Risk-based Imaging Strategies to Improve Breast Cancer Surveillance Outcomes

基于风险的影像策略可改善乳腺癌监测结果

• 批准号: 10268352
• 负责人: Janie M Lee
• 金额: $ 15万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-27 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268352
• 关键词: Accounting; Age; Bilateral; Biopsy; Breast; Breast Cancer Detection; Breast Cancer Surveillance Consortium; Breast Magnetic Resonance Imaging; Cancer Detection; Characteristics; Clinical; Community Practice; Consensus; Data Set; Decision Making; Detection; Development; Diagnosis; Diffuse; Digital Breast Tomosynthesis; Digital Mammography; Early Diagnosis; Effectiveness; Event; Face; Failure; Goals; Guidelines; Health Personnel; Health Surveys; High Risk Woman; Image; Imaging technology; Individual; Learning; Magnetic Resonance Imaging; Malignant Neoplasms; Mammary Gland Parenchyma; Mammography; Mastectomy; Modeling; Multimodal Imaging; Nonmetastatic; Outcome; Performance; Physicians; Recommendation; Recording of previous events; Recurrence; Residual state; Risk; Risk Estimate; Risk Factors; Testing; Time; Translating; Tumor Biology; Tumor Subtype; United States; Woman; Women' s Group; Work; base; breast cancer diagnosis; breast density; breast imaging; clinical care; clinical practice; clinically actionable; comparative effectiveness; demographics; design; discrete time; high risk; imaging modality; improved; malignant breast neoplasm; mortality; multimodality; novel; radiologist; risk prediction model; screening; surveillance imaging; surveillance strategy; tomosynthesis; treatment choice; treatment guidelines; treatment strategy; tumor

Project 3 Currently, 2.8 million women in the United States with a personal history of breast cancer (PHBC) face years of imaging surveillance. Breast imaging surveillance is aimed at the early detection of second breast cancer events, either local recurrence or new cancers in the other breast, with the goal of decreasing breast cancer mortality. Treatment strategies for primary breast cancers routinely take into account women's clinical and tumor characteristics. However, unlike treatment guidelines, current surveillance guidelines recommend annual mammography for all women with a PHBC regardless of risk. With new information about tumor biology and emerging imaging technologies (digital breast tomosynthesis and breast MRI), we can move toward risk-based surveillance decision making by women and their physicians. Although new imaging methods show promise for screening, their ability to improve early second breast cancer detection and longer-term outcomes is not yet established. The overall goal of this project is to facilitate a shift from a single strategy of annual mammography for all women to individualized, risk-based strategies, incorporating the full range of available imaging modalities and reliable estimates of a woman's risk of surveillance outcomes. We propose to integrate women's risk factors and tumor characteristics to produce risk estimates for important surveillance mammography outcomes: benefits (early detection of second invasive breast cancer), and failures (interval detection of second breast cancer after negative mammography). Early evidence suggests that women's risk factors, primary breast cancer characteristics, age at diagnosis, mode of detection, and treatment choices can be used to identify women at high risk of surveillance mammography failure who might benefit from alternative surveillance strategies (tomosynthesis alone or mammography and MRI). In addition, women at low risk of surveillance failure could minimize their risk of false alarms by receiving mammography or tomosynthesis alone. Our scientific premise is that tailored strategies will improve surveillance outcomes by reducing both surveillance failures and false alarms compared with guideline-recommended annual mammography alone. Our specific aims are: Aim 1: Determine the benefits and harms of surveillance tomosynthesis compared with digital mammography among women with a PHBC. Aim 2: Develop novel risk prediction models to identify and directly compare a woman's cumulative absolute risk of surveillance mammography outcomes. This project will combine clinical and imaging risk factors to estimate risks of important surveillance benefits, failures, and false alarms, supporting a shift away from a "one size fits all" annual surveillance strategy, toward individualized, risk-based strategies for women with a PHBC.

项目3目前，美国有280万有乳腺癌（PHBC）个人病史的妇女面临多年的影像学监测。乳腺成像监测旨在早期发现第二次乳腺癌事件，无论是局部复发还是另一个乳房的新癌症，目的是降低乳腺癌死亡率。原发性乳腺癌的治疗策略通常考虑到妇女的临床和肿瘤特征。然而，与治疗指南不同的是，目前的监测指南建议每年对所有患有PHBC的女性进行乳房X光检查，无论风险如何。有了关于肿瘤生物学和新兴成像技术（数字乳腺断层合成摄影和乳腺MRI）的新信息，我们可以向女性及其医生基于风险的监测决策迈进。虽然新的成像方法显示出筛查的前景，但它们改善早期第二乳腺癌检测和长期预后的能力尚未建立。该项目的总体目标是促进从每年对所有妇女进行乳房X光检查的单一战略转变为基于风险的个性化战略，其中包括各种可用的成像模式和对妇女监测结果风险的可靠估计。我们建议整合女性的风险因素和肿瘤特征，以产生重要的监测乳腺X线摄影结果的风险估计：益处（早期发现第二浸润性乳腺癌）和失败（阴性乳腺X线摄影后间隔检测第二乳腺癌）。早期证据表明，女性的风险因素、原发性乳腺癌特征、诊断时的年龄、检测模式和治疗选择可用于识别可能受益于替代监测策略（单独断层合成或乳腺X射线摄影和MRI）的监测乳腺X射线摄影失败的高风险女性。此外，监测失败风险较低的女性可以通过单独接受乳房X线摄影或断层合成来最大限度地降低误报风险。我们的科学前提是，与指南推荐的年度乳腺X线摄影相比，量身定制的策略将通过减少监测失败和误报来改善监测结果。我们的具体目标是： 目的1：确定监测断层合成摄影与数字乳腺X射线摄影相比在PHBC女性中的获益和危害。 目标2：开发新的风险预测模型，以识别和直接比较妇女的监测乳腺X射线摄影结果的累积绝对风险。 该项目将结合联合收割机的临床和影像学风险因素，以评估重要监测获益、失败和假警报的风险，支持从“一刀切”的年度监测策略转向针对PHBC女性的个性化、基于风险的策略。