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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

基本信息

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
项目类别：
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

项目摘要

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.

项目总结/文摘