STRATEGIC STUDIES IN BREAST CANCER SURVEILLANCE

本提案的长期目标是通过扩大数据收集范围来提高新罕布什尔乳房x光检查网络的研究能力，包括确定经历过乳房x光检查异常的妇女的结果，这些妇女的后续乳房结果没有记录在我们的注册表中，确定是什么促使经历过乳房x光检查假阴性的妇女获得后续护理，并收集或合并补充数据，使我们能够开展五个特殊的研究项目。这些特殊研究将包括：1)比较筛查和未筛查的NH妇女的风险和行为特征；2)确定乳腺良性病理特征与乳腺x光检查表现的关系；3)探讨月经周期阶段对乳腺密度及乳腺癌筛查表现的影响；4)建立浸润性和非浸润性乳腺癌的风险预测模型（包括将乳腺密度作为乳腺癌风险的标志）；5)使用回归建模技术开发乳房x光检查/健康状态的纵向模型，该模型由筛查依从性、乳房x光检查结果、随访和个体受试者的疾病结果定义，并确定这些状态之间转换的预测因子，包括评估乳房x光检查相关的全因死亡率和乳腺癌死亡率预测因子。我们提出的项目将在两个方面有益于乳腺癌监测联合会的工作。首先，确定随访不足的来源（无论是患者因素还是数据收集问题）将确定以人群为基础的乳房x光检查登记的捕获率，并可能为那些有异常发现而不愿寻求治疗的人确定可能的干预点。其次，我们计划合并来自三个注册中心（新罕布什尔州、佛蒙特州和北卡罗来纳州）的数据，以实现我们的三个研究目标。通过汇集这三个登记处的数据，用于分析的癌症病例数量将会增加，数据中所代表的人口特征将更加多样化。我们的具体目标可以通过三个拟议地点的数据轻松实现；然而，任何验证研究都可以将本提议的工作中成熟的方法应用于将来从联盟访问的更大的数据集。我们的目标将使我们能够利用当地的分析专家，同时为监测联盟贡献新的知识。

The long term objective of this proposal is to enhance the New Hampshire Mammography Network's research capacity by expanding data collection to include determining outcomes in women who experienced mammographic abnormalities and whose subsequent breast outcomes are not recorded in our registry, determining what motivated women who experienced a false negative mammogram to obtain follow-up care, and collecting or merging supplemental data to allow us to conduct five special research projects. These special studies will include: 1) comparing risk and behavioral characteristics of screened and unscreened NH women; 2) determining the relationships between benign breast pathology characteristics and mammography performance; 3) exploring the influence of menstrual cycle phase on breast density and breast cancer screening performance; 4) developing risk prediction models for invasive and non-invasive breast cancer (including using breast density as a marker for breast cancer risk); and 5) using regression modeling techniques to develop a longitudinal model of mammography/health states defined by screening compliance, mammography outcomes, follow-up and disease outcomes in individual subjects and to determine predictors for transitions between these states, including an evaluation of mammography-related predictors for all cause mortality and breast-cancer mortality. Our proposed projects will benefit the work of the Breast Cancer Surveillance Consortium in two ways. First, determining sources of inadequate follow-up (whether it is a patient factor or data collection issue) will identify the capture rate of population-based mammography registries and may identify possible intervention points for those with abnormal findings who are resistant to seeking care. Second, we plan to merge data from three registries (New Hampshire, Vermont, and North Carolina) to conduct three of our study aims. By pooling data from these three registries, the number of cancer cases for analysis will be increased and the characteristics of the population represented in the data will be more diverse. Our specific aims can easily be addressed with data from the three proposed sites; however, any validation studies could apply well established methods from this proposed work to a larger dataset accessed from the Consortium in the future. Our aims will allow us to employ local analytic expertise while contributing new knowledge to the Surveillance Consortium.