Supporting Personalized Decision Making for Breast Cancer Screening among Older Women

支持老年女性乳腺癌筛查的个性化决策

• 批准号: 10543791
• 负责人: Ilana Richman
• 金额: $ 25.56万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-08 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10543791
• 关键词: Age; Aging; American Cancer Society; Area; Award; Benefits and Risks; Biometry; Breast Cancer Detection; Breast Cancer Risk Factor; Cancer Control; Cessation of life; Clinical; Collaborations; Communication; Complex; Coupled; Data; Data Sources; Decision Aid; Decision Making; Development; Diagnosis; Disease; Effectiveness; Elderly; Environment; Epidemiologic Methods; Epidemiology; Equilibrium; Faculty; Future; Goals; Guidelines; Health; Heterogeneity; Home; Incidence; Individual; Internist; Knowledge; Life Expectancy; Link; Malignant Neoplasms; Mammographic screening; Mammography; Medicare; Medicare claim; Mentors; Mentorship; Methodology; Modeling; Morbidity - disease rate; Outcome; Patients; Physicians; Population; Positioning Attribute; Prevention; Probability; Qualitative Methods; Registries; Research; Research Personnel; Risk; Role; SEER Program; Screening for cancer; Techniques; Testing; Time; Training; Uncertainty; United States; United States Preventative Services Task Force; Woman; Work; age group; age related; cancer prevention; clinically significant; data access; design; effectiveness testing; effectiveness trial; experience; improved; malignant breast neoplasm; medical schools; mortality; multidisciplinary; neoplasm registry; older women; patient oriented; personalized decision; pilot test; protective effect; randomized trial; screening; skill acquisition; skills; success; surveillance data; tool; web based decision aid; young woman

PROJECT SUMMARY/ABSTRACT In the United States, approximately half of women 75 and older undergo screening mammography. Despite widespread use, the benefits of mammography in this age group remain uncertain, as no randomized trials of mammography have included women over the age of 74. Because breast cancer is an age-related disease, screening may have an important role in reducing breast cancer morbidity and mortality for older women. On the other hand, harms of screening, including overdiagnosis, may also be prevalent among older women. The overarching goal of the proposed research is to help older women who are considering breast cancer screening make more informed decisions. To do this, we will first generate improved estimates of the benefits and harms of screening that reflect the heterogeneity of life expectancy among older women. Using Medicare claims linked to cancer incidence data from the Surveillance, Epidemiology and End Results (SEER) Program, we will apply state-of-the-art techniques to generate estimates of the mortality benefit of mammography across a range of life expectancies. We will also use SEER data to quantify risk of breast cancer overdiagnosis among women 75 and older, according to life expectancy. Lastly, in collaboration with patients, we will develop and test a decision aid that presents personalized estimates of benefits and harms from breast cancer screening. Our goal is to both generate better data to support decisions and also develop a decision aid as a tool that will allow women to access that data and ultimately make more informed decisions about breast cancer screening. The candidate, Ilana Richman, MD, is a general internist at the Yale School of Medicine. Dr. Richman is committed to improving our understanding of the effectiveness and value of cancer screening. This proposal will capitalize on Dr. Richman’s foundational training in biostatistics and epidemiology, while providing an opportunity to gain additional skill in gerontologic biostatistics, qualitative methods, and decision aid design and testing. To achieve these goals, Dr. Richman has assembled an experienced multidisciplinary mentorship team. Her primary mentor, Dr. Cary Gross, is a nationally renowned physician investigator with extensive expertise in evaluating cancer outcomes, particularly among older adults. Dr. Gross also brings a track record of exceptional success as a mentor to junior faculty and trainees. Dr. Richman will benefit from the rich environment at Yale, which is home world-class investigators studying cancer screening and prevention, and the health of aging populations. At the conclusion of this award, Dr. Richman will be well positioned to become an independent investigator and a leader committed to improving patient-centered decision-making about cancer screeing.

项目摘要/摘要 在美国，大约一半的75岁及以上的女性接受了乳房X线摄影。尽管 宽度使用，在这个年龄组中乳房摄影的好处仍然不确定，因为没有随机试验 乳房X线摄影包括74岁以上的女性。由于乳腺癌是一种与年龄有关的疾病，所以 筛查可能在降低老年妇女的乳腺癌发病率和死亡率方面具有重要作用。在 另一方面，包括过度诊断在内的筛查危害在老年妇女中也可能普遍存在。 拟议的研究的总体目标是帮助考虑乳腺癌的老年妇女 筛选做出更明智的决定。为此，我们将首先产生改进的利益估计值 筛查的危害反映了老年妇女预期寿命的异质性。使用Medicare 与监视，流行病学和最终结果（SEER）计划有关的癌症事件数据相关的索赔， 我们将采用最先进的技术来估计乳房X线摄影的死亡率益处 一系列预期寿命。我们还将使用SEER数据来量化乳腺癌过度诊断的风险 根据预期寿命，妇女75岁及以上。最后，与患者合作，我们将发展和 测试一种介绍乳腺癌筛查的益处和危害的个性化估计的决策援助。 我们的目标是同时生成更好的数据以支持决策，并开发决策援助作为一种工具 允许妇女访问该数据，并最终就乳腺癌筛查做出更明智的决定。 候选人伊拉娜·里奇曼（Ilana Richman）医学博士是耶鲁大学医学院的一般在场。里奇曼博士是 致力于提高我们对癌症筛查有效性和价值的理解。这个建议 将利用Richman博士在生物统计学和流行病学领域的基础培训，同时提供 有机会获得额外技能的老年生物统计学，定性方法以及决策援助设计和 测试。为了实现这些目标，里奇曼博士召集了一项经验多学科指导 团队。她的主要导师卡里·格罗斯（Cary Gross）博士是一位全国知名的身体调查员 评估癌症结局的专业知识，尤其是在老年人中。格罗斯博士还带来了往绩 作为初级教师和学员的精神，取得了非凡的成功。里奇曼博士将从富人那里受益 耶鲁大学的环境，是研究癌症筛查和预防的世界一流调查人员， 衰老人口的健康。在该奖项结束时，Richman博士将有能力成为 独立的调查员和领导者致力于改善以患者为中心的决策 癌症筛查。