Comparative effectiveness of breast imaging strategies in community practice

社区实践中乳腺成像策略的比较有效性

• 批准号: 7861090
• 负责人: DIANA SM BUIST
• 金额: $ 199.99万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7861090
• 关键词: Affect; Age; Age Factors; Age-Years; Benign; Biopsy; Body mass index; Breast; Breast Cancer Detection; Breast Cancer Risk Factor; Breast Cancer Surveillance Consortium; Cancer Control; Cancer Intervention and Surveillance Modeling Network; Caring; Cause of Death; Cessation of life; Characteristics; Clinical; Clinical Trials; Clinical effectiveness; Collaborations; Communities; Community Practice; Comorbidity; Conduct Clinical Trials; Data; Data Collection; Databases; Diagnosis; Diagnostic; Digital Mammography; Effectiveness; Equilibrium; Ethnic Origin; Fee-for-Service Plans; Film; Goals; Health; Health Services; Image; Imaging technology; Intervention; Link; Magnetic Resonance Imaging; Malignant - descriptor; Malignant Neoplasms; Mammography; Managed Care; Measures; Medicare; Methodology; Modality; Modeling; National Cancer Institute; Observational Study; Outcome; Pathology; Patients; Pattern; Population; Positioning Attribute; Race; Randomized Controlled Clinical Trials; Recommendation; Relative (related person); Research; Research Infrastructure; Research Personnel; Resources; Risk Factors; Sampling; Screening for cancer; Screening procedure; Services; Site; Stage at Diagnosis; Statistical Methods; Subgroup; System; Testing; Triage; Vital Status; Woman; base; breast density; cancer care; cancer imaging; cancer risk; clinical practice; community setting; comparative effectiveness; cost; cost effectiveness; design; digital; effectiveness research; evidence based guidelines; follow-up; health care service utilization; imaging modality; improved; malignant breast neoplasm; models and simulation; mortality; neoplasm registry; new technology; prospective; public health relevance

DESCRIPTION (Provided by the applicant): The overall goal of this project is to conduct comparative effectiveness research on breast cancer imaging modalities and strategies to inform evidence gaps on how to optimize breast cancer screening in community practice. The Breast Cancer Surveillance Consortium (BCSC) is uniquely positioned to conduct rigorous comparative effectiveness studies on conventional and new breast imaging technologies to inform how screening strategies could be personalized based on patient demographic and risk factor information and optimize the balance of screening benefits and harms. The BCSC includes detailed longitudinal information throughout the cancer care continuum: from cancer screening and diagnosis through treatment, surveillance, and death on over 2 million women and 95,000 breast cancers. It is the only resource of this size with risk factor information (including mammographic breast density) that is also linked to: mammography examinations accurately identified as either screening or diagnostic and as either film-screen or digital; cancer registry and pathology databases to determine both benign and malignant outcomes; Medicare and Group Health managed care claims data to obtain comorbidities and healthcare utilization; and death data to ascertain vital status and cause of death. Over the next two years we will: 1) Use existing BCSC screening data with long-term follow-up (overall and breast cancer mortality) and newly linked BCSC-Medicare data to compare the clinical effectiveness of 1- vs. 2- year mammography screening intervals for subgroups of women; 2) Use BCSC-Medicare data to compare the downstream healthcare utilization and costs of digital versus film-screen mammography; 3) Use BCSC data in four Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer simulation models to compare the clinical and cost-effectiveness of various breast cancer screening strategies; 4) Implement a prospective data collection system specifically designed to capture clinically and scientifically relevant data on breast magnetic resonance imaging (MRI) across our network of BCSC community practice facilities; 5) Expand the BCSC Statistical Coordinating Center's capacity to design and conduct comparative effectiveness research in community settings by developing epidemiologic and statistical methods focused on sampling and design strategies for prospective observational and community-based randomized trials. This Grand Opportunity will increase the capacity of the BCSC and CISNET to provide evidence on how to deliver the most effective breast cancer screening in defined subgroups of women. PUBLIC HEALTH RELEVANCE: The overall goal of this project is to conduct comparative effectiveness research on breast cancer imaging modalities and strategies to inform evidence gaps on how to optimize breast cancer screening in community practice. The Breast Cancer Surveillance Consortium (BCSC) is the only resource with breast cancer risk factor information on over 2 million women linked to: mammography examinations accurately identified as either screening or diagnostic and as either film-screen or digital; cancer registry and pathology databases to determine both benign and malignant outcomes; Medicare and Group Health managed care claims data to obtain comorbidities and healthcare utilization; and death data to ascertain vital status and cause of death. We will use the BCSC infrastructure and network of mammography facilities to examine screening intervals, screening modalities, and risk factors to determine their influence on breast cancer detection and mortality and associated costs. This research will set standards and methodology for comparative effectiveness studies in community practice and enable evidence-based recommendations that maximize screening effectiveness, minimize harms of screening, and optimize healthcare utilization.

描述（由申请人提供）：该项目的总体目标是对乳腺癌成像模式和策略进行比较有效性研究，以了解如何在社区实践中优化乳腺癌筛查的证据差距。乳腺癌监测联盟 (BCSC) 具有独特的优势，可以对传统和新型乳腺成像技术进行严格的有效性比较研究，以告知如何根据患者人口统计和风险因素信息个性化筛查策略，并优化筛查益处和危害的平衡。 BCSC 包含整个癌症护理连续体的详细纵向信息：从癌症筛查和诊断到治疗、监测和死亡，涉及超过 200 万女性和 95,000 例乳腺癌。它是这种规模的唯一包含风险因素信息（包括乳房 X 光检查乳房密度）的资源，这些信息还与： 准确识别为筛查或诊断以及胶片屏幕或数字的乳房 X 光检查检查；癌症登记和病理数据库以确定良性和恶性结果；医疗保险和团体健康管理式医疗索赔数据，以获得合并症和医疗保健利用率；和死亡数据以确定生命状况和死亡原因。在接下来的两年里，我们将： 1) 使用现有的 BCSC 筛查数据和长期随访（总体死亡率和乳腺癌死亡率）和新链接的 BCSC-Medicare 数据来比较女性亚组 1 年与 2 年乳房 X 光检查间隔的临床有效性； 2) 使用 BCSC-Medicare 数据来比较数字乳房 X 光检查与胶片屏幕乳房 X 光检查的下游医疗保健利用率和成本； 3）利用四个癌症干预和监测建模网络（CISNET）乳腺癌模拟模型中的BCSC数据来比较各种乳腺癌筛查策略的临床和成本效益； 4) 实施专门设计的前瞻性数据收集系统，用于在我们的 BCSC 社区实践设施网络中捕获乳腺磁共振成像 (MRI) 的临床和科学相关数据； 5) 通过开发流行病学和统计方法，重点关注前瞻性观察和基于社区的随机试验的抽样和设计策略，扩大 BCSC 统计协调中心在社区环境中设计和开展比较有效性研究的能力。这一巨大机遇将提高 BCSC 和 CISNET 的能力，为如何在特定女性亚群中提供最有效的乳腺癌筛查提供证据。 公共卫生相关性：该项目的总体目标是对乳腺癌成像模式和策略进行比较有效性研究，以了解如何在社区实践中优化乳腺癌筛查的证据差距。乳腺癌监测联盟 (BCSC) 是唯一一个拥有超过 200 万女性乳腺癌危险因素信息的资源，这些信息与以下方面相关： 准确识别为筛查或诊断以及胶片或数字的乳房 X 光检查；癌症登记和病理数据库以确定良性和恶性结果；医疗保险和团体健康管理式医疗索赔数据，以获得合并症和医疗保健利用率；和死亡数据以确定生命状况和死亡原因。我们将使用 BCSC 基础设施和乳房 X 线摄影设施网络来检查筛查间隔、筛查方式和风险因素，以确定它们对乳腺癌检测和死亡率以及相关成本的影响。这项研究将为社区实践中的比较有效性研究制定标准和方法，并提供基于证据的建议，以最大限度地提高筛查有效性、最大限度地减少筛查的危害并优化医疗保健利用率。