72.52 years, BRCA2, 77.63 years). When radiation risk was included, a small proportion of diagnosed cancers was attributable to radiation exposure (BRCA1, <2%; BRCA2, <4%). With radiation risk, alternating DM/MRI at age 25 years or annual MRI at age 25 years/delayed alternating DM at age 30 years was the most effective, depending on the radiation risk model used. Alternating DM/MRI starting at age 25 years also produced the highest number of false-positive screens per woman (BRCA1, 4.5 BRCA2, 8.1). CONCLUSIONS Annual MRI at age 25 years/delayed alternating DM at age 30 years is probably the most effective screening strategy in BRCA mutation carriers. Screening benefits, associated risks, and personal acceptance of false-positive results should be considered in choosing the optimal screening strategy for individual women.
Collapse
Affiliation(s)
- Kathryn P. Lowry
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Janie M. Lee
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Chung Y. Kong
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Pamela M. McMahon
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael E. Gilmore
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
| | | | - Etta D. Pisano
- Medical University of South Carolina College of Medicine, Charleston, SC
| | | | | | - Elissa M. Ozanne
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - G. Scott Gazelle
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
- Harvard School of Public Health, Boston, MA
| |
Collapse
|
44
|
Brown AJ, Setji TL, Sanders LL, Lowry KP, Otvos JD, Kraus WE, Svetkey PL. Effects of exercise on lipoprotein particles in women with polycystic ovary syndrome. Med Sci Sports Exerc 2009; 41:497-504. [PMID: 19204602 DOI: 10.1249/mss.0b013e31818c6c0c] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Women with polycystic ovary syndrome (PCOS) commonly have insulin resistance. Insulin resistance is associated with marked abnormalities of lipoprotein size and subclass particle concentration. The purpose of this study was to examine the effects of a moderate-intensity exercise program without weight loss on lipoprotein profiles in women with PCOS. METHODS Thirty-seven sedentary PCOS women were randomized to either an 8- to 12-wk ramp-up followed by a 12-wk moderate-intensity exercise program (16-24 wk total, approximately 228 min x wk at 40-60% peak V x O2, n = 21) or control (no change in lifestyle, n = 16). PCOS was defined as <or=8 menses per year and hyperandrogenism (biochemical or clinical with Ferriman-Gallwey score >or=8). Fasting lipoprotein profiles were obtained before and after the intervention. Nuclear magnetic resonance spectroscopy was used to quantify the following: average particle size, total and subclass concentrations of HDL, LDL, and VLDL particles, and calculated HDL cholesterol, triglycerides, and VLDL triglycerides. Wilcoxon exact rank sums tests were used to compare changes in these parameters in the exercise group relative to controls. RESULTS Twenty women (8 exercisers, 12 controls) completed the study. Comparing exercisers to controls, significant changes were seen in concentrations of the following lipoprotein parameters that are associated with decreased insulin resistance: decreased large VLDL (P = 0.007), calculated triglycerides (P = 0.003), VLDL triglycerides (P = 0.003), and medium/small HDL (P = 0.031) and increased large HDL (P = 0.002) and average HDL size (P = 0.001). CONCLUSIONS In this trial, moderate-intensity exercise without significant weight loss improved several components of the lipoprotein profiles of women with PCOS. These findings support the beneficial role of moderate exercise in this high-risk population.
Collapse
Affiliation(s)
- Ann J Brown
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Carson JW, Keefe FJ, Lowry KP, Porter LS, Goli V, Fras AM. Conflict about expressing emotions and chronic low back pain: associations with pain and anger. J Pain 2007; 8:405-11. [PMID: 17276143 DOI: 10.1016/j.jpain.2006.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 10/02/2006] [Accepted: 11/14/2006] [Indexed: 11/27/2022]
Abstract
UNLABELLED There has been growing interest among researchers and clinicians in the role of ambivalence over emotional expression (AEE) in adjustment to chronic illness. Because of the salience of anger in chronic low back pain, this condition provides a particularly good model in which to examine the role of AEE. This study examined the relation of AEE to pain and anger in a sample of 61 patients with chronic low back pain. Patients completed standardized measures of AEE, pain, and anger. Correlational analyses showed that patients who had higher AEE scores reported higher levels of evaluative and affective pain as well as higher levels of state and trait anger and the tendency to hold in angry thoughts and feelings. Mediational analyses revealed that most of the associations between AEE and pain, and AEE and anger, were independent of one another. These findings suggest that a potentially important relationship exists between AEE and key aspects of living with persistent pain. PERSPECTIVE This preliminary study suggests that there is a relation between ambivalence over emotional expression and pain and anger in patients with chronic low back pain. Patients who report greater conflict with regard to expressing emotions may be experiencing higher pain and anger.
Collapse
Affiliation(s)
- James W Carson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27708, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Tracy L Setji
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina 27710, USA
| | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Hypertension is poorly controlled in the US due to medication nonadherence. Recent evidence suggests that nonadherence can be classified as intentional or unintentional and different patient characteristics, such as the experience of adverse effects, may be associated with each. OBJECTIVE To examine associations between patient characteristics, including reported adverse effects, and both intentional and unintentional nonadherence among 588 hypertensive patients. METHODS Baseline data from a clinical trial, the Veterans' Study To Improve the Control of Hypertension, were examined. Intentional and unintentional nonadherence were assessed using a self-report measure. Participants were presented with a list of adverse effects commonly associated with antihypertensive medication and asked to indicate which symptoms they had experienced. Logistic regression analyses were used to examine adjusted associations between patient characteristics and type of nonadherence. RESULTS Approximately 31% of patients reported unintentional nonadherence and 9% reported intentional nonadherence. Non-white participants, individuals without diabetes mellitus, and individuals reporting > or = 5 adverse effects were more likely to report intentional nonadherence than their counterparts. Individuals with less than a 10th-grade education and non-white participants were more likely to report unintentional nonadherence than their counterparts. When symptoms of increased urination and wheezing/shortness of breath were reported, patients were more likely to report intentional and unintentional nonadherence compared with those who were adherent. Unintentional nonadherence was also associated with reports of dizziness and rapid pulse. CONCLUSIONS Both intentional and unintentional nonadherence are common and related to perceived adverse effects. Furthermore, different interventions may be necessary to improve adherence in unintentionally and intentionally nonadherent patients.
Collapse
|