Comparative Effectiveness Core

越来越多的先进成像技术，如数字乳腺断层合成摄影和乳腺磁共振成像（MRI），正在用于乳腺癌筛查和监测。然而，缺乏了解其最佳用途的证据基础，并比较不同乳腺成像策略对人群死亡率的影响。乳腺癌监测联盟（BCSC）拥有独特的数据和既定的基础设施，以记录不同社区环境中妇女的乳腺癌筛查和监测表现。达特茅斯学院是BCSC的一个站点，在决策分析建模和经济评估方面拥有广泛的资源和专业知识，包括与NCI资助的癌症干预和监测建模网络（CISNET）建立的合作。达特茅斯的研究人员一直是癌症筛查、风险沟通和过度诊断研究的先驱。位于达特茅斯学院的比较有效性（CE）核心将提供决策科学、风险沟通、调查研究、经济评估和模拟建模方面的专业知识，以有效地支持该计划的比较有效性和转化目标。在这次竞争性更新中，CE Core将与项目1合作，扩展其服务，以支持识别临床可行的基于风险的筛查策略。这将通过与包括妇女和保健提供者在内的主要利益攸关方进行调查和德尔菲小组讨论来实现。与三个CISNET乳腺癌建模组合作，CE Core将继续提供比较建模服务，将短期项目结果转化为更长的时间范围，解决基于与项目1和2合作的筛查结果风险定制的创新乳腺癌筛查策略的净收益，危害和成本。CE核心的具体目标是 1)提供决策科学、风险沟通、调查研究和模型资源方面的基本方法专业知识，以支持所有与项目相关的比较有效性和临床转化目标; 2)支持识别项目1的不良筛查结果的不可接受风险的临床可操作范围; 3)支持对涉及多模态成像的创新筛查策略在风险群体中的长期比较有效性进行评估。 在CE核心内集中调查研究，建模和其他专业服务将增强所有计划组件之间的互动。CE Core支持的研究将提供有关最有效和最高效的基于风险的乳腺癌筛查策略的信息。此外，CE Core支持的研究结果将为未来的风险沟通提供信息，以支持量身定制的筛查，并将促进未来的传播和实施研究，重点是克服基于风险的成像的障碍。

PROJECT SUMMARY - Comparative Effectiveness Core A growing number of advanced imaging technologies, such as digital breast tomosynthesis and breast magnetic resonance imaging (MRI), are being used for breast cancer screening and surveillance. However, the evidence base for understanding their best use, and comparing the impact of different breast imaging strategies on population mortality, is lacking. The Breast Cancer Surveillance Consortium (BCSC) has unique data and an established infrastructure to document breast cancer screening and surveillance performance among women in diverse community settings. Dartmouth College, a BCSC site, has extensive resources and expertise in decision-analytic modeling and economic evaluation, including an established collaboration with the NCI-funded Cancer Intervention and Surveillance modeling Network (CISNET). Futhermore, Dartmouth researchers have been pioneers in the study of cancer screening, risk communication, and overdiagnosis. The Comparative Effectiveness (CE) Core, based at Dartmouth College, will provide specialized expertise in decision science, risk communication, survey research, economic evaluation, and simulation modeling to efficiently support the program's comparative effectiveness and translational goals. In this competing renewal, the CE Core will expand its services to support identification of clinically-actionable risk-based screening strategies, in collaboration with Project 1. This will be accomplished through surveys and Delphi panels with key stakeholders including women and healthcare providers. Working with three CISNET breast cancer modeling groups, the CE Core will continue to provide comparative modeling services that will translate short-term project results to a longer time horizon, addressing the net benefits, harms, and costs of innovative breast cancer screening strategies tailored based on risk of screening outcome in collaboration with Projects 1 and 2. The CE Core specific aims are to 1) provide essential methodological expertise in decision sciences, risk communication, and survey research and model resources to support all program-related comparative effectiveness and clinical translational goals; 2) support identification of clinically-actionable ranges of unacceptable risk for poor screening outcomes for Project 1; 3) support evaluation of the long- term comparative effectiveness for innovative screening strategies involving multi-modality imaging across risk groups. Centralization of survey research, modeling and other specialized services within the CE Core will enhance interactions across all program components. Research supported by the CE Core will provide information on the most effective and efficient risk-based breast cancer screening strategies. Furthermore, CE Core supported findings will inform future risk communication to support tailored screening and will facilitate future dissemination and implementation studies focused on overcoming barriers to risk-based imaging.