Penn Center for Innovation in Personalized Breast Screening

描述(由申请人提供)：关于乳房X光摄影筛查建议的持续争议突出了提高乳腺癌筛查过程中的绩效的必要性。虽然乳腺癌筛查可以降低乳腺癌死亡率的争论很少，但也很明显，现在是时候采取更好的筛查方法，利用乳房成像模式、乳腺癌风险评估和以患者为中心的护理方面的进步，以更低的成本获得更好的结果。宾夕法尼亚大学个性化乳腺癌筛查中心的这项申请将通过开发一种新的工具(乳房复杂性指数)来预测个人筛查结果，评估一种新的成像模式(数字乳房断层成像)对筛查过程和结果的比较有效性，并开发有效的战略来沟通个人对替代筛查方法的益处和风险的估计，从而更好地将个性化信息与知情的患者和提供者决策联系起来，从而推动个性化乳腺癌筛查范例的发展。除了这三个高度整合的研究项目外，该中心还将汇集在宾夕法尼亚医学综合健康网络内6个地点接受乳腺癌筛查的7.4万名不同人群的全面筛查过程和结果数据。除了来自EMR和筛查报告系统的临床、社会人口学和筛查数据外，该筛查流程文档股还将包括通过门户网站和护理点调查收集的风险因素和其他患者报告信息、筛查图像、来自州癌症登记处的癌症结果和病理记录、来自宾夕法尼亚大学地图建模实验室的患者社区特征，以及持续的DNA生物库。拟议的中心利用宾夕法尼亚大学在多个学科所需的大量专业知识，以推进个性化筛查范式(包括乳房成像、初级保健、通信、计算机科学、生物统计学、卫生服务研究、生物信息学、内科肿瘤学和癌症遗传学)，以及临床领导(包括中心主要研究人员)对宾夕法尼亚大学医学在评估和实施此类范式中的作用的承诺。该中心将解决具有直接科学、临床和政策影响的问题，并创建一个基础设施，以持续了解乳腺癌筛查过程，并通过PROSPR网络实现合作。

DESCRIPTION (provided by applicant): The ongoing controversy regarding mammography screening recommendations highlights the need for improved performance across the breast cancer screening process. While there is little debate that breast cancer screening can reduce breast cancer mortality, it is also clear that it is time for better approaches to screening that leverage advances in breast imaging modalities, breast cancer risk assessment and patient centered care to achieve better outcomes at lower cost. This application for a Penn Center for Personalized Breast Cancer Screening will advance a personalized breast cancer screening paradigm by developing a new tool (breast complexity index) for predicting individual screening outcomes, evaluating the comparative effectiveness of a new imaging modality (digital breast tomosynthesis) on screening process and outcomes, and developing effective strategies for communicating individual estimates of benefit and risk of alternative screening approaches to better link individualized information to informed patient and provider decision making. In addition to these three highly integrated research projects, the Center will bring together comprehensive screening process and outcome data on a diverse population of 74,000 women who undergo breast cancer screening at 6 sites within the Penn Medicine integrated health network. In addition to clinical, socio demographic and screening data from EMR and screening reporting systems, this Screening Process Documentation Unit will include risk factor and other patient reported information collected through web portal and point of care surveys, screening images, cancer outcomes from state cancer registries and pathology records, patient neighborhood characteristics from the Penn Cartographic Modeling Laboratory, as well as an ongoing DNA biobank. The proposed Center leverages the substantial expertise at Penn in the multiple disciplines needed to advance a personalized screening paradigm (including breast imaging, primary care, communication, computer science, biostatistics, health services research, bioinformatics, medical oncology, and cancer genetics) as well as the commitment of the clinical leadership (including the Center Principal Investigators) to Penn Medicine's role in the evaluation and implementation of such a paradigm. The Center will address questions with immediate scientific, clinical and policy impact and create an infrastructure for continuous learning about the breast cancer screening process and enabling collaboration through the PROSPR network.