Supporting Personalized Decision Making for Breast Cancer Screening among Older Women

项目总结/摘要 在美国，大约一半的75岁及以上的妇女接受筛查乳房X光检查。尽管 尽管乳房X光检查的广泛使用，但乳房X光检查在该年龄组中的益处仍不确定，因为没有随机试验 乳房X光检查包括74岁以上的妇女。因为乳腺癌是一种与年龄有关的疾病， 筛查可能在降低老年妇女乳腺癌发病率和死亡率方面发挥重要作用。对 另一方面，筛查的危害，包括过度诊断，也可能在老年妇女中普遍存在。的 这项研究的首要目标是帮助那些考虑患乳腺癌的老年妇女 筛选可以做出更明智的决定。要做到这一点，我们将首先生成改进的收益估计 以及反映老年妇女预期寿命异质性的筛查的危害。使用医疗保险 与来自监测、流行病学和最终结果（SEER）计划的癌症发病率数据相关的索赔， 我们将应用最先进的技术来估计乳房X光检查的死亡率效益， 一系列的预期寿命。我们还将使用SEER数据来量化乳腺癌过度诊断的风险， 75岁及以上的妇女，按预期寿命计算。最后，通过与患者合作，我们将开发和 测试一个决策辅助工具，它提供了对乳腺癌筛查的益处和危害的个性化估计。 我们的目标是生成更好的数据来支持决策，并开发决策辅助工具， 让妇女能够访问这些数据，并最终对乳腺癌筛查做出更明智的决定。 候选人Ilana Richman，医学博士，是耶鲁大学医学院的普通内科医生。里奇曼博士是 致力于提高我们对癌症筛查的有效性和价值的理解。这项建议 将利用Richman博士在生物统计学和流行病学方面的基础培训，同时提供 有机会获得老年生物统计学，定性方法和决策辅助设计的额外技能， 试验.为了实现这些目标，里奇曼博士组建了一个经验丰富的多学科导师 团队她的主要导师，卡里格罗斯博士，是一个全国知名的医生调查与广泛的 评估癌症预后的专业知识，特别是老年人。格罗斯博士还带来了 作为初级教师和学员的导师取得了非凡的成功。里奇曼博士将从富人那里获益 耶鲁大学的环境，这是家庭世界级的研究人员研究癌症筛查和预防， 老年人的健康。在这个奖项结束时，里奇曼博士将很好地定位成为 一个独立的研究者和领导者，致力于改善以患者为中心的决策， 癌症筛查

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.