Breast Cancer Screening Strategies in the Era of New Technologies

项目总结-项目2数字乳腺断层合成摄影在乳腺癌筛查中的使用迅速增加，超过了社区环境中对女性整体和特定人群的有效性证据。新出现的证据表明，断层合成可以降低回忆率，同时提高癌症检测。然而，关键的问题仍然存在：早期报告的改善筛查结果是否仍然超出了最初的筛查轮次，并在社区环境中可持续;断层合成结果是否因女性的特征而异;断层合成是否等于或优于补充MRI筛查;以及检测到的其他癌症是否可能导致乳腺癌发病率和死亡率的降低。随着断层合成作为主要筛查方式的快速转变，需要对其在社区环境中跨妇女亚组的有效性进行全面了解。在我们目前的P01中，利用乳腺癌监测联盟（BCSC）的丰富数据资源，我们已经证明了女性水平特征对数字乳腺X射线摄影筛查结果的重要性。鉴于BCSC中断层合成的快速吸收，现在可以检查与女性因素相关的断层合成筛查结果，并量化获益-危害平衡。我们的总体项目目标是确定最有效的筛查策略，根据妇女的风险因素将新的筛查技术纳入社区实践。我们假设，对于某些（但不是所有）女性，断层合成摄影比数字乳腺X射线摄影更好，并且有些女性可能从多模式筛查中受益。我们还将评估断层合成摄影是否可以减少数字乳腺X射线摄影遗漏癌症的高风险女性对补充磁共振成像（MRI）的需求。我们的具体目标是： 目的1）根据女性的特征，确定筛查断层合成摄影与数字乳腺X射线摄影相比的获益和危害 目的2）确定观察到的多模态筛查与补充MRI相比单独断层合成的益处和危害;以及 目的3）通过模拟建模（结合比较有效性核心），评价多模态筛查与补充MRI相比单独断层合成筛查在风险组中的长期受益和危害。 该项目将填补关于断层合成和多模态筛查有效性的关键知识空白，我们相信这将直接转化为可操作的筛查指南

PROJECT SUMMARY – Project 2 Digital breast tomosynthesis use has rapidly increased for breast cancer screening, outpacing evidence of effectiveness in community settings for women overall and for specific populations. Emerging evidence suggests tomosynthesis may lower recall rates while simultaneously improving cancer detection. However, critical questions remain: whether early reports of improved screening outcomes remain beyond initial screening rounds and are sustainable in community settings; whether tomosynthesis outcomes vary based on women’s characteristics; whether tomosynthesis is equal to or outperforms supplemental MRI screening; and whether additional cancers detected are likely to lead to reduced morbidity and mortality from breast cancer. With the rapid shift to tomosynthesis as the dominant screening modality, a thorough understanding of its effectiveness in community settings across subgroups of women is needed. In our current P01, using the rich data resource of the Breast Cancer Surveillance Consortium (BCSC), we have demonstrated the importance of woman-level characteristics on digital mammography screening outcomes. Given the quick uptake of tomosynthesis in the BCSC, it is now possible to examine outcomes of tomosynthesis screening in relation to woman-level factors and to quantify the benefit-harm balance. Our overall project objective is to identify the most effective screening strategies that incorporate new screening technologies in community practice based on women's risk factors. We hypothesize that tomosynthesis will perform better than digital mammography for some, but not all, women and that there are some women who may benefit from multi-modal screening. We will also evaluate whether tomosynthesis can reduce the need for supplemental magnetic resonance imaging (MRI) in women at high risk of a missed cancer on digital mammography. We specifically aim to: Aim 1) determine the benefits and harms of screening tomosynthesis compared to digital mammography based on women's characteristics Aim 2) determine the observed benefits and harms of multi-modality screening with supplemental MRI versus tomosynthesis alone; and Aim 3) evaluate the long- term benefits and harms from multi-modality screening with supplemental MRI versus tomosynthesis screening alone across risk groups through simulation modeling (in conjunction with the Comparative Effectiveness Core). This project will fill critical knowledge gaps regarding the effectiveness of tomosynthesis and multi-modality screening, which we believe will have direct translation into actionable screening guidelines